加纳中重度慢性肾脏病患者的生活质量-单中心研究。
Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study.
机构信息
Renal Unit, Department of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, School of Medical Sciences, Kumasi, Ghana.
出版信息
BMC Nephrol. 2019 Apr 8;20(1):122. doi: 10.1186/s12882-019-1316-z.
BACKGROUND
The prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). There is growing interest worldwide in QOL of CKD patients but paucity of data in Ghana. This study sought to assess QOL in patients with moderate to advanced CKD (not on dialysis) and establish its determinants.
METHODS
We conducted a cross sectional observational study at the renal outpatient clinic at Komfo Anokye Teaching Hospital (KATH). We collected demographic, clinical and laboratory data. A pretested self-administered Research and Development corporation (RAND®) 36-Item Health Survey questionnaire was administered and QOL scores in physical component summary (PCS) and mental component summary (MCS) were computed. Determinants of QOL were established by simple and multiple linear regression. P value of < 0.05 was considered statistically significant.
RESULTS
The study included 202 patients with CKD not on dialysis. There were 118(58.5%) males. Mean age was 46.7 ± 16.2 years. The majority, 165(81.7%) of patients were on monthly salaries of less than GHS 500 (~USD 125). Chronic glomerulonephritis was the most common cause of CKD in 118 (58.5%) patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients. The median serum creatinine was 634.2 μmol/L (IQR 333-1248) and the median eGFR was 7 ml/min/1.73m (IQR 3-16). The most common stage was CKD stage 5 accounting for 143 (71.1%), followed by CKD stage 4 with 45 (22.4%) of cases and 13 (6.5%) of CKD stage 3. The overall mean QOL score was 40.3 ± 15.4. MCS score was significantly lower than PCS score (37.3 ± 10.8 versus 43.3 ± 21.6, P < 0.001). Multiple linear regression showed that low monthly income (p = 0.002) and low haemoglobin levels (p = 0.003) were predictive of overall mean QOL.
CONCLUSION
Patients with moderate to advanced CKD had low-income status, presented with advanced disease and had poor QOL. Anaemia and low-income status were significantly associated with poor QOL.
背景
慢性肾脏病（CKD）的患病率在全球和非洲都呈上升趋势。健康相关生活质量（QOL）已成为 CKD 和终末期肾病（ESRD）患者的重要预后指标。全球对 CKD 患者的 QOL 越来越感兴趣，但加纳的数据却很少。本研究旨在评估中重度 CKD（未透析）患者的生活质量，并确定其决定因素。
方法
我们在科福阿南耶教学医院（KATH）的肾脏门诊进行了一项横断面观察性研究。我们收集了人口统计学、临床和实验室数据。使用经过预测试的研究与发展公司（RAND®）36 项健康调查问卷进行自我管理，并计算身体成分综合评分（PCS）和心理成分综合评分（MCS）的 QOL 评分。通过简单和多元线性回归确定 QOL 的决定因素。P 值<0.05 被认为具有统计学意义。
结果
该研究共纳入 202 例未透析的 CKD 患者。其中 118 例（58.5%）为男性。平均年龄为 46.7±16.2 岁。大多数患者（165 例，81.7%）的月薪低于 GHS 500（约 125 美元）。慢性肾小球肾炎是 118 例（58.5%）患者中最常见的 CKD 病因，其次是 40 例（19.8%）糖尿病患者和 19 例（9.4%）高血压患者。中位血清肌酐为 634.2μmol/L（IQR 333-1248），中位 eGFR 为 7ml/min/1.73m（IQR 3-16）。最常见的阶段是 CKD 5 期，占 143 例（71.1%），其次是 CKD 4 期，占 45 例（22.4%），CKD 3 期占 13 例（6.5%）。总体平均 QOL 评分为 40.3±15.4。MCS 评分明显低于 PCS 评分（37.3±10.8 与 43.3±21.6，P<0.001）。多元线性回归显示，低收入（p=0.002）和低血红蛋白水平（p=0.003）与整体平均 QOL 相关。
结论
中重度 CKD 患者收入较低，疾病晚期，生活质量较差。贫血和低收入与较差的 QOL 显著相关。
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