Квалитет на живот кај пациентите на хемодијализа

Abstract

In spite of the continouous improvement in the treatment field of chronic kidney disease. The mortaity rate in patients on hemodialysis remains still higher and quality of life lower than in general population. Many studies demonstrate strong association between lower quality of life scores and shorter survuval of dialysis patients. Therefore, the identification of quality of life worsening risk factors and appropriate intereventions are of high interest and need in order to provide beter and prolonged survuval. Assesement of quality of life as reflection of patients perception of their well-being is a rutin practice in a very small part of the world. Global implementation of continous follow up of this parameter is not yet being done and also the adequate frequency of measurements has not beeing estublished. The aim of his study was to evaluate the associations of quality of life scores with survival of patients treated with hemodialysis, comparison of those results with general population, assesement of predictors of life quality and its changes through time. One hundred sixty and two prevalent dialysis patients were investigated in the study. Follow up of sixty months was preformed on cardiovascular and all-cause mortality. Assesement of quality of life was performed in two suquential annual SF 36 questionnaries. In the analisys absolute values of quality of life component physical and mental component scores were used and also relative delata change between the two scores. The data where the outcome is death was analyzed using Kaplan Meier survival curves, separatelly for all-cause and cardovascular mortality. To asssess the variables significantly influecing all cause and cardiovasular mortality, a univariate Cox-proportional hazard model was used, and subsequently a multivariate Cox analysis with age adjustement was preformed. The results of the study showed as follows: o Patients treated with hemodialysis suffer from much lower quality of life when compared to general population matced for gender and age. Physical quality of life is more deteriorated than the mental one. Over 50% of patients show annual declination of quality of life scores. o Strongest predicors of better quality of life scores are youger age, lack of sleep disturbance diabetes and intradialytic hipotension, better family support and nutritional status, and arteriovenous fistula as type of vascular access. o Five years mortality rate of 43% for all-cause and 65% for cardiovasular occurred in our dialysis population.Lower physical and mental component scores were assoociated to significantely wors survival. The more recent measurement of life quality score predicted mortality over the sharpeness of the decline. o Interventions on the risk factors wich deteriorate quality of life in order to provide better survival are needed in future. More frequent assesemnet of quality of life scores I crucial for dettecting patients at risk for mortality. o Next studies are to detetrmine the adequate frequency of rutine measurements of quality of life in dialyisi patients. The multufacorial nature of quality of life and also the numerous unteractions with other factors influencing survival are tremedeous chalenge and filed of interst for improvement of outcomes in dialysis patients.