Course of symptoms and health-related quality of life during specialized pre-dialysis care.
Course of symptoms and health-related quality of life during specialized pre-dialysis care.
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DOI：
10.1371/journal.pone.0093069
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Halbesma N
中科院分区：
文献类型：
--
作者：
de Goeij MC;Ocak G;Rotmans JI;Eijgenraam JW;Dekker FW;Halbesma N
在确定开始透析的最佳时间方面，仅肾功能的价值有限。疾病相关症状和健康相关生活质量（HRQOL）在定义这一时刻可能具有额外的临床价值，但对这些参数在透析前护理期间如何变化知之甚少。我们研究的目的是描述透析前护理期间的症状和HRQOL过程，并调查其与不良健康结局的相关性。在前瞻性CTEE-2队列中，当转诊至25家参与的荷兰门诊诊所之一时（2004-2011年），纳入了开始专门透析前护理的事件患者。在本分析中，纳入了436例有症状和HRQOL数据的患者。每隔6个月收集一次临床数据、症状（修订的疾病感知问卷）和HRQOL（简表-36问卷;身心总分）。使用时间依赖性考克斯比例风险模型将症状和HRQOL与合并的不良健康结局（即开始透析、接受肾移植和死亡）相关联。所有症状都增加了，尤其是疲劳和力量丧失，身体和精神总分都随着时间的推移而下降，最明显的变化发生在最后6-12个月的随访期间。此外，每一个额外的症状（校正的HR 1.04（95% CI，1.00-1.09））和每一个低3分的身体和精神总分（校正的HR分别为1.04（1.02-1.06）和1.04（1.02-1.06））与随后6个月内达到综合健康状况不良结局的风险较高相关。在透析前护理期间，症状数量增加，身体和精神HRQOL评分降低，这些变化与开始透析、接受肾移植和死亡相关。这些结果可能表明，症状和HRQOL是透析前患者的医疗状况和疾病阶段的良好标志物。
Concerns are present on the limited value of renal function alone in defining the optimal moment to start dialysis. Disease-related symptoms and health-related quality of life (HRQOL) may have additional clinical value in defining this moment, but little is known about how these parameters change during pre-dialysis care. The aims of our study were to describe the course of symptoms and HRQOL during pre-dialysis care and to investigate their association with poor health outcomes. In the prospective PREPARE-2 cohort, incident patients starting specialized pre-dialysis care were included when referred to one of the 25 participating Dutch outpatient clinics (2004–2011). In the present analysis, 436 patients with data available on symptoms and HRQOL were included. Clinical data, symptoms (revised illness perception questionnaire), and HRQOL (short form-36 questionnaire; physical and mental summary score) were collected every 6-month interval. A time-dependent Cox proportional hazard model was used to associate symptoms and HRQOL with the combined poor health outcome (i.e. starting dialysis, receiving a kidney transplant, and death). All symptoms increased, especially fatigue and loss of strength, and both the physical and mental summary score decreased over time, with the most pronounced change during the last 6–12 months of follow-up. Furthermore, each additional symptom (adjusted HR 1.04 (95% CI, 1.00–1.09)) and each 3-point lower physical and mental summary score (adjusted HR 1.04 (1.02–1.06) and 1.04 (1.02–1.06) respectively) were associated with a higher risk of reaching the combined poor health outcome within the subsequent 6 months. The number of symptoms increased and both the physical and mental HRQOL score decreased during pre-dialysis care and these changes were associated with starting dialysis, receiving a kidney transplant, and death. These results may indicate that symptoms and HRQOL are good markers for the medical condition and disease stage of pre-dialysis patients.
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影响因子：
19.6
作者：
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通讯作者：
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影响因子：
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DOI：
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发表时间：
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影响因子：
13.6
作者：
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