The comparison of QOL and cost between hemodialysis and peritoneal dialysis

【目的】肾透析一直面临着复杂并发症、长期护理给家庭带来负担、治疗费用高等严重问题。血液透析（HD）与腹膜透析（PD）的生活质量和成本比较，在各国存在较大差异，对提高肾透析的效率和质量至关重要。[方法]收集4个肾透析中心158例终末期肾病患者的资料；140例HD患者和18例PD患者。采用含线性模拟量表的问卷，在2年的每个透析日对患者进行自我评估，并从家属和医务人员的角度评估患者的生活质量。并对每个病例的医疗费用数据进行了汇总。[结果]50例HD患者随访2年，自我评价的生活质量评分与护士评价的生活质量评分呈正相关（p<0.01）。这意味着护理人员可以准确地掌握病人的健康状况。透析前自我评价的生活质量评分与医疗费用呈负相关（p<0.01）。当需要对意外并发症进行针对性的药物治疗时，自我评价的生活质量评分往往较低。HD患者倦怠的方差大于PD患者（p<0.05）。PD患者的生活质量有提高的趋势，但由于PD病例数量与HD病例相比不足，无法进行更多的统计分析。

[Purpose] Renal dialysis has been faced with such serious problems as compound complications, burden of the family cause by long-term care, and the high cost of the therapy. The comparison of QOL and cost between hemodialysis (HD) and peritoneal dialysis (PD) in which there is comparatively a great difference by the country seems to be essential to improve efficiency and quality of the renal dialysis.[Methods] The data were collected in four renal dialysis centers for 158 patients with end stage renal disease ; 140 patients undergoing HD and 18 PD patients. QOL of the patient was assessed by himself and from the viewpoints of family and the medical staff in every dialysis day for 2 years using questionnaires containing linear analogue scale. The data of medical cost in each case were also accumulated.[Results] A positive correlation was seen between the QOL scores by self-estimation and those estimated by nurses in 50 patients with HD followed for two years (p<0.01). This means that the attendant nurses accurately grasp the patient's health status. There was a negative correlation between QOL scores by self-estimation before the dialysis and medical cost (p<0.01). When the specific medical treatments for unexpected complications are needed, QOL scores by self-estimation tend to become low. The variance of languor in HD patients is bigger than that in PD patients (p<0.05). QOL is in the trend that becomes higher with PD patients, although the more statistical analysis was impossible because number of PD cases is not sufficient in comparison with HD cases.