Renal Unit, Nephrology Department, Mater Dei Hospital, Msida, MSD 2090, Malta.
Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK.
BMC Nephrol. 2020 Dec 10;21(1):537. doi: 10.1186/s12882-020-02189-7.
Illness perceptions have been shown to predict a range of psychosocial and clinical outcomes in kidney disease; including quality of life, distress, treatment adherence and even survival in end-stage renal disease patients on dialysis. The aim of this study was to evaluate whether illness perceptions impact mortality in incident predialysis Chronic Kidney Disease (CKD) patients.
Over the study period between September 2015 and June 2019, a total of 200 participants with predialysis CKD were recruited from the Nephrology Outpatient's clinics at Mater Dei Hospital, Malta. The participants were followed up until June 2019, and the mortality information was collected. Cox proportional hazards models were used to examine the association between illness perceptions, and mortality risk, after adjustment for covariates including distress, kidney function, co-morbidity and psychological distress.
Of the 200 cases available for analysis, there were 43 deaths. The mean survival time was 718.55 days (min. 3 days, max. 1297 days). The cumulative survival 1-year post the assessment of the Revised Illness Perceptions Questionnaire (IPQ-R) was 93%. Stronger identity beliefs (HR = 1.199, 95% CI: 1.060-1.357, p = 0.004), perceptions of a chronic timeline (HR = 1.065, 95% CI: 1.003-1.132, p = 0.041), personal control beliefs (HR = 0.845, 95% CI: 0.748-0.955, p = 0.007) and perceptions of control over the treatment (HR = 0.812, 95% CI: 0.725-0.909, p = 0.000) demonstrated a significant association with mortality after controlling covariates. In a subsequent saturated model, perceived identity, chronic timeline and treatment control perceptions remained significant predictors of mortality, together with serum albumin, comorbidities and urea.
CKD patients' perceptions of treatment control, perceptions of a chronic timeline and perceived illness identity predict survival independently of clinical prognostic factors, including kidney function and co-morbidity. Illness perceptions are important and potentially modifiable risk factors in CKD. Further studies are required to test whether the assessment and the implementation of psychological interventions aimed to modify maladaptive illness perceptions influence clinical outcomes in CKD.
疾病感知已被证明可预测肾脏疾病的一系列心理社会和临床结局，包括生活质量、痛苦、治疗依从性，甚至在接受透析的终末期肾病患者中也可预测生存率。本研究旨在评估疾病感知是否会影响透析前慢性肾脏病（CKD）患者的死亡率。
在 2015 年 9 月至 2019 年 6 月期间，总共从马耳他 Mater Dei 医院的肾病门诊招募了 200 名透析前 CKD 患者。对参与者进行了随访，直到 2019 年 6 月，收集了死亡率信息。使用 Cox 比例风险模型，在调整了包括痛苦、肾功能、合并症和心理困扰等混杂因素后，检验了疾病感知与死亡率风险之间的关联。
在可进行分析的 200 例病例中，有 43 例死亡。平均生存时间为 718.55 天（最短 3 天，最长 1297 天）。评估修订后的疾病感知问卷（IPQ-R）后 1 年的累积生存率为 93%。更强的身份信念（HR=1.199，95%CI：1.060-1.357，p=0.004）、感知慢性时间轴（HR=1.065，95%CI：1.003-1.132，p=0.041）、个人控制信念（HR=0.845，95%CI：0.748-0.955，p=0.007）和对治疗控制的感知（HR=0.812，95%CI：0.725-0.909，p=0.000）与控制混杂因素后死亡率显著相关。在随后的饱和模型中，感知身份、慢性时间轴和治疗控制感知与死亡率仍然是独立的预测因素，与血清白蛋白、合并症和尿素一起。
CKD 患者对治疗控制、疾病感知的慢性时间轴和感知身份的看法可独立于包括肾功能和合并症在内的临床预后因素预测生存率。疾病感知是 CKD 的重要且潜在可改变的危险因素。需要进一步的研究来测试评估和实施旨在改变适应不良的疾病感知的心理干预是否会影响 CKD 的临床结局。
