Fostering Innovation in Symptom Management among Hemodialysis Patients Paths Forward for Insomnia, Muscle Cramps, and Fatigue
Fostering Innovation in Symptom Management among Hemodialysis Patients Paths Forward for Insomnia, Muscle Cramps, and Fatigue
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DOI：
10.2215/cjn.07670618
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发表时间：
2019-01-07
影响因子：
9.8
通讯作者：
Mehrotra, Rajnish
中科院分区：
文献类型：
--
作者：
Flythe, Jennifer E.;Hilliard, Tandrea;Mehrotra, Rajnish
接受中心维持性血液透析的个体承受着很高的身体和情绪症状负担。超过一半的血液透析患者报告睡眠障碍、肌肉痉挛和疲劳。患者将症状描述为对他们的生活质量有有害影响，这表明缓解症状可能会有意义地改善患者报告的结果。此外，血液透析患者已将症状管理确定为研究和创新的关键领域，将缓解症状置于死亡率和生化指标等其他健康结果之上。尽管症状对患者很重要，但明确针对改善患者症状的研究很少，因此在症状管理方面的创新很少。总体而言，对症状的生理基础了解甚少，阻碍了靶向治疗的发展。事实上，美国食品和药物管理局(FDA)批准的用于改善患者报告的血液透析患者预后的药物或设备很少。认识到创新方面的差距，美国肾脏学会和美国食品和药物管理局之间的公私合作伙伴关系-肾脏健康倡议召集了一个工作组，首先确定症状的优先顺序，以开发治疗干预措施，然后针对失眠、肌肉痉挛和疲劳等优先身体症状确定近期可行的研究目标。本文总结了这三个优先症状的病理生理学，确定了关键的知识差距，承认了挑战新疗法开发的因素，并为肾病界提供了针对失眠、肌肉痉挛和疲劳的可行研究目标。
Individuals receiving in-center maintenance hemodialysis bear a high burden of both physical and mood symptoms. More than half of patients on hemodialysis report sleep disturbance, muscle cramps, and fatigue. Patients describe symptoms as having a deleterious effect on their quality of life, suggesting that symptom alleviation may meaningfully improve patient-reported outcomes. Moreover, patients on hemodialysis have identified symptom management as a key area for research and innovation, prioritizing symptom alleviation over other health outcomes such as mortality and biochemical indices. Despite the importance of symptoms to patients, there has been little research explicitly geared toward improving patient symptoms, and therefore minimal innovation in symptom management. In general, the physiologic underpinnings of symptoms are poorly understood, hampering the development of targeted therapies. In fact, there have been few drugs or devices approved by the US Food and Drug Administration for the indication of improving any patient-reported outcomes for patients on hemodialysis. Recognizing this gap in innovation, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and US Food and Drug Administration, convened a workgroup to first prioritize symptoms for the development of therapeutic interventions, and then identify near-term actionable research goals for the prioritized physical symptoms of insomnia, muscle cramps, and fatigue. This paper summarizes the pathophysiology of the three prioritized symptoms, identifies key knowledge gaps, acknowledges factors that challenge development of new therapies, and offers the nephrology community actionable research goals for insomnia, muscle cramps, and fatigue.