Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands.
Nephrology (Carlton). 2022 Oct;27(10):834-844. doi: 10.1111/nep.14088.
Phosphate binders cause high pill burden for dialysis patients, complicate medication regimens, and have unpleasant taste and large size which may affect patients' quality of life. This study explores the association between phosphate binder pill burden and health-related quality of life (HRQoL) in dialysis patients.
We conducted a cross-sectional multi-centre cohort study in 21 Dutch dialysis centres. Phosphate binder pill burden was extracted from electronic patient records. Primary outcome was HRQoL measured with the Short Form 12 physical and mental component summary scores (PCS and MCS). Secondary endpoints were severity of gastro-intestinal symptoms, itching, dry mouth, and mental health symptoms, measured with the Dialysis Symptom Index.
Of 388 included patients, aged 62 ± 16 years, 77% underwent haemodialysis. PCS scores were comparable for patients with and without phosphate binders. Patients using 1-3 pills reported lower scores for decreased appetite (β -0.5; 95%CI -0.9 to -0.2), implying better appetite, than patients without phosphate binders. Patients using 4-6 pills also reported lower scores for decreased appetite (β -0.5; 95%CI -0.8 to -0.1) and for itching (β -0.5; 95%CI -0.9 to -0.1). Patients using >6 pills reported lower MCS (β -2.9; 95%CI -6.2-0.4) and higher scores for feeling nervous (β 0.6; 95%CI 0.1-1.1) and feeling sad (β 0.4; 95%CI 0.0-0.9).
Phosphate binder pill burden is not associated with physical quality of life. A higher pill burden is associated with better appetite and less itching. Patients using >6 pills per day report lower mental quality of life and felt nervous and sad more often.
磷结合剂会增加透析患者的药物负担，使药物治疗方案变得复杂，且其口感不佳、体积较大，这些因素可能会影响患者的生活质量。本研究旨在探讨透析患者的磷结合剂药物负担与健康相关生活质量（HRQoL）之间的关系。
我们在 21 家荷兰透析中心开展了一项横断面多中心队列研究。从电子病历中提取磷结合剂药物负担数据。主要结局指标为采用健康调查简表 12 项（SF-12）的生理和心理成分综合评分（PCS 和 MCS）衡量的 HRQoL。次要结局指标包括采用透析症状指数（Dialysis Symptom Index）衡量的胃肠道症状、瘙痒、口干和心理健康症状的严重程度。
在纳入的 388 例患者中，年龄为 62±16 岁，77%接受血液透析治疗。使用和未使用磷结合剂的患者 PCS 评分相当。使用 1-3 片磷结合剂的患者报告食欲减退程度较低（β -0.5；95%CI -0.9 至 -0.2），即食欲较好，而未使用磷结合剂的患者报告食欲减退程度较高。使用 4-6 片磷结合剂的患者报告食欲减退（β -0.5；95%CI -0.8 至 -0.1）和瘙痒（β -0.5；95%CI -0.9 至 -0.1）程度较低。使用 >6 片磷结合剂的患者报告 MCS 较低（β -2.9；95%CI -6.2 至 0.4），感到紧张（β 0.6；95%CI 0.1 至 1.1）和悲伤（β 0.4；95%CI 0.0 至 0.9）的频率较高。
磷结合剂药物负担与生理生活质量无关。更高的药物负担与更好的食欲和较少的瘙痒有关。每天使用 >6 片磷结合剂的患者报告心理生活质量较低，且更常感到紧张和悲伤。
