| Abstract | Cilj istraživanja. Kvaliteta života uvjetovana zdravljem (KŽUZ) značajan je pokazatelj uspješnosti liječenja bolesnika u završnom stupnju bubrežnog zatajenja. Cilj ovog istraživanja bio je usporediti KŽUZ bolesnika liječenih kroničnom hemodijalizom (HD), bolesnika s transplantiranim bubregom (TB) i kontrolne skupine (KS) iz opće populacije, ispitati povezanost sociodemografskih i kliničkih čimbenika te stupnja depresivnosti i anksioznosti na KŽUZ bolesnika liječenih HD-om i TB-om.
Ispitanici i metode. U istraživanje je uključeno 420 ispitanika (140 prevalentnih kroničnih HD bolesnika, dobi 65,10±12,55 godina, 140 bolesnika s TB-om, dobi 51,70±12,55 godina i 140 ispitanika bez kronične bubrežne bolesti kao KS, dobi 48,30±12,72 godina). Samoprocjena KŽUZ svih ispitanika mjerena je koristeći Kratki obrazac studije ishoda liječenja od 36 tvrdnji (SF-36). Za utvrđivanje stupnja depresivnosti korištena je samoprocjenska Beck-ova ljestvica depresivnosti (BDI), a za utvrđivanje stupnja anksioznosti korišten je samoprocjenski Spielberger-ov upitnik anksioznosti kao stanja (STAI-X1) i anksioznosti kao crte ličnosti (STAI-X2). Podaci o sociodemografskim i kliničkim parametrima prikupljeni su iz postojećih povijesti bolesti.
Rezultati. KŽUZ HD bolesnika bio je nizak, sumarna fizička komponenta (PCS) iznosila je 33,72±11,21, a sumarna psihička komponenta (MCS) iznosila je 43,03±12,75. Bolesnici na HD-u su u usporedbi s KS-om pokazali lošiji rezultat u svim ispitivanim dimenzijama, dok su bolesnici s TB-om u usporedbi s HD bolesnicima bolji rezultat pokazali u šest dimenzija SF-V 36: tjelesna bol, opće zdravlje, vitalnost i energija, socijalno funkcioniranje, psihičko zdravlje i PCS. KŽUZ TB bolesnika i KS-a nije se razlikovao u dimenzijama vitalnost i energija, socijalno funkcioniranje i MCS. Starija dob, ženski spol, niži stupanj školovanja, liječenje HD-om dulje od jedne godine bili su povezani s nižim KŽUZ-om u HD bolesnika. Rezultat BDI bio je značajno viši u HD bolesnika u usporedbi s TB-om i KS-om (15,12±9,05 vs 11,23±8,30 vs 4,14±3,04, p<0,05), dok su TB bolesnici imali viši BDI rezultat u usporedbi s KS-om. Značajno viši rezultat STAI-X1 i STAI-X2 imao je KS u usporedbi s HD i TB bolesnicima (STAI-X1 49,49±4,92 vs 45,12±4,94 vs 45,92±4,84, p<0,05; STAI-X2 48,15±7,14 vs 46,71±5,84 vs 46,13±5,35, p<0,05). U multivarijantnoj analizi, dob i BDI predstavljaju značajne prediktore za PCS, a BDI i STAI-X2 za MCS u HD bolesnika. U bolesnika s TB-om, BDI i STAI-X2 predstavljaju značajne prediktore za MCS, dok za PCS nisu nađeni statistički značajni prediktori.
Zaključak. KŽUZ HD bolesnika niži je u svim dimenzijama u usporedbi s KS-om. TB bolesnici imaju bolji KŽUZ u usporedbi s HD bolesnicima u većini dimenzija, osim u dimenzijama ograničenja zbog fizičkih i emocionalnih problema. Sumarna komponenta psihičkog zdravlja TB bolesnika ne razlikuje se od onog zdravih ispitanika. Stupanj depresivnosti i dob značajni su prediktori PCS u bolesnika liječenih HD-om, dok su stupanj depresivnosti i stupanj anksioznosti prediktori za MCS u obje skupine bolesnika. |
| Abstract (english) | Objectives. Health-related quality of life (HRQOL) is an important predictor of outcome in end-stage renal disease patients. The aim of the present study was to compare HRQOL in chronic haemodialysis (HD) patients with transplanted (TX) patients and control group (CG) from general population, to explore the influence of sociodemografic and clinical factors, symptoms of depression and anxiety on HRQOL in patients on chronic HD and TX patients.
Patients and Methods. Four hundred and twenty subjects were included in the study (140 prevalent chronic HD patients aged 65,10±12,55 years, 140 TX patients aged 51,70±12,55 years and 140 subjects without chronic kidney disease as CG aged 48,30±12,72 years). HRQOL was measured using self-assessment questionnaire Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). The self-administered Beck Depression Inventory (BDI) was used to determine depression symptoms and self-administered Spielberger's State Trait Anxiety Inventory (STAI-X1 and STAI-X2) was used to determine anxiety symptoms. Sociodemographic and clinical data were obtained from the patients' medical records.
Results. The HRQOL of HD patients was low, the mean physical component summary (PCS) was 33,72±11,21 and the mean mental component summary (MCS) was 43,03±12,75. The HD patient scored lower than CG in all analyzed dimensions, while TX patients scored higher than HD patients in six dimensions of SF-36: bodily pain, general health, vitality and energy, social functioning, mental health and PCS. HRQOL of TX patients was equal to CG in dimensions: vitality and energy, social functioning and MCS. We found that older age, female gender, lower educational level and HD treatment longer than one year were associated with lower HRQOL in HD patients. The BDI was significantly higher in HD patients compared to TX patients and CG (15,12±9,05 vs 11,23±8,30 vs 4,14±3,04, p<0,05), while TX patient showed higher BDI results than CG. The mean STAI-X1 and STAI-X2 scores were significantly higher in CG compared to HD and TX (STAI-X1 49,42±4,92 vs 45,12±4,94 vs 45,92±4,84, p<0,05; STAI-X2 48,15±7,14 vs 46,71±5,84 vs 46,13±5,35, p<0,05). In HD patients, multivariate analysis showed that age and BDI were significant predictors for PCS, and BDI and STAI-X2 for MCS. In TX patients, MCS was predicted by BDI and STAI-X2, whereas no significant predictors were found for PCS.
Conclusion. HD patients have lower HRQOL in all dimensions compared to CS. HRQOL of TX patients is higher than HD patients on the most of the health dimensions, except on role limitations due to physical and emotional problems. Mental health summary of TX patients is similar to mental health score of the healthy controls. Depression symptoms and age are significant predictors for PCS in HD patients, while depression and anxiety symptoms are predictors for MCS in both patient groups. |
