Quality-of-Life and Mortality in Hemodialysis Patients: Roles of Race and Nutritional Status
Quality-of-Life and Mortality in Hemodialysis Patients: Roles of Race and Nutritional Status
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DOI：
10.2215/cjn.07690910
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发表时间：
2011-05-01
影响因子：
9.8
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
--
作者：
Feroze, Usama;Noori, Nazanin;Kalantar-Zadeh, Kamyar
背景和目标 维持性血液透析 (MHD) 患者通常存在蛋白质能量浪费、健康相关生活质量 (QoL) 差和过早死亡率高，而非洲裔美国 MHD 患者的生存率高于非非洲裔美国患者。我们假设不良的生活质量评分及其营养相关因素对 MHD 患者的种族生存差异有影响。设计、设置、参与者和测量我们通过多元线性回归检查了基线自我管理的 SF36 问卷得出的生活质量评分与营养标记之间的关联，并通过 Cox 模型和三次样条在 6 年队列中检查了与生存的关联。 705 名 MHD 患者，其中包括 223 名非裔美国人。结果 更糟糕的 SF36 心理和身体健康评分与较低的血清白蛋白和肌酐水平有关，但与较高的总体脂肪百分比相关。样条分析证实了较差生活质量的死亡率可预测性，与非裔美国人的心理健康评分几乎严格线性相关，尽管种族生活质量交互作用在统计上并不显着。在完全调整的分析中，所有MHD患者和两个种族的心理健康评分显示出比身体健康评分与死亡率更稳健和线性的相关性：对于所有患者和非洲裔美国患者，心理健康评分每降低10个单位的死亡风险比（95%置信区间）分别为1.12（1.05-1.19）和1.10（1.03-1.18）。 结论 肌酐浓度感知较差的生活质量。所有非裔美国人患者的心理健康状况不佳和身体健康状况不佳与死亡率相关。通过可以改善营养状况而不增加体脂肪的干预措施来改善生活质量值得进行临床试验。 Clin J Am Soc Nepkrol 6：1100-1111，2011。doi：10.2215/CJN.07690910
Background and objectives Maintenance hemodialysis (MHD) patients often have protein-energy wasting, poor health-related quality of life (QoL), and high premature death rates, whereas African-American MHD patients have greater survival than non-African-American patients. We hypothesized that poor QoL scores and their nutritional correlates have a bearing on racial survival disparities of MHD patients.Design, setting, participants, & measurements We examined associations between baseline self-administered SF36 questionnaire derived QoL scores with nutritional markers by multivariate linear regression and with survival by Cox models and cubic splines in the 6-year cohort of 705 MHD patients, including 223 African Americans.Results Worse SF36 mental and physical health scores were associated with lower serum albumin and creatinine levels but higher total body fat percentage. Spline analyses confirmed mortality predictability of worse QoL, with an almost strictly linear association for mental health score in African Americans, although the race QoL interaction was not statistically significant. In fully adjusted analyses, the mental health score showed a more robust and linear association with mortality than the physical health score in all MHD patients and both races: death hazard ratios for (95% confidence interval) each 10 unit lower mental health score were 1.12 (1.05-1.19) and 1.10 (1.03-1.18) for all and African American patients, respectively.Conclusions MHD patients with higher percentage body fat or lower serum albumin or creatinine concentration perceive a poorer QoL. Poor mental health in all and poor physical health in non-African American patients correlate with mortality. Improving QoL by interventions that can improve the nutritional status without increasing body fat warrants clinical trials. Clin J Am Soc Nepkrol 6: 1100-1111, 2011. doi: 10.2215/CJN.07690910