Quality of life and psychological issues in peritoneal dialysis patients
Quality of life and psychological issues in peritoneal dialysis patients
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DOI：
10.1111/j.1525-139x.2005.18215.x
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发表时间：
2005-03-01
影响因子：
1.6
通讯作者：
Piraino, B
中科院分区：
文献类型：
--
作者：
Lew, SQ;Piraino, B
腹膜透析（PD）和血液透析（HD）患者的生活质量（QOL）评分均低于健康患者。随着时间的推移，生活质量趋于下降，身体健康质量的恶化程度超过心理健康。然而，许多患者仍然感到绝望、焦虑和担心经济、性功能丧失、家庭负担和丧失独立性。抑郁症是慢性肾脏疾病患者中最被广泛认可的社会心理因素。25%面临透析的患者出现重度抑郁症。一旦患上帕金森病，重度抑郁症患者的比例急剧下降至6%左右。这可能是由于对透析的适应，但也可能是因为抑郁症状与死亡风险增加有关。低生活质量评分和抑郁与较高的合并症、较差的营养状况、贫血、较低的残余肾功能和较高的住院率相关。抑郁评分的增加是腹膜炎风险升高的独立预测，可能是由于注意力不集中，或者是由于免疫防御的降低。小分子清除似乎与抑郁症状没有什么关系。抑郁症是PD和其他透析患者的一个重要问题。心理社会因素、疾病感知和临床结果之间存在相互关系，需要进一步研究。所有PD患者均应常规获得抑郁和生活质量的系列和简单测量。这允许快速识别问题，并可能加强患者对抑郁症重要性的教育。迫切需要进一步研究干预措施。
Both peritoneal dialysis (PD) and hemodialysis (HD) patients have diminished quality of life (QOL) scores compared to healthy patients. QOL tends to decline over time, with the perception of the quality of physical health deteriorating more than mental health. However, many patients continue to feel hopeless, anxious, and worry about finances, loss of sexual function, family burden, and loss of independence. Depression is the most widely acknowledged psychosocial factor seen in patients with chronic kidney disease. Major depression occurs in 25% of patients facing impending dialysis. Once on PD, the proportion with major depression sharply declines to approximately 6%. This may be due to adjustment to dialysis, but may also be because depressive symptoms are associated with an increased risk of death. A low QOL score and depression are associated with higher comorbidity, poorer nutritional status, anemia, lower residual renal function, and increased hospitalization rates. Increased depressive scores are independently predictive of an elevated peritonitis risk, perhaps due to inattentiveness, or alternatively from a decrease in immune defenses. Small molecule clearances appear to have little to do with depressive symptoms. Depression is a significant problem in PD and other dialysis patients. There is an interrelationship between psychosocial factors, perception of illness, and clinical outcome that requires further study. Serial and simple measures of both depression and QOL should be obtained routinely in all PD patients. This permits rapid recognition of problems and may enhance patients' education on the importance of depression. Further research on interventions is urgently needed.