综合保守治疗或血液透析老年患者的生活质量：在类似基础条件下的病例对照研究。

The Quality of Life in Elderly Patients in Comprehensive Conservative Management or Hemodialysis: A Case-Control Study in Analogous Basal Conditions.

机构信息

Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy.

Department of Medicine (DIMED), Clinical Nutrition, University of Padua, 35128 Padua, Italy.

出版信息

Nutrients. 2024 Sep 9;16(17):3037. doi: 10.3390/nu16173037.

DOI:10.3390/nu16173037

PMID:39275352

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11396888/

Abstract

BACKGROUND/OBJECTIVES: Comprehensive conservative management (CCM) is a viable treatment option for elderly patients with end-stage kidney disease (ESKD). However, it involves a significant change in dietary habits, such as adopting a low-protein diet. Therefore, it is crucial to understand its impact on the patient's quality of life (QoL), particularly when compared to hemodialysis (HD). The study aims to evaluate the differences in the QoL between patients undergoing CCM and HD.

METHODS

The study included 50 patients over 75 with ESKD, with 25 patients in the CCM group and 25 in the HD group. The CCM group followed a personalized low-protein diet, while the HD group did not have protein restrictions. Various parameters were assessed, including demographic data, urine output, blood tests, comorbidity index, Visual Analog Scale (VAS), and hospitalization. The SF-12 questionnaire assessed the QoL, and the Physical Composite Score (PCS) and Mental Composite Score (MCS) were calculated.

RESULTS

The study revealed no age and comorbidity index differences between CCM and HD patients. In contrast, CCM patients reported significantly better physical and mental well-being than HD patients. In univariate analysis, CCM (B 0.24, = 0.001), protein intake (B -0.004, = 0.008), hospitalization (B -0.18, = 0.024), urine output (B 0.25, = 0.001), and VAS (B -0.26, < 0.001) influenced the PCS. At the same time, only the type of treatment (B = 0.15, = 0.048), urine output (B 0.18, = 0.02), and VAS (B -0.14, = 0.048) influence the MCS. In contrast, in multivariate analysis, only CCM contributed to an improved PCS (B 0.19, = 0.003) and MCS (B 0.16, = 0.03), while a higher VAS worsened the PCS (B -0.24, < 0.001) and MCS (B -0.157, = 0.0024).

CONCLUSIONS

In elderly patients with similar basal conditions, health-related QoL perception is better in CCM than in HD patients.

摘要

背景/目的：综合保守治疗（CCM）是老年终末期肾病（ESKD）患者的一种可行的治疗选择。然而，它涉及饮食习惯的重大改变，例如采用低蛋白饮食。因此，了解其对患者生活质量（QoL）的影响至关重要，尤其是与血液透析（HD）相比。本研究旨在评估接受 CCM 和 HD 治疗的患者之间 QoL 的差异。

方法

该研究纳入了 50 名 75 岁以上的 ESKD 患者，其中 CCM 组 25 例，HD 组 25 例。CCM 组采用个性化低蛋白饮食，而 HD 组无蛋白质限制。评估了各种参数，包括人口统计学数据、尿量、血液检查、合并症指数、视觉模拟量表（VAS）和住院情况。SF-12 问卷评估了 QoL，并计算了身体综合评分（PCS）和心理综合评分（MCS）。

结果

研究显示，CCM 和 HD 患者的年龄和合并症指数无差异。相比之下，CCM 患者的身体和心理健康状况明显优于 HD 患者。在单因素分析中，CCM（B0.24，=0.001）、蛋白质摄入（B-0.004，=0.008）、住院（B-0.18，=0.024）、尿量（B0.25，=0.001）和 VAS（B-0.26，<0.001）影响 PCS。同时，只有治疗类型（B=0.15，=0.048）、尿量（B0.18，=0.02）和 VAS（B-0.14，=0.048）影响 MCS。相比之下，在多因素分析中，只有 CCM 有助于改善 PCS（B0.19，=0.003）和 MCS（B0.16，=0.03），而较高的 VAS 会降低 PCS（B-0.24，<0.001）和 MCS（B-0.157，=0.0024）。