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1.
Clin J Am Soc Nephrol ; 5(2): 252-60, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20019120

RESUMO

BACKGROUND AND OBJECTIVES: The Short Form 12 (SF-12) has not been validated for long-term dialysis patients. The study compared physical and mental component summary (PCS/MCS) scores from the SF-36 with those from the embedded SF-12 in a national cohort of dialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All 44,395 patients who had scorable SF-36 and SF-12 from January 1, 2006, to December 31, 2006, and were treated at Fresenius Medical Care, North America facilities were included. Death and first hospitalization were followed for up to 1 year from the date of survey. Correlation and agreement were obtained between PCS-36 and PCS-12 and MCS-36 and MCS-12; then Cox models were constructed to compare associated hazard ratios (HRs) between them. RESULTS: Physical and mental dimensions both exhibited excellent intraclass correlation coefficients of 0.94. Each incremental point for both PCS-12 and PCS-36 was associated with a 2.4% lower adjusted HR of death and 0.4% decline in HR for first hospitalization (both P < 0.0001). Corresponding improvement in HR of death for each MCS point was 1.2% for MCS-12 and 1.3% for MCS-36, whereas both had similar 0.6% lower HR for hospitalization per point (all P < 0.0001). CONCLUSIONS: The use of the SF-12 alone or as part of a larger survey is valid in dialysis patients. Composite scores from the SF-12 and SF-36 have similar prognostic association with death and hospitalization risk. Prospective longitudinal studies of SF-12 surveys that consider responsiveness to specific clinical, situational, and interventional changes are needed in this population.


Assuntos
Hospitalização/estatística & dados numéricos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Diálise Renal/mortalidade , Inquéritos e Questionários , Atividades Cotidianas , Idoso , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Falência Renal Crônica/complicações , Masculino , Saúde Mental , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Diálise Renal/efeitos adversos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
2.
Am J Kidney Dis ; 54(6): 1098-107, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19782455

RESUMO

BACKGROUND: Incremental achievement of quality indicator goals has been associated with progressive improvement in mortality and hospitalization risk in hemodialysis (HD) patients. STUDY DESIGN: Descriptive cross-sectional study. SETTING & PARTICIPANTS: All 33,879 HD patients treated at Fresenius Medical Care North America facilities for >90 days with scorable 36-Item Short Form Health Survey responses from January 1, 2006, to December 31, 2006. PREDICTOR: We hypothesized that achieving up to 5 HD goals before the survey (albumin >or= 4.0 g/dL, hemoglobin of 11-12 g/dL, equilibrated Kt/V >or= 1.2, phosphorus of 3.5-5.5 mg/L, and absence of HD catheter) results in better self-reported quality of life (QoL). OUTCOMES & MEASUREMENTS: Distributions of Physical and Mental Component Summary (PCS/MCS) scores within and across quality indicator categories determined during the prior 90 days from survey date (compared using analysis of covariance and linear regression models, with adjustment for case-mix and each of the quality indicators). RESULTS: Incremental achievement of up to 5 goals was associated with progressively higher PCS and MCS scores (both P for trend < 0.001). Compared with patients meeting all 5 goals (n = 4,208; reference group), case-mix-adjusted PCS score was lower by 1.8 point with only 4 goals met (n = 11,785), 3.4 points for 3 goals (n = 10,906), 4.9 points for 2 goals (n = 5,119), 5.9 points for 1 goal (n = 1,592), and 7.8 points in the 269 patients who failed to meet any goal (each P < 0.001 vs the reference group). The corresponding decreases in case-mix-adjusted MCS scores were 1.0 point for 4 goals met, 1.7 point for 3 goals, 2.3 points for 2 goals, 3.0 points for 1 goal, and 4.7 points with no goal met, with each P < 0.001 compared with the MCS score from patients who achieved all 5 goals. LIMITATIONS: Potential residual confounding from unmeasured covariates. CONCLUSION: Patients progressively meeting more quality goals report incrementally better QoL. Further studies are needed to determine whether prospective achievement of quality goals will result in improved QoL for HD patients.


Assuntos
Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade de Vida/psicologia , Diálise Renal , Idoso , Estudos Transversais , Grupos Diagnósticos Relacionados , Feminino , Inquéritos Epidemiológicos , Hemoglobinas/metabolismo , Humanos , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , América do Norte , Fósforo/sangue , Análise de Regressão , Albumina Sérica/metabolismo
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