Reliability and validity of the Patient Generated Index (PGI) in patients with chronic kidney disease (CKD) on dialysis, a new approach to quality of life.

PURPOSE: To evaluate the test-retest reliability and validity of the Patient Generated Index (PGI) in individuals with Chronic Kidney Disease (CDK) undergoing hemodialysis. METHODS: Through a non-experimental study with repeated measures, PGI was applied twice to assess internal consistency and test-retest reliability. Correlations with the Kidney Disease Quality of Life Short Form (KDQOL-SF), the Human Activity Profile (HAP) questionnaire, the Social Participation Scale, and the Glittre ADL Test were used. RESULTS: 91 individuals with CKD were evaluated. There was high reliability for the PGI (ICC= 0.97) PGI correlated with KQDOL - SF in Functional Capacity r = 0.38 (p < 0.001), Emotional Well-Being r = 0.31 (p = 0.003), Social Aspect r = 0.22 (p = 0.036), Emotional Function r = 0.22 (p = 0.038) and Effect of Kidney Disease r = 0.21 (p = 0.042), and Physical scores r = 0.24 (p = 0.021)), Mental r = 0.21 (p = 0.05) and General r = 0.22 (p = 0.037) summarized. There was a significant correlation between PGI and HAP r = 0.40 (p < 0.001) and the Social Participation Scale r = -0.36 (p < 0.001). There was no correlation between the PGI and Glittre ADL scores r = 0.12 (p = 0.247). CONCLUSION: In adults receiving hemodialysis, the PGI proved to be an accurate and reliable instrument for the assessment of the quality of life from the perspective of the patient.IMPLICATIONS FOR REHABILITATIONAlthough hemodialysis treatment is associated with increased survival and symptom control, there is a significant change in the patient's lifestyle.In order to provide a more focused view of the individual, the Patient Generated Index (PGI) was created to evaluate the quality of life.PGI is reliable and correlates with KQDOL - SF and the Social Participation Scale in this population.

Avaliação da qualidade de vida de pacientes renais crônicos submetidos à hemodiálise ­ casos da Santa Casa de Caridade de Diamantina / Quality of life assessment of chronic kidney patients undegoing hemodialysis ­ Cases of Santa Casa in caridade / Evaluación de la calidad de vida de los pacientes con insuficiencia renal crónica sometidos a hemodiálisis - casos de la Santa Casa de Caridade de Diamantina

Contexto: A doença renal crônica representa um sério problema de saúde pública, devido aos crescentes índices de morbimortalidade, e que associado à rotina de sessões de hemodiálise, promove alterações na qualidade de vida dos indivíduos com esta condição. Objetivo: Avaliar os fatores relacionados à qualidade de vida de pacientes renais crônicos em tratamento hemodialítico. Desenho e local: Estudo transversal, quantitativo, composto por 52 pacientes em hemodiálise no hospital Santa Casa de Caridade de Diamantina, Diamantina (MG), em 2017. Métodos: Foram utilizados dois questionários: socioeconômico-demográfico e o instrumento Kidney Disease and Quality of life Short Form. Os dados referentes à qualidade de vida foram analisados pelo programa elaborado e disponibilizado pelo Working Group. Resultados: Como fatores relacionados à baixa qualidade de vida foram encontrados: situação ocupacional (33,65 ± 26,71), peso da doença renal (49,28 ± 21,58), funcionamento físico (53,37 ± 22,39), saúde geral (54,71 ± 27,19) e função emocional (58,97 ± 26,23); em relação à boa qualidade de vida foram encontrados: função sexual (80,17 ± 22,46), função cognitiva (80,26 ± 35,32), satisfação do paciente (83,33 ± 20,51) e estímulo por parte da equipe de diálise (91,59 ± 29,17). Discussão: Por comparação aos trabalhos realizados em Goiânia (2006), Indaiatuba (2009), Mogi das Cruzes (2014) e ao presente estudo (2017) verificaram escores semelhantes na maioria das dimensões avaliadas, a exemplo das funções social e satisfação do paciente. Conclusão: A qualidade de vida apresentou-se como boa na maioria das dimensões avaliadas, entretanto, os fatores determinantes da baixa qualidade de vida reforçam a ideia da implementação de estratégias da equipe de saúde para melhorar a expectativa de vida desses pacientes.

Chronic kidney disease represents a serious public health problem, due to the increasing rates of morbidity and mortality, which, associated with the routine of hemodialysis sessions, promotes changes in the quality of life of individuals with this condition. Objective: To evaluate factors related to the quality of life of chronic renal patients undergoing hemodialysis. Design and location: Cross-sectional, quantitative study, composed of 52 hemodialysis patients at the Santa Casa de Caridade hospital in Diamantina, Diamantina (MG), in 2017. Methods: Two questionnaires were used: socioeconomic-demographic and the Kidney Disease and Quality of instrument life Short Form. Data on quality of life were analyzed using the program developed and made available by the Working Group. Results: As factors related to low quality of life were found: occupational situation (33.65 ± 26.71), weight of kidney disease (49.28 ± 21.58), physical functioning (53.37 ± 22.39), general health (54.71 ± 27.19) and emotional function (58.97 ± 26.23); in relation to good quality of life, sexual function (80.17 ± 22.46), cognitive function (80.26 ± 35.32), patient satisfaction (83.33 ± 20.51) and stimulation on the part were found of the dialysis team (91.59 ± 29.17). Discussion: Comparing the studies carried out in Goiânia (2006), Indaiatuba (2009), Mogi das Cruzes (2014) and the present study (2017) found similar scores in most of the dimensions evaluated, such as social functions and patient satisfaction. Conclusion: Quality of life was shown to be good in most of the dimensions evaluated, however, the determinants of low quality of life reinforce the idea of implementing health team strategies to improve the life expectancy of these patients.

Antecedentes: La enfermedad renal crónica representa un grave problema de salud pública, debido a las crecientes tasas de morbilidad y mortalidad, y la asociada a la rutina de sesiones de hemodiálisis, promueve cambios en la calidad de vida de los individuos con esta condición. Objetivo: Evaluar los factores relacionados con la calidad de vida de los pacientes renales crónicos en tratamiento hemodialítico. Diseño y entorno: Estudio transversal, cuantitativo, compuesto por 52 pacientes en hemodiálisis en el hospital Santa Casa de Caridade de Diamantina, Diamantina (MG), en 2017. Métodos: Se utilizaron dos cuestionarios: socioeconómico-demográfico y el instrumento Kidney Disease and Quality of life Short Form. Los datos relativos a la calidad de vida fueron analizados por el programa preparado y puesto a disposición por el Grupo de Trabajo. Resultados: Como factores relacionados con la baja calidad de vida se encontraron: la situación laboral (33,65 ± 26,71), la carga de la enfermedad renal (49,28 ± 21,58), el funcionamiento físico (53,37 ± 22,39), la salud general (54,71 ± 27,19) y la función emocional (58,97 ± 26,23); en relación con la buena calidad de vida se encontraron: la función sexual (80,17 ± 22,46), la función cognitiva (80,26 ± 35,32), la satisfacción del paciente (83,33 ± 20,51) y el estímulo del equipo de diálisis (91,59 ± 29,17). Discusión: En comparación con los estudios realizados en Goiânia (2006), Indaiatuba (2009), Mogi das Cruzes (2014) y el presente estudio (2017) se encontraron puntuaciones similares en la mayoría de las dimensiones evaluadas, como las funciones sociales y la satisfacción del paciente. Conclusión: La calidad de vida se presentó como buena en la mayoría de las dimensiones evaluadas, mientras que los factores determinantes de la baja calidad de vida refuerzan la idea de la implementación de estrategias del equipo de salud para mejorar las expectativas de vida de los pacientes.

The Glittre activities of daily living as a potential test for functional evaluation of patients on hemodialysis: a validation study.

PURPOSE: To investigate the validity and within-day reliability of the Glittre activities of daily living test (Glittre ADL-test) in patients on hemodialysis. METHODS: Ninety-one patients on hemodialysis were evaluated using Glittre ADL-test, functional tests, health-related quality of life, human activity profile, and social participation. Convergent validity was analyzed by the correlation analysis. The Glittre ADL-test results were compared among different levels of the functional tests, human activity profile, and participation (known-groups validity). Within-day reliability was examined by Intra-class Correlation Coefficient (ICC). RESULTS: There was a significant moderate to strong correlation between Glittre ADL-test and functional tests (r = 0.62 to 0.66 and -0.70 to -0.44). A significant weak correlation was found between Glittre ADL-test, health-related quality of life (r = 0.28 to 0.32), and human activity profile (r=-0.33). There was no significant correlation with participation. Except for participation level, the Glittre ADL-test results were able to identify individuals with low performance in all evaluated tests and were able to differentiate among inactive and active individuals by human activity profile (p < 0.05). Within-day reliability was evaluated in 42 patients. The ICC was 0.97. CONCLUSION: The Glittre ADL-test is a reliable test associated with functional parameters and physical aspects related to health-related quality of life, with potential value in the functional evaluation of patients on hemodialysis.Implications for rehabilitationFunctional impairment is a common clinical finding and is an important predictor of poor prognosis in patients on hemodialysis.The Glittre ADL-test has excellent within-day reliability and is a valid instrument for functional assessment in patients on hemodialysis.Activity limitations of patients on hemodialysis can be assessed by Glittre ADL-test.

The reliability and validity of the 30-seconds sit-to-stand test and its capacity for assessment of the functional status of hemodialysis patients.

PURPOSE: To investigate the validity of the 30-seconds sit-to-stand test (STS-30) and its reliability in hemodialysis patients. METHODS: Patients receiving hemodialysis treatment three times a week for at least six months were evaluated using STS-30, Incremental Shuttle Walking Test, and health-related quality of life by KDQOL-SF questionnaire. The data obtained from the Incremental Shuttle Walking Test were divided into tertiles, and the STS-30 results were compared among tertiles. The accuracy of the STS-30 to identify low exercise capacity was evaluated. A second STS-30 was performed after 6 to 8-weeks for the reliability analyses using Intraclass Correlation Coefficient (ICC). Minimal detectable change scores were calculated. RESULTS: Sixty-three individuals (66.7% men) aged 48.3 years (95%CI 44.6-51.9) were evaluated. There were significant correlations between STS-30, exercise capacity (r = 0.72), and physical domains of health-related quality of life (0.30 ≤ r ≤ 0.51). Tertile 1 of the Incremental Shuttle Walking Test was different from tertiles 2 and 3 for STS-30 [difference of 3.4 repetitions (95%CI 1.5-5.4) and 4.7 repetitions (95%CI 2.8-6.7), respectively]. The value of 12 repetitions was the cut-off points for stratification of individuals with low exercise capacity. The STS-30 had a high test-retest reliability (ICC = 0.93) and the minimal detectable change was 2.1 repetitions. CONCLUSION: The STS-30 is a reliable test, associated with exercise capacity and physical domains of health-related quality of life. Thus, is a valid method for functional evaluation in hemodialysis patients.

Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial.

OBJECTIVE: Evaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients. METHODS: A randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA. RESULTS: 37 hemodialysis patients aged 48.2 years old (IC95% 43.2-54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6-189.9), 34.5cmH2O (IC95% 22.4-46.7) and 2.2repetitions (IC95% 1.1-3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5-1.1) and 0.8ng/dL (IC95% 0.3-1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT. CONCLUSION: IMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients. TRIAL REGISTRATION: Registro Brasileiro de Ensaios clínicos RBR-4hv9rs.

The role of the inspiratory muscle weakness in functional capacity in hemodialysis patients.

INTRODUCTION: Inspiratory muscle function may be affected in patients with End-Stage Renal Disease (ESRD), further worsening the functional loss in these individuals. However, the impact of inspiratory muscle weakness (IMW) on the functional capacity (FC) of hemodialysis patients remains unknown. Thus, the present study aimed to evaluate the impact of IMW on FC in ESRD patients undergoing hemodialysis. MATERIALS AND METHODS: ESRD patients on hemodialysis treatment for more than six months were evaluated for inspiratory muscle strength and FC. Inspiratory muscle strength was evaluated based on maximal inspiratory pressure (MIP). IMW was defined as MIP values less than 70% of the predicted value. FC was evaluated using the Incremental Shuttle Walk test (ISWT). Patients whose predicted peak oxygen uptake (VO2peak) over the distance walked during the ISWT was less than 16mL/kg/min were considered to have FC impairment. Associations between variables were assessed by linear and logistic regression, with adjustment for age, sex, body mass index (BMI), presence of diabetes and hemoglobin level. Receiver-operating characteristic (ROC) analysis was used to determine different cutoff values of the MIP for normal inspiratory muscle strength and FC. RESULTS: Sixty-five ERSD patients (67.7% male), aged 48.2 (44.5-51.9) years were evaluated. MIP was an independent predictor of the distance walked during the ISWT (R2 = 0.44). IMW was an independent predictor of VO2peak < 16mL/kg/min. (OR = 5.7; p = 0.048) in adjusted logistic regression models. ROC curves showed that the MIP cutoff value of 82cmH2O had a sensitivity of 73.5% and specificity of 93.7% in predicting normal inspiratory strength and a sensitivity and specificity of 76.3% and 70.4%, respectively, in predicting VO2peak ≥ 16mL/kg/min. CONCLUSIONS: IMW is associated with reduced FC in hemodialysis patients. Evaluation of the MIP may be important to functional monitoring in clinical practice and can help in the stratification of patients eligible to perform exercise testing.