Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Nephrol Dial Transplant. 2019 Oct 1;34(10):1707-1715. doi: 10.1093/ndt/gfy167.
Quality of life (QoL) is an important outcome in chronic kidney disease (CKD). Patients feel that symptoms are an important determinant of QoL. However, this relation is unknown. The aims of this study were to investigate the impact of the number and severity of symptoms on QoL in elderly pre-dialysis patients, assessed by both the effect of symptoms and their importance relative to kidney function, and other clinical variables on QoL.
The European Quality study (EQUAL study) is an ongoing European prospective follow-up study in late Stage 4/5 CKD patients aged ≥65 years. We used patients included between March 2012 and December 2015. Patients scored their symptoms with the Dialysis Symptom Index, and QoL with the research and development-36 (RAND-36) item Health Survey (RAND-36). The RAND-36 results in a physical component summary (PCS) and a mental component summary (MCS). We used linear regression to estimate the relation between symptoms and QoL at baseline and after 6 months, and to calculate the variance in QoL explained by symptoms.
The baseline questionnaire was filled in by 1079 (73%) patients (median age 75 years, 66% male, 98% Caucasian), and the follow up questionnaire by 627 (42%) patients. At baseline, every additional symptom changed MCS with -0.81 [95% confidence interval (CI): -0.91 to -0.71] and PCS with -0.50 (95% CI: -0.62 to -0.39). In univariable analyses, number of symptoms explained 22% of MCS variance and 11% of PCS variance, whereas estimated glomerular filtration rate only explained 1%.
In elderly CKD Stage 4/5 patients, symptoms have a substantial impact on QoL. This indicates symptoms should have a more prominent role in clinical decision-making.
生活质量（QoL）是慢性肾脏病（CKD）的一个重要结果。患者认为症状是 QoL 的一个重要决定因素。然而，这种关系尚不清楚。本研究的目的是调查在老年透析前患者中，通过症状的数量和严重程度对 QoL 的影响，以及其他临床变量对 QoL 的影响，评估症状对 QoL 的影响，以及相对于肾功能的重要性。
欧洲质量研究（EQUAL 研究）是一项正在进行的欧洲前瞻性随访研究，涉及年龄≥65 岁的晚期 4/5 期 CKD 患者。我们使用 2012 年 3 月至 2015 年 12 月期间纳入的患者。患者使用透析症状指数（Dialysis Symptom Index）对其症状进行评分，使用研究和发展-36（RAND-36）项目健康调查（RAND-36）对其生活质量进行评分。RAND-36 结果包括生理成分综合评分（PCS）和心理成分综合评分（MCS）。我们使用线性回归来估计基线和 6 个月时症状与 QoL 之间的关系，并计算症状对 QoL 的解释方差。
基线问卷由 1079 名（73%）患者填写（中位年龄 75 岁，66%为男性，98%为白种人），随访问卷由 627 名（42%）患者填写。基线时，每增加一个症状，MCS 就会降低 0.81（95%可信区间：0.91 至 0.71），PCS 就会降低 0.50（95%可信区间：0.62 至 0.39）。在单变量分析中，症状数量解释了 MCS 变异的 22%和 PCS 变异的 11%，而估算肾小球滤过率仅解释了 1%。
在老年 CKD 4/5 期患者中，症状对 QoL 有重大影响。这表明症状在临床决策中应具有更突出的作用。
