Li Yi-Nan, Shapiro Bryan, Kim Jun Chul, Zhang Min, Porszasz Janos, Bross Rachelle, Feroze Usama, Upreti Rajeev, Martin David, Kalantar-Zadeh Kamyar, Kopple Joel David
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA.
Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China.
Chronic Dis Transl Med. 2016 Nov 3;2(2):110-119. doi: 10.1016/j.cdtm.2016.09.004. eCollection 2016 Jun.
Maintenance hemodialysis (MHD) patients often have impaired quality of life (QOL), anxiety, depression, and reduced daily physical activity (DPA) and physical performance. The contributions of these latter factors to reduced QOL in MHD are poorly understood. We examined the association of QOL with anxiety, depression, DPA, and physical performance.
Seventy-two relatively healthy adult MHD patients, vintage ≥6 months, and 39 normals of similar age range and gender distribution were studied. QOL was assessed using the Kidney Disease Quality of Life-Short Form (KDQOL-SF). Anxiety and depression were each evaluated with two questionnaires. DPA and physical performance were assessed with a physical activity monitor, Human Activity Profile, and 6-minute walk, sit-to-stand, and stair-climbing tests.
Most KDQOL components were reduced in MHD patients versus normals. KDQOL components in patients were commonly inversely correlated with measures of anxiety and depression ( < 0.05) and were more reduced in patients with both anxiety and depression. KDQOL was often impaired in patients with either anxiety or depression. However, most KDQOL scores did not differ between patients and normals without anxiety or depression. DPA, Human Activity Profile, and physical performance often correlated with KDQOL scores in adjusted models, but after further adjustment for anxiety and depression, DPA, Human Activity Profile, and physical performance correlated less frequently with KDQOL scores. This reduction in significant correlations after adjustment for anxiety and depression was particularly pronounced for the association between KDQOL and DPA.
In relatively healthy MHD patients, KDQOL scores are usually decreased in those with anxiety and/or depression but are usually normal in those without anxiety or depression. Lower DPA in MHD patients with reduced KDQOL scores often appears to be associated with anxiety and depression. The relationship between QOL and physical performance appears to be less influenced by anxiety and/or depression. These data suggest that treatment of anxiety and depression in MHD patients may improve their QOL, DPA, and possibly physical performance.
维持性血液透析（MHD）患者的生活质量（QOL）常常受损，伴有焦虑、抑郁，日常身体活动（DPA）及身体机能下降。目前对于这些因素对MHD患者生活质量下降的影响了解甚少。我们研究了生活质量与焦虑、抑郁、日常身体活动及身体机能之间的关联。
研究了72例透析龄≥6个月、相对健康的成年MHD患者以及39例年龄范围和性别分布相似的正常人。使用肾脏病生活质量简表（KDQOL-SF）评估生活质量。分别用两份问卷评估焦虑和抑郁。通过身体活动监测仪、人类活动概况以及6分钟步行、从坐到站和爬楼梯测试来评估日常身体活动和身体机能。
与正常人相比，MHD患者的大多数KDQOL指标均降低。患者的KDQOL指标通常与焦虑和抑郁指标呈负相关（P<0.05），且在同时患有焦虑和抑郁的患者中降低得更多。焦虑或抑郁患者的KDQOL常常受损。然而，在没有焦虑或抑郁的患者与正常人之间，大多数KDQOL评分并无差异。在调整模型中，日常身体活动、人类活动概况和身体机能通常与KDQOL评分相关，但在进一步调整焦虑和抑郁因素后，日常身体活动、人类活动概况和身体机能与KDQOL评分的相关性降低。在调整焦虑和抑郁因素后，KDQOL与日常身体活动之间的显著相关性下降尤为明显。
在相对健康的MHD患者中，伴有焦虑和/或抑郁的患者KDQOL评分通常降低，但没有焦虑或抑郁的患者通常正常。KDQOL评分降低的MHD患者日常身体活动减少似乎常与焦虑和抑郁有关。生活质量与身体机能之间的关系似乎受焦虑和/或抑郁的影响较小。这些数据表明，治疗MHD患者的焦虑和抑郁可能会改善他们的生活质量、日常身体活动，并可能改善身体机能。
