Neijenhuis Myrte K, Kievit Wietske, Perrone Ronald D, Sloan Jeff A, Erwin Patricia, Murad Mohammad Hassan, Gevers Tom J G, Hogan Marie C, Drenth Joost P H
Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, code 455, 6500 HB, Nijmegen, the Netherlands.
Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands.
BMC Nephrol. 2017 May 25;18(1):169. doi: 10.1186/s12882-017-0578-6.
Little is known about determinants of quality of life (QoL) in autosomal dominant polycystic kidney disease (ADPKD). Recent studies suggest that QoL in ADPKD is determined by more factors than mere renal function. We investigated the effect of ADPKD on QoL and evaluated how Qol is affected by disease severity markers renal function, kidney volume and liver volume.
We performed a systematic review, meta-analysis and meta-regression analyses of cohort studies and randomized controlled trials investigating patient-reported QoL in adult patients with ADPKD not yet on dialysis. EMBASE, MEDLINE, and Web of Science were searched to August 2015 without language restrictions. Two investigators independently reviewed title, abstracts and full text of potentially relevant citations to determine eligibility. We compared pooled QoL summary scores of ADPKD patients using a random-effects meta-analytic model. These scores were compared with mean and age-corrected reference scores of the general population. In a meta-regression analysis, we investigated the univariate effect of renal function, kidney volume and liver volume on QoL.
We included nine studies in meta-analysis including 1623 patients who completed the SF-36 questionnaire. Pooled physical (PCS) and mental component scores (MCS) of the SF-36 of individuals with ADPKD were lower than those of the reference population (45.7 vs. 50.0 and 47.8 vs. 50.0 points, both P < 0.001). QoL of ADPKD patients remained lower after comparison with age-corrected reference values (age 35-44 year; PCS 52.2, MCS 49.9 points, both P < 0.05). Larger liver volume negatively impacted PCS (P < 0.001) and MCS (P = 0.001), whereas there was no association with renal function (PCS P = 0.1, MCS P = 0.9) and kidney volume (PCS P = 0.5, MCS P = 0. 5). Total liver and kidney volume had no impact on PCS (P = 0.1), but did have impact on MCS (P = 0.02).
QoL reported by non-dialysis patients with ADPKD is impaired compared to the general population. Large liver volume was the most important factor that diminishes QoL. PROSPERO International Registry number CRD42015026428.
关于常染色体显性多囊肾病（ADPKD）患者生活质量（QoL）的决定因素，我们了解得很少。最近的研究表明，ADPKD患者的生活质量由比单纯肾功能更多的因素决定。我们研究了ADPKD对生活质量的影响，并评估了疾病严重程度指标（肾功能、肾脏体积和肝脏体积）如何影响生活质量。
我们对队列研究和随机对照试验进行了系统评价、荟萃分析和荟萃回归分析，这些研究调查了尚未接受透析的成年ADPKD患者报告的生活质量。检索了截至2015年8月的EMBASE、MEDLINE和科学引文索引，无语言限制。两名研究人员独立审查潜在相关文献的标题、摘要和全文以确定其是否符合要求。我们使用随机效应荟萃分析模型比较了ADPKD患者的合并生活质量汇总得分。将这些得分与一般人群的平均得分和年龄校正参考得分进行比较。在荟萃回归分析中，我们研究了肾功能、肾脏体积和肝脏体积对生活质量的单变量影响。
我们纳入了9项荟萃分析研究，包括1623名完成SF-36问卷的患者。ADPKD患者SF-36的合并身体（PCS）和心理成分得分（MCS）低于参考人群（分别为45.7对50.0和47.8对50.0分，P均<0.001）。与年龄校正参考值（35 - 44岁；PCS 52.2，MCS 49.9分，P均<0.05）比较后，ADPKD患者的生活质量仍然较低。较大的肝脏体积对PCS（P<0.001）和MCS（P = 0.001）有负面影响，而与肾功能（PCS P = 0.1，MCS P = 0.9）和肾脏体积（PCS P = 0.5，MCS P = 0.5）无关。肝脏和肾脏总体积对PCS无影响（P = 0.1），但对MCS有影响（P = 0.02）。
与一般人群相比，未透析的ADPKD患者报告的生活质量受损。较大的肝脏体积是降低生活质量的最重要因素。国际前瞻性注册编号CRD42015026428。
