腹膜透析中的临床事件及患者报告的结局指标
Clinical events and patient-reported outcome measures in peritoneal dialysis.
作者信息
Malaweera Aruni, Huang Louis L, McMahon Lawrence P
机构信息
Department of Renal Medicine, Eastern Health 5, Arnold Street, Box Hill, 3128, Australia.
Department of Renal Medicine, Eastern Health Clinical School Monash University, 5, Arnold Street, Box Hill, 3128, Australia.
出版信息
BMC Nephrol. 2025 Jul 1;26(1):328. doi: 10.1186/s12882-025-04240-x.
BACKGROUND
Traditional markers of dialysis adequacy in peritoneal dialysis (PD) correlate poorly with both patient symptoms and outcomes, and residual kidney function remains the better determinant of each. Largely in response to these findings, guidelines now recommend focussing on patient-reported outcome measures (PROMs) in addition to assessing dialysis adequacy, where they have been shown to predict mortality, technique survival and hospitalisations. We aim to assess whether symptom burden measured by Palliative care Outcome Scale Symptom (POS-S)-renal questionnaire correlate with traditional markers of dialysis adequacy and is associated with future patient outcomes.
HYPOTHESIS
We hypothesise that the POS-S renal score does not correlate with traditional markers of dialysis adequacy but that it might be associated with future outcomes including mortality, technique survival and hospitalisations.
METHOD
This was a retrospective study on adult PD patients who underwent a POS-S-renal questionnaire within 2-weeks of their routine Peritoneal Equilibrium Test (PET)-Adequest test. We assessed for the association between POS-S renal scores with adequacy measures (Kt/V and creatinine clearance or CCr) and whether POS-S renal scores were associated with future outcomes (remaining on PD, transition to haemodialysis, kidney transplantation or death on PD).
RESULTS
There were 107 patients with at least one paired PET-Adequest and POS-S renal questionnaire. There was no correlation between markers of dialysis adequacy (CCr and Kt/V) and symptom burden measured by POS-S renal questionnaire. Higher symptom burden was associated with less favourable outcomes including technique failure, hospitalisations and death (p < 0.05). There was also an association between a higher symptom burden and a lower serum albumin level (p < 0.001).
CONCLUSION
There was no association between markers of dialysis adequacy and the POS-S renal score; however, a higher POS-S renal score was associated with technique failure, hospitalisations and death compared to traditional markers. The measurement of PROMs may provide a beneficial addition to dialysis assessment in routine PD care.
CLINICAL TRIAL NUMBER
Not applicable.
背景
腹膜透析（PD）中透析充分性的传统标志物与患者症状及预后的相关性较差，而残余肾功能仍是二者更好的决定因素。主要鉴于这些发现，目前指南建议除评估透析充分性外，还应关注患者报告的结局指标（PROMs），这些指标已被证明可预测死亡率、技术存活时间和住院情况。我们旨在评估通过姑息治疗结局量表症状（POS-S）-肾脏问卷测量的症状负担是否与透析充分性的传统标志物相关，以及是否与患者未来的结局相关。
假设
我们假设POS-S肾脏评分与透析充分性的传统标志物不相关，但可能与包括死亡率、技术存活时间和住院情况在内的未来结局相关。
方法
这是一项针对成年PD患者的回顾性研究，这些患者在进行常规腹膜平衡试验（PET）-Adequest试验的2周内接受了POS-S-肾脏问卷调查。我们评估了POS-S肾脏评分与充分性指标（Kt/V和肌酐清除率或CCr）之间的关联，以及POS-S肾脏评分是否与未来结局（继续接受PD治疗、转为血液透析、肾移植或在PD治疗期间死亡）相关。
结果
有107例患者至少进行了一次配对的PET-Adequest和POS-S肾脏问卷调查。透析充分性标志物（CCr和Kt/V）与通过POS-S肾脏问卷测量的症状负担之间无相关性。较高的症状负担与不太理想的结局相关，包括技术失败、住院和死亡（p<0.05）。较高的症状负担与较低的血清白蛋白水平之间也存在关联（p<0.001）。
结论
透析充分性标志物与POS-S肾脏评分之间无关联；然而，与传统标志物相比，较高的POS-S肾脏评分与技术失败、住院和死亡相关。在常规PD护理中，PROMs的测量可能会为透析评估提供有益补充。
临床试验编号
不适用。
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