Показники якості життя залежно від стадії хронічної хвороби нирок на тлі цукрового діабету 2-го типу

Abstract

Метою нашого дослідження було дослідити зміни показників якості життя пацієнтів залежно від стадії хронічної хвороби нирок (ХХН), оцінити кореляційні зв’язки і вивчити фактори, що впливають на прогресування ХХН та на якість життя пацієнтів. Нами вивчався вплив психологічних та соматичних порушень у хворих з ХХН на тлі цукрового діабету 2-го типу на складові якості життя. Досліджувалася гендерна особливість причин виникнення цукрового діабету.

Целью нашего исследования было изучить изменения показателей качества жизни пациентов в зависимости от стадии хронической болезни почек (ХБП), оценить кореляционные связи и изучить факторы, которые влияют на прогрессирование ХБП и на качество жизни пациентов. Нами также изучалось влияние психологических и соматических нарушений у больных с ХБП на фоне сахарного диабета 2-го типа на составляющие качества жизни. Мы исследовали гендерную особенность причин возникновения сахарного диабета.

The aim of our study was to investigate changes in quality of life of patients depending on the stage of chronic kidney disease (CKD), to assess the correlation and study the factors that affect the progression of CKD and affect the quality of life of patients. We studied impact of psychological and somatic disorders in patients with CKD secondary to diabetes type 2 in these components of quality of life. We studied gender features causing diabetes.

Materials and Methods. We observed a group of 120 patients with diabetes mellitus type 2, and DN of I–V stages and chronic kidney disease of I–V stages. Among the patients studied, 59 (49 %) were men and 61 (51 %) were women. Average age was 59.2 ± 0.9 years, mean duration of diabetes constituted 11.8 ± 0.7 years, mean duration of diabetic nephropathy – 2.5 ± 0.3 years, the average length of CKD – 2.7 ± 0.3. The average weight was 84.0 ± 1.3 kg. Stage CKD was defined by GFR determined by the formula CKD-EPI.

We established diagnosis by classification of diseases of the urinary system, which was adopted in 2005 by The II National Congress Nephrology, stage DN – according to the classification Mogensen C.E. in 1983. We used general clinical examination methods (serum creatinine and serum glucose, glycosylated hemoglobin, blood pressure measurements); quality of life using a questionnaire quality of life SF-36 [7].

The data were subjected to statistical research processing, used for this application package statistica (StartSoft USA, v.12). We used the method of nonparametric statistics: Pearson’s Chi-sguare test to determine the causes of diabetes in men and women; ANOVA using Fisher’s F-criteria to test the null hypothesis; Spearman rank correlation to determine the presence and strength of communication between the studied parameters. Statistically significant difference: p ˂ 0.05.

All patients were divided into 5 groups according to the stage of CKD. The first group included 26 patients with CKD stage I, the second group – 27 people with CKD stage II, the third group – 15 people with CKD stage III, the fourth group accordingly – 17 patients with CKD stage IV, and the fifth group – 35 people with CKD stage V.

Discussion. Positive correlation was found between age and stage of CKD patients, weight, duration of diabetes, duration of NAM, blood pressure. Inverse correlation was found between CKD and GFR, and fasting glucose levels and some indicators of quality of life: physical functioning (PF); Role-Physical (R p); pain (P); vitality (VT); emotional functioning (RE); psychological health (MH). But we did not find the correlation between CKD and general health (GH) and social functioning (SF).

During the investigation it was found that one of the causes of diabetes is stress, but there are also some gender features. Men have got problems related to work, while women – family problems.

In the patients, who have got progression of CKD, life quality is worse. Our data suggests that the correction of weight, blood pressure control and adequate treatment of hypertension have got not only positive effect on the progression of CKD, but also improves life quality in our patients.