Quality of life in primary caregivers of patients in peritoneal dialysis and hemodialysis

Abstract Background: Peritoneal dialysis (PD) is gaining track as an efficient/affordable therapy in poor settings. Yet, there is little data regarding differences in quality of life (QoL) of primary caregivers (PCG) of patients in PD and hemodialysis (HD). Aim: To compare the QoL of PCG of patients in PD and HD from an upper middle-income population in a Mexican city. Methods: Cross-sectional study was carried out with PCG of patients in PD (n=42) and HD (n=95) from 4 hospitals (response rate=70.2%). The SF 36-item QoL questionnaire, the Zarit burden interview, and the Goldberg anxiety/depression scale were used. Mean normalized scores for each QoL domain were compared by dialysis type. Adjusted odds were computed using logistic regression to determine the probability of low QoL (<70% of maximum possible score resulting from the added scores of the 8 dimensions). Results: The PD group had higher mean scores for emotional role functioning (+10.6; p=0.04), physical functioning (+9.2; p=0.002), bodily pain (+9.2; p=0.07), social functioning (+5.7; p=0.25), and mental health (+1.3; p=0.71); the HD group had higher scores for physical role functioning (+7.9, p=0.14), general health perception (+6.1; p=0.05), and vitality (+3.3; p=0.36). A non-significant OR was seen in multivariate regression (1.51; 95% CI 0.43-5.31). Zarit scores were similar, but workload levels were lower in the PD group (medium/high: PD 7.2%, HD 14.8%). Anxiety (HD 50.5%, PD 19%; p<0.01) and depression (HD 49.5%, PD 16.7%; p<0.01) were also lower in the PD group. Conclusion: Adjusted analysis showed no differences in the probability of low QoL between the groups. These findings add to the value of PD, and strengthen its importance in resource-limited settings.

【摘要】背景：腹膜透析（Peritoneal dialysis, PD）在资源匮乏地区正逐渐成为一种高效且可负担的治疗手段。然而，目前针对腹膜透析与血液透析（hemodialysis, HD）患者的主要照护者（primary caregivers, PCG）生活质量（quality of life, QoL）差异的相关研究数据仍较为有限。
目的：本研究旨在对比墨西哥某中等偏上收入城市中，腹膜透析与血液透析患者的主要照护者的生活质量。
方法：本研究为横断面研究，纳入来自4家医院的腹膜透析患者主要照护者42名、血液透析患者主要照护者95名，整体应答率为70.2%。研究采用SF-36项生活质量问卷、Zarit负担访谈量表以及Goldberg焦虑/抑郁量表进行评估。根据透析类型比较各生活质量维度的标准化平均得分。采用logistic回归计算校正比值比，以明确低生活质量（即8个维度得分之和未达到满分的70%）的发生概率。
结果：腹膜透析组在情感职能（+10.6；P=0.04）、躯体功能（+9.2；P=0.002）、躯体疼痛（+9.2；P=0.07）、社会功能（+5.7；P=0.25）以及精神健康（+1.3；P=0.71）维度的平均得分更高；血液透析组在躯体职能（+7.9，P=0.14）、总体健康感知（+6.1；P=0.05）以及活力（+3.3；P=0.36）维度得分更高。多因素回归分析显示校正比值比无统计学意义（1.51；95%置信区间0.43~5.31）。Zarit量表得分两组相似，但腹膜透析组的中/高负担照护者占比更低（腹膜透析组7.2%，血液透析组14.8%）。腹膜透析组的焦虑发生率（血液透析组50.5%，腹膜透析组19%；P<0.01）与抑郁发生率（血液透析组49.5%，腹膜透析组16.7%；P<0.01）均显著低于血液透析组。
结论：校正分析显示，两组间低生活质量的发生概率无显著差异。本研究结果进一步佐证了腹膜透析的临床价值，并强化了其在资源受限地区的应用重要性。