Quality of sleep and psychosocial factors for patients undergoing peritoneal dialysis.

OBJECTIVES: Sleep disorders are common in end-stage renal disease patients. This study examined the relationship between self-reported quality of sleep (QoS) and certain psychosocial domains for patients on peritoneal dialysis (PD). METHODS: The study subjects included 190 PD patients from 7 urban dialysis clinics in Northern Taiwan, from whom we obtained biochemical parameters and demographic data. QoS, quality of life (QoL), religious/spiritual activity, and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Medical Outcomes Study Short Form (SF-36) for QoL, the Royal Free Questionnaire, and the Beck Depression Inventory, respectively. RESULTS: The average PSQI score was 9.1 +/- 4.1 and, in total, 85.8% of all patients were poor sleepers (global PSQI > or =5). There was no difference in age, gender, and mode or duration of PD between good and poor sleepers. Biochemical data did not differ between the two groups. Widowed patients experienced significantly poorer QoS than patients with other marital status (PSQI scores: 12.3 +/- 4.9 vs 8.88 +/- 4.0, p = 0.006). The percentage of patients that held a bachelor's degree or above was significantly higher in good sleepers (55.6% vs 29.4%, p = 0.008). The PSQI value correlated negatively with the QoL scale in both physical (r = -0.295, p < 0.001) and mental domains (r = -0.410, p < 0.001), and correlated positively with the depression scale (r = 0.351, p < 0.001). There appeared to be no association between QoS and spiritual/religious activity (r = -0.097, p = 0.223). CONCLUSIONS: Psychosocial factors including depression, patients' perceptions regarding QoL, marital status, and educational background correlated significantly to the subjective QoS for PD patients. When dealing with sleep disorders in PD patients, physicians should pay considerable attention to their psychosocial backgrounds.

Sexual dysfunction in peritoneal dialysis patients.

BACKGROUND/AIMS: Sexual dysfunction in patients undergoing peritoneal dialysis (PD) is highly prevalent, but studies addressing this issue are scarce. This cross-sectional study aims to evaluate sexual dysfunction and the determinants among PD patients. METHODS: All chronic PD patients in 8 PD centers were asked to complete a self-reported questionnaire - the International Index of Erectile Function (IIEF) for men and the Index of Female Sexual Function (IFSF) for women - so that sexual function could be assessed. They also answered the Beck Depression Inventory (BDI) to measure depressive symptoms. RESULTS: Among 294 patients invited for study, 54 men (mean age 48.8 +/- 10.8 years) and 45 women (mean age 43.6 +/- 7.4 years) were willing to and completed the sexual function questionnaires. The median IIEF score in the men was 56.25. The prevalence of erectile dysfunction, identified by the score in erectile domain of IIEF

Impact of near-death experiences on dialysis patients: a multicenter collaborative study.

BACKGROUND: People who have come close to death may report an unusual experience known as a near-death experience (NDE). This study aims to investigate NDEs and their aftereffects in dialysis patients. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 710 dialysis patients at 7 centers in Taipei, Taiwan. PREDICTOR: Demographic characteristics, life-threatening experience, depression, and religiosity. OUTCOMES: NDE and self-perceived changes in attitudes or behaviors. MEASUREMENTS: Greyson's NDE scale, Royal Free Questionnaire, 10-Question Survey, Ring's Weighted Core Experience Index, and Beck Depression Inventory. RESULTS: 45 patients had 51 NDEs. Mean NDE score was 11.9 (95% confidence interval, 11.0 to 12.9). Out-of-body experience was found in 51.0% of NDEs. Purported precognitive visions, awareness of being dead, and "tunnel experience" were uncommon (<10%). Compared with the no-NDE group, subjects in the NDE group were more likely to be women and younger at life-threatening events. Both frequency of participation in religious ceremonies and pious religious activity correlated significantly with NDE score in patients with NDEs (P < 0.01 and P = 0.01, respectively). The NDE group reported being kinder to others (P = 0.04) and more motivated (P = 0.02) after their life-threatening events than the no-NDE group. LIMITATIONS: Determining the incidence of NDEs is dependent on self-reporting. Many NDEs occurred before the patient began long-term dialysis therapy. Causality between NDE and aftereffects cannot be inferred. CONCLUSIONS: NDE is not uncommon in the dialysis population and is associated with positive aftereffects. Nephrology care providers should be aware of the occurrence and aftereffects of NDEs. The high occurrence of life-threatening events, availability of medical records, and accessibility and cooperativeness of patients make the dialysis population very suitable for NDE research.

A prospective study to compare subcutaneously buried peritoneal dialysis catheter technique with conventional technique.

AIMS: To reduce peritoneal dialysis-related infections, Moncrief-Popovich (MP) designed a special catheter and implantation technique. Herein we report our experience of patients treated with the MP and conventional approach. METHODS: A total of 214 patients were divided into three groups according to catheter type and implantation technique: group A received a MP catheter (MPC) via MP technique (n = 27); group B received Tenckhoff catheters via MP technique (n = 32), and group C received Tenckhoff catheters via conventional technique (n = 155). Data were collected for infection and catheter survival. RESULTS: The catheter survival and peritonitis rate was similar in our study groups. Age was found to be the significant factor associated with peritonitis rate. CONCLUSIONS: Although the MP technique was not associated with a lower peritonitis rate in our practice, the possible benefit of less healthcare costs is still considerable.

The association of higher depressive symptoms and sexual dysfunction in male haemodialysis patients.

BACKGROUND: The prevalence of sexual dysfunction among male haemodialysis patients is high. Sexual dysfunction is composed of both physiological and psychological factors. However, the role of psychological depression is still obscure. METHODS: A multicentre cross-sectional study of 411 male haemodialysis patients was conducted to define the determinants of sexual dysfunction. Mid-week pre-dialytic biochemical and haematological parameters were obtained. All patients were required to complete three questionnaires by themselves: (i) the International Index of Erectile Function (IIEF, Chinese version); (ii) the Beck Depression Inventory (BDI, Chinese version) and (iii) the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0). RESULTS: In total, 154 male patients completed the IIEF questionnaire. Their mean age was 50.2 +/- 10.7 years. A linear multivariable regression analysis demonstrated advanced age, diabetes and the presence of depressive symptoms to be independently associated with sexual dysfunction. Subjects with sexual dysfunction had significantly lower quality of life scores. CONCLUSIONS: The presence of depressive symptoms, highly prevalent in haemodialysis patients, is an independent factor of sexual dysfunction in male haemodialysis patients. In a comprehensive approach to the management of sexual dysfunction, a thorough evaluation of psychological depression must be included.

Sexual dysfunction in female hemodialysis patients: a multicenter study.

BACKGROUND: Sexual function is one aspect of physical functioning. Sexual dysfunction, no matter the etiology, could cause distress. In female hemodialysis patients, sexual problems have often been neglected in clinical performance and research. METHODS: We conducted this study by use of self-reported questionnaires. A total of 578 female hemodialysis patients in northern Taiwan were included in this study. Demographic data, comorbid diseases, medications in use, biochemical, and hematologic parameters were analyzed. All patients were asked to complete by themselves three questionnaires: (1) the Index of Female Sexual Function (IFSF) to assess sexual function; (2) the Beck Depression Inventory (BDI) (Chinese version) to rate the severity of depressive symptoms; and (3) the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0) to survey their quality of life. RESULTS: A total of 138 female patients were enrolled into further analysis. The mean age was 48.7 +/- 11.2 years old. The mean IFSF score was 24.5 +/- 9.3. Age, BDI score, and serum triglyceride levels were the independent factors of dysfunction in each sexual functional dimension. Patients with higher IFSF scores had significantly higher scores in physical functioning and mental health (P= 0.007 and 0.018, respectively). Patients with higher intercourse satisfaction had significantly higher general health scores (P= 0.001). CONCLUSION: Sexual dysfunction is frequent in the female hemodialysis population. It is strongly associated with increasing age, dyslipidemia, and depression. The subjects with sexual dysfunction had poorer quality of life. The diagnosis and treatment of sexual dysfunction should be included in the clinical assessment.