Health-related quality of life among dialysis patients on three continents: The Dialysis Outcomes and Practice Patterns Study
Health-related quality of life among dialysis patients on three continents: The Dialysis Outcomes and Practice Patterns Study
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DOI：
10.1046/j.1523-1755.2003.00289.x
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发表时间：
2003-11-01
影响因子：
19.6
通讯作者：
Held, PJ
中科院分区：
文献类型：
--
作者：
Fukuhara, S;Lopes, AA;Held, PJ
背景。评估与健康有关的生活质量（HRQOL）可以提供有关慢性疾病患者（包括终末期肾病（ESRD））所承受负担的类型和程度的信息。几项研究显示了接受血液透析治疗的ESRD患者之间存在重要的国际差异，但没有研究比较这些患者的HRQOL。我们的目的是记录透析患者在HRQOL方面的国际差异，并确定这些差异的可能解释。我们检查了透析结果和实践模式研究（DOPPS）的数据，这是一项针对血液透析患者的前瞻性、观察性国际研究。我们对来自美国、欧洲五个国家（法国、德国、意大利、西班牙和英国）和日本的DOPPS数据进行了横断面分析。采用线性混合模型分析HRQOL的差异，使用KDQOL-SFTM。以规范为基础的评分被用来最小化文化反应偏差。采用线性回归分析对混杂因素进行校正。其他变量包括人口统计学变量、合并症、ESRD的主要原因、ESRD的并发症和治疗，以及社会经济地位。在所有通用HRQOL亚量表中，三大洲患者的得分都远低于各自的人口标准值。美国患者的心理健康亚量表得分最高，心理成分总结得分最高。与美国或欧洲的患者相比，日本患者报告的身体功能更好，但他们也报告了肾脏疾病的最大负担。总的来说，即使在调整了可能的混杂因素后，这些差异仍然存在。在所有三大洲，ESRD和血液透析深刻影响HRQOL。在美国，对心理健康的影响比其他国家要小。日本血液透析患者认为他们的肾脏疾病带来了更大的负担，但他们的身体功能明显更高。社会经济因素和主要合并症的不同分布不能解释身体功能的差异。其他可能的因素，如透析质量和相关的卫生保健，值得仔细研究。
Background. Assessing health-related quality of life (HRQOL) can provide information on the types and degrees of burdens that afflict patients with chronic medical conditions, including end-stage renal disease (ESRD). Several studies have shown important international differences among ESRD patients treated with hemodialysis, but no studies have compared these patients' HRQOL. Our goal was to document international differences in HRQOL among dialysis patients and to identify possible explanations of those differences.Methods. We examined data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective, observational, international study of hemodialysis patients. We performed a cross-sectional analysis of DOPPS data from the United States, five countries in Europe (France, Germany, Italy, Spain, and the United Kingdom), and Japan. Linear mixed models were used to analyze differences in HRQOL, using the KDQOL-SFTM. Norm-based scores were used to minimize cultural response bias. Linear regression analysis was used to adjust for confounding factors. Other variables included demographic variables, comorbidities, primary cause of ESRD, complications of ESRD and treatment, and socioeconomic status.Results. In all generic HRQOL subscales, patients on all three continents had much lower scores than their respective population norm values. Patients in the United States had the highest scores on the mental health subscale and the highest mental component summary scores. Japanese patients reported better physical functioning than did patients in the United States or Europe, but they also reported the greatest burden of kidney disease. Overall, these differences remained even after adjusting for possible confounders.Conclusion. On all three continents, ESRD and hemodialysis profoundly affect HRQOL. In the United States, the effects on mental health are smaller than in other countries. Japanese hemodialysis patients perceived that their kidney disease imposes a greater burden, but their physical functioning was significantly higher. Different distributions of socioeconomic factors and major comorbid conditions could explain little of this difference in physical functioning. Other possible factors, such as quality of dialysis and related health care, deserve careful study.