Iyasere Osasuyi, Brown Edwina A, Johansson Lina, Davenport Andrew, Farrington Ken, Maxwell Alexander P, Collinson Helen, Fan Stanley, Habib Ann-Marie, Stoves John, Woodrow Graham
John Walls Renal Unit, Leicester General Hospital, Leicester, UK.
Imperial College Renal and Transplant centre, Hammersmith Hospital, London, UK.
Clin Kidney J. 2018 Jul 20;12(2):262-268. doi: 10.1093/ckj/sfy059. eCollection 2019 Apr.
There is little information about quality of life (QoL) for patients with end-stage kidney disease (ESKD) choosing conservative kidney management (CKM). The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer QoL outcomes with little difference between dialysis modalities [assisted peritoneal dialysis (aPD) or haemodialysis (HD)]. We therefore extended the FEPOD study to include CKM patients with estimated glomerular filtration rate ≤10 mL/min/1.73 m (i.e. individuals with ESKD otherwise likely to be managed with dialysis).
CKM patients were propensity matched to HD and aPD patients by age, gender, ethnicity, diabetes status and index of deprivation. QoL outcomes measured were Short Form-12 (SF12), Hospital Anxiety and Depression Scale depression score, symptom score, Illness Intrusiveness Rating Scale (IIRS) and Renal Treatment Satisfaction Questionnaire. Frailty was assessed using the Clinical Frailty Scale. Generalized linear modelling was used to assess the impact of treatment modality on QoL outcomes, adjusting for baseline characteristics.
In total, 84 (28 CKM, 28 HD and 28 PD) patients were included. Median age for the cohort was 82 (79-88) years. Compared with CKM, aPD was associated with higher SF12 physical component score (PCS) [Exp B (95% confidence interval) = 1.20 (1.00-1.45), P < 0.05] and lower symptom score [Exp B = 0.62 (0.43-0.90), P = 0.01]; depression score was lower in HD compared with CKM [Exp B = 0.70 (0.52-0.92), P = 0.01]. Worsening frailty was associated with higher depression scores [Exp B = 2.59 (1.45-4.62), P < 0.01], IIRS [Exp B = 1.20 (1.12-1.28), P < 0.01] and lower SF12 PCS [Exp B = 0.87 (0.83-0.93), P < 0.01].
Treatment by dialysis, both with aPD and HD, improved some QoL measures. Overall, aPD was equal to or slightly better than the other modalities in this elderly population. However, as in the primary FEPOD study, frailty was associated with worse QoL measures irrespective of CKD modality. These findings highlight the need for an individualized approach to the management of ESKD in older people.
关于终末期肾病（ESKD）患者选择保守肾脏管理（CKM）的生活质量（QoL）信息较少。透析中的虚弱和老年患者（FEPOD）研究表明，虚弱与较差的生活质量结果相关，不同透析方式[辅助腹膜透析（aPD）或血液透析（HD）]之间差异不大。因此，我们扩展了FEPOD研究，纳入估计肾小球滤过率≤10 mL/min/1.73 m²的CKM患者（即ESKD患者，否则可能接受透析治疗）。
根据年龄、性别、种族、糖尿病状态和贫困指数，将CKM患者与HD和aPD患者进行倾向匹配。测量的生活质量结果包括简明健康调查简表（SF12）、医院焦虑抑郁量表抑郁评分、症状评分、疾病侵扰评定量表（IIRS）和肾脏治疗满意度问卷。使用临床衰弱量表评估虚弱程度。采用广义线性模型评估治疗方式对生活质量结果的影响，并对基线特征进行调整。
总共纳入了84例患者（28例CKM患者、28例HD患者和28例PD患者）。该队列的中位年龄为82（79 - 88）岁。与CKM相比，aPD与更高的SF12身体成分得分（PCS）相关[指数B（95%置信区间）= 1.20（1.00 - 1.45），P < 0.05]，且症状评分更低[指数B = 0.62（0.43 - 0.90），P = 0.01]；与CKM相比，HD的抑郁评分更低[指数B = 0.70（0.52 - 0.92），P = 0.01]。虚弱程度加重与更高的抑郁评分[指数B = 2.59（1.45 - 4.62），P < 0.01]、IIRS评分[指数B = 1.20（1.12 - 1.28），P < 0.01]以及更低的SF12 PCS相关[指数B = 0.87（0.83 - 0.93），P < 0.01]。
aPD和HD透析治疗均改善了一些生活质量指标。总体而言，在老年人群中，aPD等于或略优于其他治疗方式。然而，与最初的FEPOD研究一样，无论CKD治疗方式如何，虚弱都与较差的生活质量指标相关。这些发现凸显了对老年ESKD患者进行个体化管理的必要性。
