Jung Hee-Yeon, Jang Hye Min, Kim Yang Wook, Cho Seong, Kim Hye-Young, Kim Sung-Ho, Bang Kitae, Kim Hyun Woo, Lee So Young, Jo Sang Kyung, Lee Jonghyo, Choi Ji-Young, Cho Jang-Hee, Park Sun-Hee, Kim Chan-Duck, Kim Yong-Lim
From the Department of Internal Medicine, Kyungpook National University School of Medicine (H-YJ, J-YC, J-HC, S-HP, C-DK, Y-LK), Department of Statistics (HMJ), BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University (Y-LK), Department of Internal Medicine, Daegu Fatima Hospital, Daegu (S-HK), Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan (YWK), Department of Internal Medicine, College of Medicine, The Sungkyunkwan University of Korea, Samsung Changwon Hospital, Changwon (SC), Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju (H-YK), Department of Internal Medicine, Eulji University Hospital, Daejeon (KB), Department of Internal Medicine, Jeju National University, School of Medicine, Jeju National University Hospital, Jeju (HWK), Department of Internal Medicine, Eulji Medical Centerl (SYL), Department of Internal Medicine, Korea University Anam Hospital, Seoul (SKJ), and Department of Internal Medicine, St. Carollo Hospital, Suncheon (JL), Korea.
Medicine (Baltimore). 2016 May;95(21):e3795. doi: 10.1097/MD.0000000000003795.
Health-related quality of life (HRQOL) is an important clinical outcome for dialysis patients. However, relative superiority in HRQOL between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) are not clearly known. We compared HRQOL over time between APD and CAPD patients and evaluated factors associated with HRQOL.All 260 incident patients initiating APD or CAPD at multiple centers throughout Korea were prospectively enrolled in this study between October 2010 and February 2013. HRQOL, depressive symptoms, and renal treatment satisfaction were assessed 1 and 12 months after the start of dialysis by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36), the Beck Depression Inventory (BDI), and the Renal Treatment Satisfaction Questionnaire (RTSQ), respectively.Of 196 patients who completed all questionnaires and did not change the peritoneal dialysis (PD) modality during the 1-year follow-up period, 160 were matched. APD patients showed better baseline HRQOL than CAPD patients for the symptoms, patient satisfaction, pain, and social function domains. There were no differences in HRQOL between the 2 groups at 12 months, and CAPD patients had significantly greater improvements in symptoms (P = 0.02), the mental composite summary (P = 0.03), and health status domains (P = 0.03) than APD patients. There were similar improvements in depressive symptoms (P = 0.01) and patient satisfaction with treatment (P = 0.01) in CAPD and APD patients. Interestingly, depressive symptoms, not PD modality, was the most influential and consistent factor for HRQOL. Despite the spontaneous improvement of depressive symptoms, considerable PD patients still had depressive symptoms at the 1-year appointment.APD has no advantage over CAPD for HRQOL. Considering the substantial negative effect of depressive symptoms on HRQOL, it is important to evaluate PD patients for depression and to treat those with depression to improve their HRQOL.
健康相关生活质量（HRQOL）是透析患者一项重要的临床结局。然而，自动腹膜透析（APD）和持续非卧床腹膜透析（CAPD）在HRQOL方面的相对优势尚不明确。我们比较了APD和CAPD患者随时间变化的HRQOL，并评估了与HRQOL相关的因素。2010年10月至2013年2月期间，韩国多个中心所有开始进行APD或CAPD的260例初治患者前瞻性纳入本研究。分别在透析开始后1个月和12个月，采用肾脏病生活质量简表36（KDQOL - 36）、贝克抑郁量表（BDI）和肾脏治疗满意度问卷（RTSQ）评估HRQOL、抑郁症状和肾脏治疗满意度。在196例完成所有问卷且在1年随访期内未改变腹膜透析（PD）方式的患者中，160例进行了匹配。APD患者在症状、患者满意度、疼痛和社会功能领域的基线HRQOL优于CAPD患者。12个月时两组间HRQOL无差异，且CAPD患者在症状（P = 0.02）、心理综合评分（P = 0.03）和健康状况领域（P = 0.03）的改善显著大于APD患者。CAPD和APD患者在抑郁症状（P = 0.01）和患者对治疗的满意度（P = 0.01）方面有相似的改善。有趣的是，抑郁症状而非PD方式是HRQOL最具影响力且一致的因素。尽管抑郁症状有自发改善，但相当一部分PD患者在1年复诊时仍有抑郁症状。APD在HRQOL方面并不优于CAPD。考虑到抑郁症状对HRQOL有显著负面影响，评估PD患者的抑郁情况并治疗抑郁患者以改善其HRQOL很重要。
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