健康相关希望与 CKD 患者遵医嘱治疗之间的关系：多中心横断面研究。
Association between health-related hope and adherence to prescribed treatment in CKD patients: multicenter cross-sectional study.
机构信息
Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.
Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
出版信息
BMC Nephrol. 2020 Oct 31;21(1):453. doi: 10.1186/s12882-020-02120-0.
BACKGROUND
In chronic kidney disease (CKD), patients' adherence to prescriptions for diet and for medications might depend on the degree to which they have hope that they will enjoy life, and that hope could vary with the stage of CKD. The aims of this study were to quantify both the association of CKD stage with health-related hope (HR-Hope), and the association of that hope with psychological and physiological manifestations of adherence.
METHODS
This was a cross-sectional study involving 461 adult CKD patients, some of whom were receiving dialysis. The main exposure was HR-Hope, measured using a recently-developed 18-item scale. The outcomes were perceived burden of fluid restriction and of diet restriction, measured using the KDQOL, and physiological manifestations of adherence (systolic and diastolic blood pressure [BP], and serum phosphorus and potassium levels). General linear models and generalized ordered logit models were fit.
RESULTS
Participants at non-dialysis stage 4 and those at stage 5 had lower HR-Hope scores than did those at stage 2 or 3 (combined). Those at non-dialysis stage 5 had the lowest scores. HR-Hope scores of participants at stage 5D were similar to those of participants at stage 4, but they were lower than the scores of participants at stage 2 or 3 (combined). Higher HR-Hope scores were associated with lower perceived burdens of fluid restriction and of diet restriction (adjusted ORs per ten-point difference were 0.82 and 0.84, respectively). Higher HR-Hope scores were associated with lower systolic BP (adjusted mean difference in systolic BP per ten-point difference in HR-Hope scores was - 1.87 mmHg). In contrast, HR-Hope scores were not associated with diastolic BP, serum phosphorus levels, or serum potassium levels.
CONCLUSIONS
Among CKD patients, HR-Hope is associated with disease stage, with psychological burden, and with some physiological manifestations of adherence.
背景
在慢性肾脏病（CKD）患者中，他们对饮食和药物治疗方案的坚持程度可能取决于他们对生活质量的期望程度，而这种期望可能会因 CKD 分期的不同而有所变化。本研究的目的是定量分析 CKD 分期与健康相关希望（HR-Hope）之间的关系，以及这种希望与患者坚持治疗的心理和生理表现之间的关系。
方法
这是一项横断面研究，共纳入了 461 名成年 CKD 患者，其中一些患者正在接受透析治疗。主要暴露因素为 HR-Hope，采用最近开发的 18 项量表进行测量。结局指标为患者对液体限制和饮食限制的感知负担，采用 KDQOL 进行测量，以及坚持治疗的生理表现（收缩压和舒张压[BP]以及血清磷和钾水平）。采用一般线性模型和广义有序逻辑回归模型进行拟合。
结果
与 2 期或 3 期相比，未进行透析的 4 期和 5 期患者的 HR-Hope 评分较低（两者合并），而未进行透析的 5 期患者的评分最低。5D 期患者的 HR-Hope 评分与 4 期患者相似，但低于 2 期或 3 期（两者合并）患者的评分。较高的 HR-Hope 评分与较低的液体限制和饮食限制感知负担相关（HR-Hope 评分每增加 10 分，相应的感知负担分别降低 0.82 和 0.84）。较高的 HR-Hope 评分与收缩压较低相关（HR-Hope 评分每增加 10 分，收缩压的平均差值为-1.87mmHg）。相反，HR-Hope 评分与舒张压、血清磷水平或血清钾水平无关。
结论
在 CKD 患者中，HR-Hope 与疾病分期、心理负担以及坚持治疗的某些生理表现相关。
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