| BackgroundBecause of the global aging process, end-stage renal disease (ESRD) of the patients is gradually increasing. Because of the poor prognosis, high cost, ESRD has been an important problem of public health in the world. In recent years, the prevalence of ESRD in Europe, Japan and America was6%-16%. In China, there were45423new ESRD patients in2008, the incidence rate was36.1/million people, and the trend kept growing. Maintenance hemodialysis (MHD) was one of the most common renal replacement therapies, and has formed a large group in society.Gastrointestinal disorders are the most common complication of ESRD patients, and they are divided into functional and organic. The diagnosis of organic disease by endoscopy or pathology is invasive, high cost and inconvenient, so it is not widely used in dialysis patients. Some scale was used to assess functional gastrointestinal symptoms of MHD patients, such as Rome standard Ⅰ, standard Ⅱ, standard Ⅲ and gastrointestinal symptoms rating scale. In foreign countries, the incidence of gastrointestinal symptoms in MHD patients was63.1～79%. There was just one research assume that incidence of gastrointestinal symptoms in China was85.7%. Some studies had found that uremic toxin stimulation, anemia, drugs, depression and anxiety might lead to gastrointestinal dysfunction, but the factors affecting the occurrence of gastrointestinal symptoms were complex and difficult to clear, so more research was needed to prove that.At present, gastrointestinal symptoms in MHD patients have not gotten enough attention in our country. There is little research about relevance between gastrointestinal symptoms and quality of life (QOL) in MHD patients. The purpose of this study was to investigate the gastrointestinal symptoms, QOL and clinical data of MHD patients, aimed to understand the occurrence of gastrointestinal symptoms in patients and its impact on QOL, and clinical influencing factors of gastrointestinal symptoms.Objective1. Investigated the incidence and severity of G1symptoms in MHD patients, to understand the GI symptoms situation of MHD patients.2. Investigated the QOL of MHD patients, to understand the patients with gastrointestinal symptoms and its impact on the QOL.3. Analyzed the general situation, clinical conditions and dialysis related laboratory parameters, to understand the influencing factors of gastrointestinal symptoms in MHD patients.Methods1. Part IQuestionnaire and interview method.150MHD patients were investigated by a questionnaire from May to July in2013. Inclusion criteria: Age≥18year; Stable disease, dialysis ages≥3months; Understood the content of the study, and voluntarily joined this research. Exclusion criteria: had gastrointestinal disease or related complications in nearly three months; with mental disorders, or Alzheimer; with serious infectious disease, or hepatobiliary disease; with blindness, disability, or disability; failed to cooperate. The questionnaire included:①General data included age, gender, marital status, type of insurance, annual family income, primary disease and dialysis ages etc.②GSRS included abdominal pain, reflux, dyspepsia, constipation, diarrhea and eating disorder, a total of6layers18items. All the items according to Likert7score. Score=sum of each item score/items.③KDQOL-SF1M1.3Included two parts: KDTA and SF-36. The dimensions include symptoms/problems, Effects of kidney disease, Burden of kidney disease, Work status, Cognitive function, Quality of social interaction, Sleep, Social support, Overall health,36-item health survey, Physical functioning, Role physical, Pain, General health perceptions, Emotional well-being/Mental health, Role-emotional, Social function, Energy/fatigue/v ital ity.2. Part ⅡQuestionnaire and interview method.107MHD patients were investigated by a questionnaire from May to July in2013. Inclusion criteria: Age≥18year; Stable disease, dialysis ages≥3months; Understood the content of the study, and voluntarily joined this research. Exclusion criteria: had gastrointestinal disease or related complications in the past three months; with mental disorders in senile dementia; with serious infectious disease, or hepatobiliary disease; do not want to participate in this research. The questionnaire included:①Gastrointestinal symptoms.②The general data of patients:included gender, age and BMI.③The clinical data of patients: included the primary disease, hemodialysis ages,24hour urine volume, diabetes situation, medication, hemoglobin, albumin, HCT, serum calcium, phosphorus, potassium, intact parathyroid hormone, Kt/V.3. Data analysisAll statistical analysis was performed using SPSS13.0software. The measurement data was descriptive as mean±standard deviation (x±s). Count data expressed as the frequency and percentage. Spearman rank correlation test, two independent samples t test, one-way anova and multiple linear regression (stepwise) were used to analyze the effects of gastrointestinal symptoms on the QOL in MHD patients. Spearman rank correlation test, two independent samples t test and multiple linear regression (stepwise) analysis were used to analyze the influencing factors of gastrointestinal symptoms in MHD patients. Inspection level was α=0.05, and P<0.05meant results had statistical significance.ResultsPart Ⅰ1. In this research,150questionnaires were sent out, all of them were recovered and effective questionnaire rate was100%.2. The prevalence of gastrointestinal symptoms in MHD patients was78.4%. The incidence of gastrointestinal symptoms from high to low were indigestion, obstipation, reflux, diarrhea, abdominal pain, eating disorder.3. The severity of gastrointestinal symptoms in MHD patients was mild mostly.4. The QOL in MHD patients with gastrointestinal symptoms was worse than patients without gastrointestinal symptoms (P<0.05).5. With more types of gastrointestinal symptoms, the MHD patients QOL were worse (P<0.05).6. Abdominal pain, reflux, eating disorder and age maybe the influencing factors of QOL in MHD patients (P<0.05). With more serious gastrointestinal symptoms, the QOL of MHD patients was worse.7. The condition of gastrointestinal symptoms affected QOL in MHD patients with different ages was different. In young MHD patients with18～44years old, there was a significant negative correlation between the QOL and symptoms of reflux, abdominal pain and eating disorder (P<0.05). In middle-aged MHD patients with45～59years old, there was a significant negative correlation between the QOL and symptoms of reflux, abdominal pain, obstipation, diarrhea, indigestion and eating disorder (P<0.05). In geratic MHD patients with more than60years old, there was a significant negative correlation between the QOL and symptoms of eating disorder (P<0.05). With more serious gastrointestinal symptoms, the QOL of MHD patients was worse.8. The condition of gastrointestinal symptoms affected QOL in MHD patients with different dialysis ages was different. In patients on dialysis for3～12months, there was a significant negative correlation between the QOL and symptoms of abdominal pain and obstipation (P<0.05). In patients on dialysis for13-48months, there was a significant negative correlation between the QOL and symptoms of reflux, abdominal pain, obstipation, indigestion and eating disorder (P<0.05). In patients on dialysis more than48months, there was a significant negative correlation between the QOL and symptoms of abdominal pain, reflux, obstipation and eating disorder (P<0.05).9. The condition of gastrointestinal symptoms affected QOL in MHD patients with different gender was different. In male patients with MHD, there was a significant negative correlation between the QOL and symptoms of reflux and eating disorder (P<0.05). In female patients with MHD, there was a significant negative correlation between the QOL and symptoms of reflux, abdominal pain, obstipation, indigestion and eating disorder (P<0.05).Part Ⅱ1. In this research,150questionnaires were sent out, all of them were recovered and effective questionnaire rate was71.3%.2. The single factor analysis showed that there was a significant correlation between gastrointestinal symptoms and age, dialysis ages, urine volume for24h, type of drug, but it was very week (|r|<0.3, P<0.5). BMI, Alb, HCT, calcium, phosphorus, potassium, iPTH and Kt/V was not correlated to gastrointestinal symptoms. 3. There was statistical difference in scores of gastrointestinal symptoms in MHD patients with different gender (P=0.024), and the scores of abdominal pain in female patients were higher than male.4. Compared the MHD patients with diabetes and without diabetes, the result showed that there was a statistical difference (P=0.005), and the scores of diarrhea in diabetes patients were higher than not diabetes.5. Influencing factors of gastrointestinal symptoms in MHD patients with different ages was different. In young MHD patients with18-44years old, there was a significant positive correlation between the gastrointestinal symptoms and weather have diabetes(P<0.05). The patients with diabetes have more serious gastrointestinal symptoms than patients without diabetes. In middle-aged MHD patients with45～59years old, there was a significant positive correlation between gastrointestinal symptoms and dialysis ages, types of medicine, weather have diabetes (P<0.05). With longer dialysis ages, taking more types of medicine, the gastrointestinal symptoms in MHD patients were more serious. The gastrointestinal symptoms were more serious in MHD patients with diabetes than without diabetes. In geratic MHD patients with more than60years old, there was a significant negative correlation between the gastrointestinal symptoms and gender (P<0.05). The types of medicine, weather have diabetes were positive correlated with gastrointestinal symptoms in geratic MHD patient (P0.05). The result showed that female MHD patients have more serious gastrointestinal symptoms than male. Taking more types of medicine, the severity of gastrointestinal symptoms was more serious in geratic MHD patients. The geratic MHD patients with diabetes have more serious gastrointestinal symptoms than patients without diabetes.Conclusion 1. The prevalence of gastrointestinal symptoms in MHD patients was high, but the severity was not heavy mostly. The prevalence from high to low were indigestion, obstipation, reflux.2. The gastrointestinal symptoms affected QOL of MHD patients. The QOL of patients with gastrointestinal symptoms was worse than patients without gastrointestinal symptoms. With more gastrointestinal symptoms, the QOL of MHD patients was worse.3. Abdominal pain, reflux, obstipation and other gastrointestinal symptoms were influencing factors of QOL in MHD patients. The conditions of gastrointestinal symptoms impacting on QOL of MHD patients were different in different age, dialysis ages and gender.4. Influencing factors of gastrointestinal symptoms in MHD patients with different ages was different. Gender, age, types of medicine, dialysis ages, weather has diabetes maybe the influencing factors of gastrointestinal symptoms in MHD patients. |
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