Effects of hemodialysis dose and membrane flux on health-related quality of life in the HEMO Study

被引:148
作者
Unruh, M
Benz, R
Greene, T
Yan, GF
Beddhu, S
DeVita, M
Dwyer, JT
Kimmel, PL
Kusek, JW
Martin, A
Rehm-McGillicuddy, J
Teehan, BP
Meyer, KB
机构
[1] Univ Pittsburgh, Med Ctr, Pittsburgh, PA 15261 USA
[2] Lankenau Hosp & Med Res Ctr, Wynnewood, PA USA
[3] Cleveland Clin Fdn, Cleveland, OH 44195 USA
[4] Univ Utah, Salt Lake City, UT USA
[5] Vet Affairs Salt Lake City Hlth Care Syst, Salt Lake City, UT USA
[6] Beth Israel Deaconess Med Ctr, New York, NY 10003 USA
[7] Tufts Univ New England Med Ctr, Boston, MA USA
[8] NIDDKD, Bethesda, MD 20892 USA
[9] Brigham & Womens Hosp, Boston, MA 02115 USA
关键词
clinical trial; hemodialysis; quality of life; dialysis dose; membrane flux;
D O I
10.1111/j.1523-1755.2004.00738.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background. It has been widely supposed that high dose and high flux hemodialysis would affect the quality as well as the length of life of patients treated by maintenance hemodialysis. The HEMO Study examined changes in health-related quality of life as a secondary study outcome. Specific hypotheses were that study interventions would affect physical functioning, vitality, Short Form-36 Health Survey (SF-36) physical and mental component summary scores, symptoms and problems associated with kidney disease, and sleep quality. Methods. At baseline and annually, subjects responded to both the Index of Well-Being and the Kidney Disease Quality of Life-Long Form questionnaires. The interventions were assessed on the basis of their average effects over 3 years. Results. At baseline, the SF-36 physical component summary score was lower than in healthy populations, but the mental component score was nearly normal. Over 3-year follow-up, physical health continued to decline; mental health and kidney disease-targeted scores remained relatively stable. The high dose hemodialysis intervention was associated with significantly less pain (4.49 points, P < 0.001) and higher physical component scores (1.23 points P = 0.007), but these effects were small compared to the natural variability in scores. High flux membranes were not associated with statistically significant differences in health-related quality of life. Conclusion. The HEMO Study results demonstrate the marked burden of chronic kidney failure and hemodialysis treatment on daily life. In this trial among patients undergoing maintenance three times a week hemodialysis, the SF-36 physical component summary score and pain scale showed significant but very small clinical effects favoring the higher dialysis dose. No clinically meaningful benefits or either the dose or flux interventions were observed for other indices of health-related quality of life.
引用
收藏
页码:355 / 366
页数:12
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