Sesso R, Yoshihiro M M
Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
Nephrol Dial Transplant. 1997 Oct;12(10):2111-6. doi: 10.1093/ndt/12.10.2111.
Time of diagnosis of chronic renal failure ani predialysis care may be important factors related to the quality of life of patients on dialysis treatment.
We evaluated the quality of life of 113 haemodialysis patients who had a late (< or = 1 month before starting dialysis, n = 53) or early (> or = 6 months, n = 60) diagnosis of chronic renal failure. At the time of the survey patients had been on dialysis for a median duration of 55 days (range 1-109). Quality of life was measured by the Kidney Disease Questionnaire (KDQ), including five dimensions with scales ranging from 1.0 to 7.0 (1.0 = more impairment): the health and life satisfaction indices (higher score = more dissatisfied), functional status (Karnofsky scale), and the time trade-off technique.
Mean scores of quality of life measures were worse in the late- than in the early-diagnosis group. A significant difference (P < 0.05) was observed in the depression (4.46 +/- 1.45 vs 5.23 +/- 1.36), relationships with others (3.95 +/- 1.31 vs 4.53 +/- 1.31) and frustration (4.08 +/- 1.51 vs 5.21 +/- 1.34) dimensions of the KDQ. and in life satisfaction (4.11 +/- 1.92 vs 3.32 +/- 1.57). Functional status declined compared to 1 year before dialysis, particularly in the late-diagnosis group. Among the elderly patients, the magnitude of the difference was more pronounced, (including in the physical symptoms item of the KDQ).
Our findings demonstrate that late diagnosis of chronic renal failure and the consequent lack of predialysis care adversely affect the quality of life of haemodialysis patients. Early diagnosis and regular predialysis care should be encouraged to improve the quality of life during dialysis treatment.
慢性肾衰竭的诊断时间及透析前护理可能是与透析治疗患者生活质量相关的重要因素。
我们评估了113例接受血液透析患者的生活质量，这些患者慢性肾衰竭诊断较晚（开始透析前≤1个月，n = 53）或较早（≥6个月，n = 60）。在调查时，患者已接受透析的中位时长为55天（范围1 - 109天）。生活质量通过肾脏病问卷（KDQ）进行测量，包括五个维度，量表范围为1.0至7.0（1.0 = 损害更严重）：健康和生活满意度指数（分数越高 = 越不满意）、功能状态（卡诺夫斯基量表）以及时间权衡技术。
生活质量测量的平均得分在诊断较晚组比诊断较早组更差。在KDQ的抑郁（4.46 ± 1.45对5.23 ± 1.36）、与他人关系（3.95 ± 1.31对4.53 ± 1.31）和挫折感（4.08 ± 1.51对5.21 ± 1.34）维度以及生活满意度（4.11 ± 1.92对3.32 ± 1.57）方面观察到显著差异（P < 0.05）。与透析前1年相比，功能状态下降，尤其是在诊断较晚组。在老年患者中，差异程度更为明显（包括在KDQ的身体症状项目中）。
我们的研究结果表明，慢性肾衰竭的延迟诊断以及随之而来的透析前护理不足对血液透析患者的生活质量产生不利影响。应鼓励早期诊断和定期透析前护理，以改善透析治疗期间的生活质量。
