亚洲透析前患者贫血及矿物质与骨代谢异常与健康相关生活质量的关联
Association of anemia and mineral and bone disorder with health-related quality of life in Asian pre-dialysis patients.
作者信息
Wee Hwee-Lin, Seng Benjamin Jun Jie, Lee Jia Jia, Chong Kok Joon, Tyagi Pallavi, Vathsala Anantharaman, How Priscilla
机构信息
Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Singapore.
Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
出版信息
Health Qual Life Outcomes. 2016 Jun 24;14:94. doi: 10.1186/s12955-016-0477-8.
BACKGROUND
Patients with chronic kidney disease (CKD) have poor health-related quality of life (HRQoL). The association of CKD-related complications such as anemia and mineral and bone disorders (MBD) with HRQoL in pre-dialysis patients is not well-studied. As such, this study aimed to determine the association of anemia and MBD with HRQoL in pre-dialysis patients.
METHODS
This was a cross-sectional study involving 311 adult pre-dialysis patients with stage 3-5 CKD from an acute-care hospital in Singapore. Patients' HRQoL were assessed using Kidney Disease Quality of Life Short Form (KDQOL-SF™) and EuroQol 5 Dimensions-3 levels (EQ5D-3L). HRQoL between patients with and without anemia or MBD were compared by separate hierarchical multiple linear regression analyses using various HRQoL scales as dependent variables, adjusted for sociodemographic, clinical and psychosocial variables.
RESULTS
After adjusting for MBD, anemia was associated with lower HRQoL scores on work status (WS), physical functioning (PF) and role physical [β (SE): -10.9 (4.18), p = 0.010; -3.0 (1.28), p = 0.018; and -4.2 (1.40), p = 0.003, respectively]. However, significance was lost after adjustments for sociodemographic variables. Patients with MBD had poorer HRQoL with respect to burden of kidney disease, WS, PF and general health [(β (SE): -7.9 (3.88), p = 0.042; -9.5 (3.99), p = 0.018; -3.0 (1.22) p = 0.014; -3.6 (1.48), p = 0.015, respectively]. Although these remained significant after adjusting for sociodemographic variables, significance was lost after adjusting for clinical variables, particularly pill burden. This is of clinical importance due to the high pill burden of CKD patients, especially from medications for the management of multiple comorbidities such as cardiovascular and mineral and bone diseases.
CONCLUSIONS
Neither anemia nor MBD was associated with HRQoL in our pre-dialysis patients. Instead, higher total daily pill burden was associated with worse HRQoL. Medication reconciliation should therefore be routinely performed by clinicians and pharmacists to reduce total daily pill burden where possible.
背景
慢性肾脏病（CKD）患者的健康相关生活质量（HRQoL）较差。对于透析前患者，贫血以及矿物质和骨代谢紊乱（MBD）等CKD相关并发症与HRQoL之间的关联尚未得到充分研究。因此，本研究旨在确定透析前患者中贫血和MBD与HRQoL之间的关联。
方法
这是一项横断面研究，纳入了新加坡一家急症医院的311例3-5期CKD成年透析前患者。使用肾脏病生活质量简表（KDQOL-SF™）和欧洲五维健康量表-3级（EQ5D-3L）评估患者的HRQoL。以各种HRQoL量表作为因变量，通过单独的分层多元线性回归分析比较有无贫血或MBD患者的HRQoL，并对社会人口统计学、临床和心理社会变量进行调整。
结果
在对MBD进行调整后，贫血与工作状态（WS）、身体功能（PF）和身体角色方面较低的HRQoL得分相关[β（标准误）：-10.9（4.18），p = 0.010；-3.0（1.28），p = 0.018；-4.2（1.40），p = 0.003]。然而，在对社会人口统计学变量进行调整后，这种相关性不再显著。患有MBD的患者在肾病负担、WS、PF和总体健康方面的HRQoL较差[β（标准误）：-7.9（3.88），p = 0.042；-9.5（3.99），p = 0.018；-3.0（1.22），p = 0.014；-3.6（1.48），p = 0.015]。虽然在对社会人口统计学变量进行调整后这些相关性仍然显著，但在对临床变量，尤其是药物负担进行调整后，这种相关性不再显著。这具有临床重要性，因为CKD患者的药物负担较重，尤其是用于治疗多种合并症（如心血管疾病以及矿物质和骨疾病）的药物。
结论
在我们的透析前患者中，贫血和MBD均与HRQoL无关。相反，每日总药物负担较高与较差的HRQoL相关。因此，临床医生和药剂师应常规进行用药核对，以尽可能减轻每日总药物负担。
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