Nalankilli Kurinji, Stallworthy Elizabeth, Ducharlet Kathryn, Hole Barnaby D, O'Hara Daniel V, Agarwal Neeru, Snead Charlotte M, Caskey Fergus J, Smyth Brendan
Renal Department, Waikato Hospital, Hamilton, New Zealand.
Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.
BMC Nephrol. 2025 Apr 23;26(1):204. doi: 10.1186/s12882-025-04107-1.
Kidney failure is associated with a high symptom burden, yet few studies describe real-world management approaches.
Kidney care units in Australia, New Zealand (NZ) and the United Kingdom (UK) were surveyed regarding their pharmacological treatment of a range of common symptoms affecting those with kidney failure. The present report describes the results for insomnia, restless legs syndrome (RLS), cramps, and pain. Variation in responses was described using normalised generalised variance (NGV), resulting in a score from 1 (most diverse) to 0 (least diverse).
One hundred and twelve (of 171 contacted) kidney units responded, including 56 units in Australia (50%), 7 in NZ (6%), and 49 in the UK (44%). Diversity of practice was highest for insomnia (mean NGV 0.95, range 0.93-0.98), where melatonin was the leading first-line agent (38%), followed by zolpidem and zopiclone (29%). Diversity of practice was lowest for RLS (mean NGV 0.66, range 0.30-0.99), owing to widespread use of iron replacement as first line (69%), gabapentinoids (45%), and dopamine agonists (37%). Diversity of practice was moderate for neuropathic pain (mean NGV 0.71, range 0.44-0.93), cramps (mean NGV 0.72, range 0.48-0.97), and opioids (mean NGV 0.88, range 0.75-0.97). Numerous significant between-country differences in treatment preferences were noted.
There is wide variation in treatment approaches to common symptoms affecting people living with advanced CKD or kidney failure, both within and between countries, indicating a need for evidence-based guidelines and further randomised studies to inform practice.
Not applicable.
肾衰竭与高症状负担相关，但很少有研究描述实际的管理方法。
对澳大利亚、新西兰（NZ）和英国（UK）的肾脏护理单位进行了调查，了解其对一系列影响肾衰竭患者的常见症状的药物治疗情况。本报告描述了失眠、不宁腿综合征（RLS）、痉挛和疼痛的调查结果。使用归一化广义方差（NGV）描述反应的差异，得出的分数范围为1（差异最大）至0（差异最小）。
（在联系的171个单位中）有112个肾脏单位做出了回应，其中澳大利亚有56个单位（50%），新西兰有7个单位（6%），英国有49个单位（44%）。失眠的治疗方法差异最大（平均NGV为0.95，范围为0.93 - 0.98），其中褪黑素是主要的一线药物（38%），其次是唑吡坦和佐匹克隆（29%）。RLS的治疗方法差异最小（平均NGV为0.66，范围为0.30 - 0.99），这是由于广泛使用铁剂替代作为一线治疗（69%）、加巴喷丁类药物（45%）和多巴胺激动剂（37%）。神经性疼痛（平均NGV为0.71，范围为0.44 - 0.93）、痉挛（平均NGV为0.72，范围为0.48 - 0.97）和阿片类药物（平均NGV为0.88，范围为0.75 - 0.97）的治疗方法差异适中。注意到国家之间在治疗偏好上存在许多显著差异。
对于影响晚期慢性肾脏病或肾衰竭患者的常见症状，各国国内和国家之间的治疗方法存在很大差异，这表明需要基于证据的指南和进一步的随机研究来为实践提供信息。
不适用。
