Kopple Joel D, Shapiro Bryan B, Feroze Usama, Kim Jun Chul, Zhang Min, Li Yinan, Martin David J
Clin Nephrol. 2017 Oct;88(10):205-217. doi: 10.5414/CN109112.
Anxiety is common in maintenance hemodialysis (MHD) patients. The extent to which anxiety is engendered by the dialysis treatment itself is not known. We investigated whether anxiety occurs with individual hemodialysis treatments and examined factors associated with these symptoms.
This was a cross-sectional study examining 246 MHD patients. Anxiety and other emotional distresses associated with hemodialysis treatments were examined with a questionnaire. Patients were also assessed with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI).
Patients were 57 ± 15 (SD) years; 58% male, 46% diabetic, and undergoing MHD for a median of 40 months (range: 6 - 210 months). 32 - 51% of patients reported anxiety when coming to dialysis, hearing an alarm sound, being connected to the dialysis machine by a new person or seeing paramedics in the dialysis unit. 12 - 18% of patients experienced severe anxiety with one or more of these events. Dialysis-related anxiety correlated with severity of anxiety and depression as determined by BAI and BDI (p < 0.0001 for each comparison) but generally not with dialysis vintage. Even among patients with no or minimal anxiety according to BAI, 9 - 23% reported a little bit to moderate anxiety and 9 - 15% described quite a bit to extreme anxiety with hemodialysis treatments. The frequency that patients described distressing thoughts and feelings correlated directly with their degree of anxiety or depression as determined by BAI and BDI.
CONCLUSION: Patients commonly experience anxiety, which is often severe, with MHD treatments. Hemodialysis-induced anxiety is directed related to the presence and severity of underlying anxiety and depression. Hemodialysis-associated anxiety is prevalent and may be severe even in patients with minimal or no anxiety and/or depression, as determined by BAI and BDI. The frequency and severity of hemodialysis anxiety does not decrease with greater dialysis vintage except for a reduction in anxiety when hearing the dialysis machine alarm. .
焦虑在维持性血液透析（MHD）患者中很常见。尚不清楚焦虑在多大程度上是由透析治疗本身引起的。我们调查了个体血液透析治疗过程中是否会出现焦虑，并研究了与这些症状相关的因素。
这是一项横断面研究，共纳入246例MHD患者。通过问卷调查来评估与血液透析治疗相关的焦虑及其他情绪困扰。同时使用贝克焦虑量表（BAI）和贝克抑郁量表（BDI）对患者进行评估。
患者年龄为57±15（标准差）岁；男性占58%，糖尿病患者占46%，接受MHD治疗的中位时间为40个月（范围：6 - 210个月）。32% - 51%的患者表示在前来透析、听到警报声、由新人连接透析机或在透析单元看到医护人员时会感到焦虑。12% - 18%的患者在上述一种或多种情况下会经历严重焦虑。与透析相关的焦虑与BAI和BDI所确定的焦虑和抑郁严重程度相关（每次比较p<0.0001），但一般与透析时间无关。即使在根据BAI显示无焦虑或焦虑程度最低的患者中，仍有9% - 23%的患者报告在血液透析治疗时存在轻度至中度焦虑，9% - 15%的患者描述存在中度至极度焦虑。患者描述的痛苦想法和感受的频率与BAI和BDI所确定的焦虑或抑郁程度直接相关。
MHD治疗过程中患者普遍会经历焦虑，且焦虑程度往往较为严重。血液透析引起的焦虑与潜在焦虑和抑郁的存在及严重程度直接相关。血液透析相关的焦虑很普遍，即使是根据BAI和BDI显示焦虑和/或抑郁程度最低或无焦虑的患者，也可能出现严重焦虑。除了听到透析机警报时焦虑有所减轻外，血液透析焦虑的频率和严重程度不会随着透析时间的延长而降低。
