Kitagawa Masashi, Sada Ken-Ei, Hinamoto Norikazu, Kimachi Miho, Yamamoto Yosuke, Onishi Yoshihiro, Fukuhara Shunichi
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan.
PLoS One. 2017 Sep 6;12(9):e0184019. doi: 10.1371/journal.pone.0184019. eCollection 2017.
Health-related quality of life (HRQOL) is often prioritized over long-term survival in elderly patients. Although a longer dialysis session length (DSL) has been shown to reduce mortality, its effects on improving the HRQOL are unknown.
Using data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS), patients aged ≥ 65 years on maintenance hemodialysis were enrolled. DSL was categorized as short (<210 minutes), medium (210-240 minutes), or long (>240 minutes). The primary outcomes were changes in mental health (ΔMH) and physical functioning (ΔPF) scores assessed using the Japanese version of SF-12, in one year. The differences in the ΔMH and ΔPF among the three groups were assessed via regression (beta) coefficients derived using a linear regression model.
Of 1,187 patients at baseline, 319 (26.9%) had a short length, 686 (57.8%) a medium length, and 182 (15.3%) a long length. We assessed the ΔMH data from 793 patients and the ΔPF data from 738. No significant differences in the ΔMH were noted for the short or long groups compared with the medium group (score difference: 0.26, 95% confidence interval [CI]: -4.17 to 4.69 for short; score difference: -1.15, 95% CI: -6.17 to 3.86 for long). Similarly, no significant differences were noted for these groups versus the medium group in ΔPF either (score difference: -1.43, 95% CI: -6.73 to 3.87 for short; score difference: -1.71, 95% CI: -7.63 to 4.22 for long).
A shorter DSL might have no adverse effects on MH or PF for elderly patients.
在老年患者中，与健康相关的生活质量（HRQOL）通常比长期生存更受重视。虽然较长的透析疗程时长（DSL）已被证明可降低死亡率，但其对改善HRQOL的影响尚不清楚。
利用日本透析结果与实践模式研究（J-DOPPS）的数据，纳入年龄≥65岁的维持性血液透析患者。DSL分为短（<210分钟）、中（210-240分钟）或长（>240分钟）。主要结局是使用SF-12日本版评估的一年内心理健康（ΔMH）和身体功能（ΔPF）评分的变化。通过使用线性回归模型得出的回归（β）系数评估三组之间ΔMH和ΔPF的差异。
在基线时的1187名患者中，319名（26.9%）疗程时长较短，686名（57.8%）疗程时长中等，182名（15.3%）疗程时长较长。我们评估了793名患者的ΔMH数据和738名患者的ΔPF数据。与中等疗程时长组相比，短疗程时长组或长疗程时长组在ΔMH方面未发现显著差异（评分差异：短疗程时长组为0.26，95%置信区间[CI]：-4.17至4.69；长疗程时长组为-1.15, 95% CI：-6.17至3.86）。同样，在ΔPF方面，这些组与中等疗程时长组相比也未发现显著差异（评分差异：短疗程时长组为-1.43，95% CI：-6.73至3.87；长疗程时长组为-1.71，95% CI：-7.63至4.22）。
较短的DSL可能对老年患者的MH或PF没有不利影响。
