Mapping Multidimensional Illness Trajectories of Patients With ESKD

描述（由申请人提供）：在美国，需要维持性透析的终末期肾病（ESKD）患者数量正在迅速增加。ESKD通常伴有多种合并症，包括其他器官衰竭。并发症是常见的，它们会影响生存和生活质量。当急性疾病与合并症叠加时，它们通常会导致死亡。很少有人能逃过危及生命的急性发作；然而，当ESKD患者经历危及生命的急性发作时，他们的症状、身体功能、社会心理需求以及情绪和精神健康的轨迹却知之甚少。这些数据非常需要指导这一人群的姑息治疗。因此，这项拟议的研究将确定症状的轨迹，身体

DESCRIPTION (provided by applicant): The number of patients with end-stage kidney disease (ESKD) requiring maintenance dialysis is increasing rapidly in the U.S. ESKD is typically accompanied by multiple co-morbidities, including other organ failure. Complications are common, and they undermine survival and quality of life. When acute illnesses are superimposed on co-morbidities, they typically cause death. Few escape acute life-threatening episodes; yet little is known about the trajectories of symptoms, physical functioning, psychosocial needs, and emotional and spiritual well-being of patients with ESKD when they experience acute life-threatening episodes. Such data are in great need to guide palliative care for this population. This proposed study will therefore identify trajectories of symptoms, physical functioning, psychosocial needs, and emotional and spiritual well-being in a sample of 200 patients with ESKD who are at a high risk of experiencing acute life-threatening events and mortality within 12 months. Specific aims are to (1) identify longitudinal patterns of the five dimensions of quality of life, i.e., symptoms, physical functioning, psychosocial needs, and emotional and spiritual well- being of patients with ESKD who experience acute life-threatening events; (2) examine the relationships among these five dimensions of quality of life over time and the impact of acute life-threatening events on the relationships; and (3) examine the relationships of trajectories of the five dimensions to survival. This study will use a prospective descriptive design with repeated measures over 12 months, or until patient death. The five dimensions of quality of life will be assessed monthly. A linear mixed model will be used as the primary statistical technique for assessing the longitudinal patterns of the five dimensions of quality of life and the relationships among the repeated measures and multiple predictors of each dimension. This study will provide data to help identify and meet the complex needs of patients with ESKD who experience acute life-threatening events superimposed on the demands of dialysis and co-morbidities.