Impact of chronic kidney disease on health-related quality-of-life improvement after coronary artery bypass surgery
Impact of chronic kidney disease on health-related quality-of-life improvement after coronary artery bypass surgery
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DOI：
10.1001/archinte.166.18.2014
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发表时间：
2006-10-09
影响因子：
--
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
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作者：
Parikh, Chirag R.;Coca, Steven G.;Krumholz, Harlan M.
背景资料：鲜为人知的是，慢性肾脏疾病（CKD）对健康相关的生活质量的影响后冠状动脉旁路移植术（CABG）。方法：我们的目标是检查身体功能（PF）和心理健康（MH）的变化6个月后，在1055例患者CABG和无CKD。主要终点是从基线到CABG后6个月，根据CKD分期（0-5）分层的医学结局信托简表36项健康调查的PF和MH子量表评分和“改善”或“恶化”状态的平均变化。重度CKD（4-5期）患者在6个月时PF评分平均（SD）降低3（3），而其他患者则增加（P <0.001）。校正基线评分后，21%的晚期CKD患者PF评分恶化，而0 - 2期和3期CKD患者为0%（P <0.001）。与PF评分相比，6个月时有和无CKD患者的平均MH评分改善相似，4 - 5期CKD患者的MH评分改善频率最高（77%）。调整后，没有患者出现恶化的MH scores.Conclusions：6个月后，严重CKD患者接受CABG的MH有所改善，但PF没有改善，可能有恶化的PF相比，那些没有严重CKD。在没有CABG的情况下，需要关于生活质量结局的可比证据，以更充分地为重度CKD和冠状动脉疾病患者的决策提供信息。
Background: Little is known about the impact of chronic kidney disease (CKD) on health-related quality-of-life outcomes after coronary artery bypass grafting (CABG).Methods: Our objective was to examine the changes in physical function (PF) and mental health (MH) 6 months after CABG in 1055 patients with and without CKD. The primary end points were mean change in score and status of "improved" or "worsened" in both PF and MH sub-scales of the Medical Outcomes Trust Short Form 36-Item Health Survey from baseline to 6 months after CABG, stratified by CKD stage (0-5).Results: Absolute PF and MH scores at baseline and at 6 months varied by renal impairment level. Patients with severe CKD (stages 4-5) had a mean (SD) decrease in PF score at 6 months of 3 (3) compared with increases in the rest of the cohort (P < .001). After adjustment for baseline score, 21% of patients with advanced CKD experienced worsened PF scores, compared with 0% of patients with stages 0 to 2 and stage 3 CKD (P < .001). In contrast to PF scores, patients with and without CKD had similar improvements in mean MH scores at 6 months, and patients with stages 4 to 5 CKD had the highest frequency of those with improved MH scores (77%). After adjustment, no patients experienced worsened MH scores.Conclusions: After 6 months, patients with severe CKD who underwent CABG had improvement in MH but not improvement in PF and may have had worsened PF compared with those without severe CKD. Comparable evidence regarding quality-of-life outcomes in the absence of CABG is needed to more fully inform decision making regarding patients with severe CKD and coronary artery disease.