School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
Curr Opin Nephrol Hypertens. 2024 Nov 1;33(6):573-582. doi: 10.1097/MNH.0000000000001013. Epub 2024 Jul 22.
With ageing populations and rising prevalence of key risk factors, the prevalence of many long-term conditions including chronic kidney disease (CKD) is increasing globally. Health-related quality of life (HRQoL) is important to people living with CKD but not all HRQoL determinants are modifiable. This review summarizes recently identified potentially modifiable factors affecting HRQoL for people with CKD and recent trials incorporating HRQoL as an outcome.
Considering a broad definition of 'potentially modifiable', many factors have been associated with HRQoL in recent observational studies. These include mental health conditions, symptoms, medications, health behaviours, weight-related issues, poor social support, lower education, limited literacy and directly CKD- related factors such as anaemia. Some potentially modifiable factors have been tested in CKD trials, though often with HRQoL as a secondary outcome, so may be underpowered for HRQoL. Interventions with evidence of effect on HRQoL include physical activity, education, some nutritional interventions and medications targeting CKD-related anaemia.
Clinicians should consider the range of potentially modifiable factors influencing HRQoL as part of a holistic approach to CKD care. High-quality, adequately-powered trials, with HRQoL as a primary outcome, with interventions focusing on the other potentially modifiable factors identified are needed.
随着人口老龄化和主要危险因素的流行率上升，包括慢性肾脏病（CKD）在内的许多长期疾病的流行率在全球范围内正在上升。健康相关生活质量（HRQoL）对患有 CKD 的人很重要，但并非所有 HRQoL 决定因素都是可改变的。本综述总结了最近确定的可能影响 CKD 患者 HRQoL 的可改变因素，以及最近将 HRQoL 作为结局纳入的试验。
考虑到“潜在可改变”的广义定义，许多因素已在最近的观察性研究中与 HRQoL 相关。这些因素包括心理健康状况、症状、药物、健康行为、与体重相关的问题、社会支持不足、受教育程度低、有限的读写能力以及直接与 CKD 相关的因素，如贫血。一些潜在的可改变因素已在 CKD 试验中进行了测试，但通常 HRQoL 是次要结局，因此可能对 HRQoL 的影响作用没有足够的效力。对 HRQoL 有影响的干预措施包括体力活动、教育、一些营养干预措施和针对 CKD 相关贫血的药物治疗。
临床医生应考虑影响 HRQoL 的一系列潜在可改变因素，作为 CKD 护理整体方法的一部分。需要进行高质量、充分效力的试验，将 HRQoL 作为主要结局，干预措施重点关注其他已确定的潜在可改变因素。
