Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands.
PLoS One. 2018 Sep 20;13(9):e0204405. doi: 10.1371/journal.pone.0204405. eCollection 2018.
Health-related quality of life (HRQOL) is an important outcome measure in patients with end-stage renal disease. HRQOL is assumed to improve with kidney transplantation and also with nocturnal hemodialysis compared to conventional hemodialysis. However, there is no evidence regarding HRQOL to support the optimal treatment choice for patients on nocturnal hemodialysis who hesitate opting for transplantation. We therefore compared HRQOL between patients who were treated with kidney transplantation or nocturnal hemodialysis for one year.
We assessed HQROL using the Kidney Disease Quality of Life-Short Form questionnaire in a cross-sectional sample of patients who were treated with kidney transplantation (n = 41) or nocturnal hemodialysis (n = 31) for one year. All patients on nocturnal hemodialysis were transplantation candidates. Using linear regression, we compared HRQOL between kidney transplantation and nocturnal hemodialysis, and adjusted for age, sex, dialysis duration, cardiovascular disease, and presence of residual urine production.
At one year follow-up, mean age of the study population was 54 ±13 years, and median dialysis duration was 3.2 (IQR 2.1-5.0) years. Kidney transplantation was associated with significantly higher HRQOL on the domain "effects" compared to nocturnal hemodialysis (adjusted difference 12.0 points, 95% CI 3.9; 20.1). There were potentially clinically relevant differences between kidney transplantation and nocturnal hemodialysis on the domains "burden" (adjusted difference 11.1 points, 95% CI -2.6; 24.8), "social support" (adjusted difference 6.2, 95% CI -6.6; 19.1), and the physical composite score (adjusted difference 3.0, 95% CI -2.0; 8.1), but these were not significant.
After kidney transplantation, HRQOL is especially higher on the domain "effects of kidney disease" compared to nocturnal hemodialysis. This can be useful when counseling patients on nocturnal hemodialysis who may opt for transplantation.
健康相关生活质量（HRQOL）是终末期肾病患者的重要结局衡量指标。与常规血液透析相比，肾移植和夜间血液透析都被认为可以提高 HRQOL。然而，对于那些犹豫不决选择移植的接受夜间血液透析治疗的患者，目前还没有关于 HRQOL 的证据来支持最佳治疗选择。因此，我们比较了接受肾移植或夜间血液透析治疗一年的患者之间的 HRQOL。
我们使用肾脏病生活质量简表评估了接受肾移植（n=41）或夜间血液透析（n=31）治疗一年的患者的 HRQOL。所有接受夜间血液透析的患者均为移植候选者。我们采用线性回归比较了肾移植和夜间血液透析之间的 HRQOL，并根据年龄、性别、透析时间、心血管疾病和残余尿产生情况进行了调整。
在一年的随访中，研究人群的平均年龄为 54±13 岁，中位透析时间为 3.2（IQR 2.1-5.0）年。与夜间血液透析相比，肾移植在“影响”领域的 HRQOL 显著更高（调整后的差异为 12.0 分，95%CI 3.9；20.1）。肾移植和夜间血液透析在“负担”（调整后的差异为 11.1 分，95%CI -2.6；24.8）、“社会支持”（调整后的差异为 6.2，95%CI -6.6；19.1）和身体综合评分（调整后的差异为 3.0，95%CI -2.0；8.1）方面存在潜在的临床相关差异，但这些差异无统计学意义。
肾移植后，与夜间血液透析相比，HRQOL 在“肾脏疾病的影响”方面尤其更高。这对于那些可能选择移植的接受夜间血液透析治疗的患者进行咨询时可能会有所帮助。
