Al-Talib Mohammed, Caskey Fergus J, Inward Carol, Ben-Shlomo Yoav, Hamilton Alexander J
Population Health Sciences, University of Bristol, Bristol, United Kingdom.
Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom.
Kidney Med. 2023 Dec 1;6(2):100763. doi: 10.1016/j.xkme.2023.100763. eCollection 2024 Feb.
RATIONALE & OBJECTIVE: There have been no longitudinal studies examining the evolution of psychosocial health of young adults with kidney failure as they age. We aimed to address this in the Surveying Patients Experiencing Young Adult Kidney Failure-2 (SPEAK-2) study.
5-year follow-up longitudinal survey of the original SPEAK cohort.
SETTING & PARTICIPANTS: 16- to 30-year-olds in the UK receiving kidney replacement therapy (KRT) between 2015 and 2017 who participated in the SPEAK study.
Kidney failure and KRT modality.
Psychosocial health and lifestyle behaviors.
Within-cohort changes in psychosocial health were analyzed using the paired test, Wilcoxon signed-rank test and McNemar's test. We compared responses to the age-matched population and examined the impact of changes in KRT modality on psychological health using linear regression for continuous outcome variables as well as logistic, ordered logistic and multinomial logistic regression for binary, ordered categorical and unordered categorical variables, respectively.
We obtained 158 survey responses; 129 had previously responded to SPEAK. Of these, 90% had a kidney transplant. Compared to the general population, respondents were less likely to be married or have children and were more likely to be living with their parents. Respondents had nearly 15 times greater odds of being unable to work due to health (odds ratio [OR] = 14.41; 95% confidence interval [CI], 8.0-26.01; < 0.001). Respondents had poorer quality of life and mental wellbeing and were more likely to report psychological problems (OR = 5.37; 95% CI, 3.45-8.35; < 0.001). A negative association between remaining on or moving to dialysis and psychosocial health was observed, although this was attenuated when controlling for the psychosocial state in SPEAK.
Low response rate resulting in imprecise and potentially biased estimates and impact of COVID-19 pandemic while survey was active on psychosocial health.
Young adults with kidney failure have persistent poorer psychosocial health compared to their healthy peers as they age. Our findings also suggest a potential causal relationship between KRT modality and psychosocial health.
尚无纵向研究考察肾衰竭青年成人随着年龄增长其心理社会健康状况的演变。我们旨在通过“调查青年成人肾衰竭患者-2（SPEAK-2）”研究来解决这一问题。
对原始SPEAK队列进行为期5年的随访纵向调查。
2015年至2017年间在英国接受肾脏替代治疗（KRT）且参与了SPEAK研究的16至30岁人群。
肾衰竭及KRT方式。
心理社会健康状况及生活方式行为。
使用配对t检验、Wilcoxon符号秩检验和McNemar检验分析队列中心理社会健康状况的变化。我们将应答者与年龄匹配的人群进行比较，并分别使用线性回归分析连续结局变量、使用逻辑回归、有序逻辑回归和多项逻辑回归分析二元、有序分类和无序分类变量，以检验KRT方式变化对心理健康的影响。
我们获得了158份调查问卷回复；其中129人之前曾回复过SPEAK问卷。在这些回复者中，90%接受了肾移植。与普通人群相比，回复者结婚或生育的可能性较小，与父母同住的可能性较大。回复者因健康问题无法工作的几率几乎高出15倍（优势比[OR]=14.41；95%置信区间[CI]，8.0-26.01；P<0.001）。回复者的生活质量和心理健康状况较差，更有可能报告心理问题（OR=5.37；95%CI，3.45-8.35；P<0.001）。观察到继续接受或转为透析与心理社会健康之间存在负相关，尽管在控制了SPEAK中的心理社会状态后这种相关性有所减弱。
回复率较低导致估计不准确且可能存在偏差，以及在调查进行期间COVID-19大流行对心理社会健康的影响。
与健康同龄人相比，肾衰竭青年成人随着年龄增长其心理社会健康状况持续较差。我们的研究结果还表明KRT方式与心理社会健康之间可能存在因果关系。
