Study on the correlation between symptom clusters and dialysis adequacy in continuous ambulatory peritoneal dialysis patients
LU Haizhen1 HUANG Yanlin2 LI Haoyu1 WU Yiping2 YANG Zhen2 WANG Han2 CHEN Guowei2
1.Department of Nephrology, the Second Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning 530007, China; 2.Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract Objective To investigate the symptom cluster classification of continuous ambulatory peritoneal dialysis (CAPD) patients and to analyze the correlation between symptom clusters and dialysis adequacy. Methods A total of 180 CAPD patients in the Peritoneal Dialysis Center of the First Affiliated Hospital of Guangxi Medical University from October 2018 to December 2019 were selected by convenience sampling method. The general information questionnaire and dialysis symptom assessment scale were used for the investigation. Results Fatigue, dry mouth, dry skin, difficulty sleeping and pruritus were the top five symptoms in the incidence of symptoms in CAPD patients, while pruritus, difficulty sleeping, headache, lower limb edema and dry skin were the most serious symptoms in CAPD patients. Exploratory factor analysis was used to extract five symptom groups, which were water and electrolyte symptom group, psychological symptom group, energy symptom group, gastrointestinal symptom group, and skin symptom group. Pearson correlation analysis showed that water and electrolyte symptom group was positively correlated with parathyroidin (r = 0.157, P ＜ 0.05), and negatively correlated with 24 h ultrafiltration volume (r = -0.157, P ＜ 0.05). Psychological symptom group was positively correlated with blood urea nitrogen (r = 0.168, P ＜ 0.05). The energy symptom group was positively correlated with serum phosphorus and blood urea nitrogen (r = 0.190, 0.209, P ＜ 0.05 or P ＜ 0.01), and negatively correlated with serum albumin and 24 h urine volume (r = -0.158, -0.263, P ＜ 0.05 or P ＜ 0.01). Gastrointestinal symptom group was negatively correlated with 24 h urine volume and total creatinine clearance (r = -0.242, -0.244, P ＜ 0.01). The skin symptom group was positively correlated with serum phosphorus, blood urea nitrogen, serum creatinine, and parathyroid hormone (r = 0.256, 0.169, 0.222, 0.172, P ＜ 0.05 or P ＜ 0.01), and negatively correlated with 24 h urine volume and total creatinine clearance (r = -0.382, -0.275, P ＜ 0.01). Conclusion CAPD patients experience a variety of symptoms with a high degree of distress, and the symptoms constitute a group of symptoms. Symptom clusters are associated with dialysis adequacy.
LU Haizhen1 HUANG Yanlin2 LI Haoyu1 WU Yiping2 YANG Zhen2 WANG Han2 CHEN Guowei2. Study on the correlation between symptom clusters and dialysis adequacy in continuous ambulatory peritoneal dialysis patients[J]. 中国医药导报, 2021, 18(22): 104-108.
[1] Jain AK，Blake P，Cordy P，et al. Global trends in rates of peritoneal dialysis [J]. J Am Soc Nephrol，2012，23（3）：533-544.
[2] 曹雪莹.维持性腹膜透析患者流行病学调查及预后相关性研究[D].北京：解放军总医院；军医进修学院；中国人民解放军总医院；解放军医学院，2015.
[3] Dodd MJ，Miaskowski C，Paul SM. Symptom clusters and their effect on the functional status of patients with cancer [J]. Oncol Nurs Forum，2001，28（3）：465-470.
[4] Aktas A. Cancer symptom clusters：current concepts and controversies [J]. Curr Opin Support Palliat Care，2013，7（1）：38-44.
[5] Weisbord SD，Fried LF，Arnold RM，et al. Development of a symptom assessment instrument for chronic hemodialysis patients：the Dialysis Symptom Index [J]. J Pain Symptom Manage，2004，27（3）：226-240.
[6] 周晓娟，赵庆华，刘丽萍.维持性血液透析患者症状群调查研究[J].重庆医科大学学报，2013，38（7）：697-700.
[7] Kim E，Jahan T，Aouizerat BE，et al. Changes in symptom clusters in patients undergoing radiation therapy [J]. Support Care Cancer，2009，17（11）：1383-1391.
[8] 李九红，黄伶智，任小红，等.维持性血液透析患者症状困扰与睡眠质量和生活质量的相关性研究[J].中国护理管理，2016，16（1）：25-29.
[9] 黎渐英，蔡金辉，林建雄，等.腹膜透析患者的症状负担相关因素调查与分析[J].中国血液净化，2015，14（5）：277-280.
[10] 郝艳华.血液透析患者症状的相关研究[D].北京：北京协和医学院，2016.
[11] Dziubek W，Kowalska J，Kusztal M，et al. The Level of Anxiety and Depression in Dialysis Patients Undertaking Regular Physical Exercise Training--a Preliminary Study [J]. Kidney Blood Press Res，2016，41（1）：86-98.
[12] 尚子妺，吴静，周洁.乳腺癌患者睡眠及相关症状的轨迹研究[J].中华护理杂志，2019，54（10）：1456-1462.
[13] Yang JY，Huang JW，Chiang CK，et al. Higher plasma interleukin-18 levels associated with poor quality of sleep in peritoneal dialysis patients [J]. Nephrol Dial Transplant，2007，22（12）：3606-3609.
[14] 詹周兵，沈华英，罗蔚锋.终末期肾脏病患者不宁腿综合征研究进展[J].中华急诊医学杂志，2019，28（11）：1453-1454.
[15] 徐月萍，胡倩，朱晓珍，等.抗阻训练联合有氧运动对维持性血液透析病人睡眠质量及疲乏状况的影响[J].护理研究，2018，32（2）：317-319.
[16] 王无瑕，李佳玲，于涛，等.透析中脚踏车运动对尿毒症患者不安腿综合征的防治效果观察[J].中国血液净化，2020，19（4）：230-233.
[17] Lee SJ，Jeon J. Relationship between symptom clusters and quality of life in patients at stages 2 to 4 chronic kidney disease in Korea [J]. Appl Nurs Res，2015，28（4）：e13-e19.
[18] Szepietowski JC，Reich A，Schwartz RA. Uraemic xerosis [J]. Nephrol Dial Transplant，2004，19（11）：2709-2712.
[19] Wang X，Axelsson J，Lindholm B，et al. Volume status and blood pressure in continuous ambulatory peritoneal dialysis patients [J]. Blood Purif，2005，23（5）：373-378.
[20] Thong MS，van Dijk S，Noordzij M，et al. Symptom clusters in incident dialysis patients：associations with clinical variables and quality of life [J]. Nephrol Dial Transplant，2009，24（1）：225-230.
[21] 唐春苑，朱春平，卢伟，等.维持性血液透析患者营养状况与症状困扰的相关性研究[J].中国中西医结合肾病杂志，2017，18（4）：324-328.
[22] 何玉婷，门春翠，牛庆雨，等.维持性腹膜透析患者皮肤瘙痒的发生情况和影响因素分析[J].中国血液净化，2019，18（9）：653-657.
[23] 张倩，王洪志，高静，等.中医调欲疗法对老年性皮肤瘙痒症患者睡眠质量的影响[J].中华护理杂志，2017，52（2）：161-165.
[24] 刘洋，沙丽艳，李慧，等.血液透析病人症状群分类及与实验室指标的相关性研究[J].护理研究，2020，34（4）：632-636.
[25] 热孜万古丽·阿布都拉，贾依娜西·阿扎提，姜鸿，等.老年终末期肾病患者腹膜透析对肾功能及心功能的影响[J].疑难病杂志，2020，19（4）：349-352，357.
[26] 夏阳阳，万骋，张庆燕，等.腹膜透析钙磷代谢紊乱患者使用低钙腹膜透析液及碳酸镧的随访分析[J].安徽医药，2016，20（7）：1386-1388.
