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Исходы хронической болезни почек с точки зрения пациента
Аннотация
В обзоре приведено определение понятия «исходы с точки зрения пациента» (patient-reported outcomes – PRO). К основным компонентам PRO относят качество жизни (КЖ), связанное со здоровьем; симптоматику, оцениваемую пациентом; функциональный статус; удовлетворенность лечением. Представлено описание наиболее часто применяемых опросников для оценки КЖ пациентов с хронической болезнью почек (ХБП). Показано, что на додиализных стадиях ХБП страдает, в первую очередь, физическая составляющая КЖ. По мере прогрессирования ХБП снижаются суммарный показатель физического здоровья опросника SF-36, а также оценки шкал физического функционирования, влияния физического здоровья на повседневную деятельность, боли, общего здоровья. Из специфических для ХБП шкал КЖ отмечается ухудшение оценок шкал «симптомы/проблемы», «бремя заболевания почек», «влияние заболевания почек на повседневную деятельность». Убедительных данных в пользу снижения показателей психосоциальной компоненты КЖ у больных с ХБП в литературе не представлено. В обзоре приведено определение понятия «всесторонняя консервативная помощь», предложенное экспертами, присутствовавшими на состоявшейся в 2013 году Согласительной конференции KDIGO по поддерживающей помощи. Показано, что всесторонняя консервативная помощь может быть достаточно эффективным методом выбора для пожилых пациентов с 5-й стадией ХБП. Продемонстрировано, что снижение суммарного показателя физического здоровья опросника SF-36 независимо ассоциировано с прогрессированием ХБП и повышением риска смерти. Вместе с тем, исследования КЖ пациентов с ХБП додиализных стадий немногочисленны. Сопоставимость данных затруднена вследствие использования различных опросников для оценки КЖ. Практически отсутствуют рандомизированные клинические исследования, что снижает ценность полученных результатов.
Об авторах
И. А. Васильева
Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова
Россия
Россия
Васильева Ирина Андреевна, д-р психол. наук, научно-исследовательский институт нефрологии, лаборатория почечной недостаточности, старший научный сотрудник
197022, Санкт-Петербург, ул. Л. Толстого, д. 17, корп. 54
Тел.: +7(812)338-69-34
В. А. Добронравов
Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова
Россия
Россия
Проф. Добронравов Владимир Александрович, д-р мед. наук, заместитель директора по научной работе научно-исследовательского института нефрологии, профессор кафедры пропедевтики внутренних болезней с клиникой
197022, Санкт-Петербург, ул. Л. Толстого, д. 17, корп. 54
Тел.: +7(812)338-69-01
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Для цитирования:
Васильева И.А., Добронравов В.А. Исходы хронической болезни почек с точки зрения пациента. Нефрология. 2020;24(6):9-18. https://doi.org/10.36485/1561-6274-2020-24-6-9-18
For citation:
Vasilieva I.A., Dobronravov V.A. Patient-reported outcomes in chronic kidney disease. Nephrology (Saint-Petersburg). 2020;24(6):9-18. (In Russ.) https://doi.org/10.36485/1561-6274-2020-24-6-9-18
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