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1.
Nurs Res ; 70(1): 34-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32991531

RESUMO

BACKGROUND: Patients with end-stage renal disease receiving dialysis experience a significant symptom burden. Identifying factors associated with this burden may improve symptom management. However, specific evidence about patients' experiences is lacking. OBJECTIVES: The aim of this study was to explore factors that are associated with patients' symptom experiences. METHODS: The convergent parallel mixed methods design was used. In the quantitative component, the Dialysis Symptom Index was used to assess the symptom burden of 271 participants to examine its associations with patient characteristics using correlation coefficients and multivariate regression analyses. In the qualitative component, associated factors reported by 10 participants were identified through semistructured interviews using content analysis. Assessments were conducted at enrollment, 6 months, and 12 months. After separate data analyses, findings were integrated using side-by-side comparison and joint display. RESULTS: Several significant associations were identified between patient characteristics and symptom burden, and the participants described four categories of factors (i.e., treatment related, pathophysiological, situational, dietary) associated with a higher symptom burden during their interviews. Across both components of this study, three factors were consistent (i.e., employment, hyperphosphatemia, anemia). Participants described several factors not reported previously. DISCUSSION: This study explored subjective and objective factors influencing the symptom experiences of patients with end-stage renal disease using a mixed methods design. These risk factors can be used to identify high-risk patients. Our findings suggest that participants relied on laboratory results and treatments to explain their symptom experiences. These findings suggest that assessment of both subjective and objective factors is needed to explore patients' symptom experiences.


Assuntos
Fadiga/fisiopatologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Satisfação do Paciente , Diálise Renal/efeitos adversos , Diálise Renal/psicologia , Avaliação de Sintomas/métodos , Idoso , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
2.
Medicine (Baltimore) ; 99(40): e22240, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019398

RESUMO

Children with end stage renal disease (ESRD) are liable to various health disorders that possibly impair their quality of life (QoL). Low dietary intake of Omega-3 fatty acids also called marine n-3 fatty acid (n-3 FA) may be associated with health problems which are among the leading causes of impaired QoL.The objective of this study was to assess the effect of omega-3 Fatty acid (n-3 FA) supplements on quality of life among children on dialysis and to evaluate its use regarding adequacy of dialysis and inflammatory markers.A prospective cohort study was conducted on 31 hemodialysis children. Quality of life was measured for patients and an equal number of matched controls using the PedsQL Inventory where the higher the score the poorer is the quality of life. n-3FA supplementation had been given to the patients for 3 months to study its effects on QoL. Laboratory investigations like hemoglobin, lipid profile, inflammatory markers, and tests for adequacy of dialysis had been carried out.Patients had significantly higher QoL scores (42.22 ±â€Š13.31) than controls (22.70 ±â€Š1.31) (P < .001). Young ages showed higher score of physical functioning (18.23 ±â€Š4.22) than older ones (13.92 ±â€Š6.84) (P = .049). Females had significantly higher total QoL score (25.53 ±â€Š6.61) than males (20.06 ±â€Š7.09) (P = .010). The total QoL score was significantly lower post than pre administration of n-3FA (35.41 ±â€Š10.36 vs 42.22 ±â€Š13.31) (P < .001). Triglycerides and CRP were significantly lower post than pre n-3FA supplementation (160.64 ±â€Š32.55 vs 169.35 ±â€Š31.82) (P < .001) and (10.29 ±â€Š4.39 vs 11.19 ±â€Š4.83) (P = .006) respectively. Means of Kt/V and urea reduction ratio (URR) were significantly higher post (1.37 ±â€Š0.09, 70.0 ±â€Š5.99 respectively) than pre n-3FA (1.31 ±â€Š0.07 and 65.25 ±â€Š6.06 respectively) (P = .005, .001 respectively).Quality of life and adequacy of dialysis get improved after n-3FA supplementation among children on dialysis which encourages its testing for more patients to evaluate its long term effects and support its routine use.


Assuntos
Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Qualidade de Vida , Diálise Renal/efeitos adversos , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Falência Renal Crônica , Masculino , Estudos Prospectivos , Melhoria de Qualidade , Diálise Renal/psicologia
3.
Qual Life Res ; 29(10): 2705-2714, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32654053

RESUMO

BACKGROUND: Patients with kidney failure have multifaced clinical needs. Continuous quality improvement (CQI) programs initiated by large healthcare provider networks bear the promise of improving guideline adherence and improving patient-centered outcome, including health-related quality of life (HRQOL). We aimed at evaluating the association between key performance indicators (KPI) adopted for our CQI and HRQOL in a large network of dialysis providers. METHODS: We conducted a survey study in 39 centers belonging to the Portuguese Fresenius Medical Care (FME) network, in September 2017. For each participant, we retrospectively extracted clinical information during the 6-month period preceding survey administration. We used this information to calculate KPI as defined by the FME-CQI policy. Those KPI were selected in the FME-CQI policy as modifiable intermediate endpoints for which previous evidence suggested a causal relationship with patients' morbidity and mortality. HRQOL was assessed by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaire. RESULTS: Among 4691 eligible patients who were invited to participate in the survey, 2263 (48.2%) answered the self-administered survey. Based on KPI standards, patients had 1.5 (± 1.2) off-target clinical parameters on average. KDQOL-36 score were generally higher than those observed in European reference population. We found a significant linear association between KPI parameters and HRQOL. This pattern was robust to adjustment for satisfaction scores. CONCLUSIONS: Our data demonstrated a graded, monotonic, dose-response relationship between the number of off-target KPIs and HRQOL. Such relationship was not mediated by patients' satisfaction and may be attributed to amelioration of disease-specific symptoms and functional capacity.


Assuntos
Setor de Assistência à Saúde/normas , Qualidade de Vida/psicologia , Diálise Renal/métodos , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Portugal , Diálise Renal/psicologia , Estudos Retrospectivos , Inquéritos e Questionários
4.
Nephrol Nurs J ; 47(3): 229-237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639124

RESUMO

The aim of this study was to develop a patient on hemodialysis resilience scale and to verify validity and reliability. This patient on hemodialysis resilience scale (PHRS) was developed according to the scale development process by DeVellis (2017). Thirty-one publications on the subject were reviewed, and in-depth interviews with seven patients on hemodialysis were conducted. Items comprising the scale were reviewed and modified through evaluation by a panel of experts and face validity. For verification of validity, a content validity index for the items, exploratory factor analysis, and confirmatory factor analysis were performed. In the exploratory factor analysis, the PHRS was categorized into three factors: 'pursuing a positive meaning in life,' 'accepting hemodialysis as a part of daily life,' and 'building a willingness to live through meaningful relationships.'


Assuntos
Diálise Renal/psicologia , Resiliência Psicológica , Inquéritos e Questionários , Análise Fatorial , Humanos , Reprodutibilidade dos Testes
5.
Health Qual Life Outcomes ; 18(1): 207, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600360

RESUMO

BACKGROUND: Chronic kidney disease (CKD) leads to decreased quality of life (QOL) by increasing the risk of death during the progression of its pathogenesis. However, many factors can be improved to support QOL. This study aimed to assess QOL among CKD patients in Nepal and to determine the factors associated with their QOL. METHOD: A cross-sectional study was used for data collection. CKD cases receiving medical attention in the Bir Hospital in Mahaboudh, Kathmandu; Tribhuvan University Teaching Hospital in Maharajgunj, Kathmandu; Sumeru Hospital in Dhapakhel, Lalitpur; and Shahid Dharma Bhakta National Transplant Centre in Bhaktapur between August and October 2019 were invited to participate in the study. A validated questionnaire and the kidney disease quality of life short form (KDQOL-SF™ 1.3) were used to assess QOL. A questionnaire was completed by the researcher in face-to-face interviews. Logistic regression was used to detect the associations between variables at the significance level of α = 0.05. RESULTS: A total of 440 participants were recruited into the study: 56.59% were males, 74.32% were aged between 31 and 70 years, 25.68% were illiterate, and 82.95% were unemployed. The prevalence of good QOL among CKD in the domains of the physical component summary (PCS), mental component summary (MCS), and kidney disease component summary (KDCS) with and without hemodialysis were 53.64, 22.05, 21.28, and 13.19%, respectively. After controlling for all potential confounding factors, eight variables were found to be associated with good QOL in the domain of PCS: age, education, stage of CKD, hemodialysis, transporting oneself to a hospital, health insurance, medical expenses, and perceived lack of difficulty in handling medical expenses. Six variables were associated with good QOL in the domain of MCS after controlling for all potential confounding factors: residence, stage of CKD, transporting oneself to a hospital, health insurance, medical expenses, and perceived lack of difficulty in handling medical expenses. CONCLUSIONS: Public health interventions should be developed and implemented to improve QOL among CKD patients in Nepal by focusing on older female patients who have low education, live in rural areas and no health insurance.


Assuntos
Qualidade de Vida , Diálise Renal/psicologia , Insuficiência Renal Crônica/psicologia , Adulto , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Inquéritos e Questionários
6.
Health Qual Life Outcomes ; 18(1): 233, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680519

RESUMO

BACKGROUND: End-stage kidney disease is highly prevalent worldwide. Currently, one of the most effective treatment modalities is dialysis therapy, which leads to serious side effects. Furthermore, psychiatric illnesses are prevalent among dialysis patients. Recently, researchers asserted that psychological resilience and family support could be helpful to maintain or improve patients' mental well-being. Therefore, the purpose of this study was to examine the mediating effects of resilience on the relationship between family functioning and mental well-being in these patients. METHODS: To investigate the aim of this study, a cross-sectional design was employed. A total of 110 hemodialysis patients, who were receiving outpatient treatment from dialysis units at the University of Fukuoka and St. Maria Health Care Center in Japan, participated. Only the patients who met the criteria and who were willing to participate in this 30-min study were given The General Health Questionnaire-12, Conner-Davidson Resilience Scale, and Family Assessment Device. Structural Equation Modeling (SEM) was performed to test the hypothesis that resilience would mediate the relationship between each subscale of family functioning, namely, cohesion, adaptability, communication, and mental well-being. Then Sobel's test was employed to examine the indirect effect. RESULTS: The results of the SEM showed that the model had an acceptable fit (RMSEA = .077; CFI = .93; and IFI = .94). According to the results, resilience fully mediated the relationship between family functioning, specifically family adaptability and communication, and mental health well-being of the dialysis patients. However, family cohesion was not associated with resilience. CONCLUSIONS: The present study revealed that higher family adaptability and communication resulted in greater resilience, thus associated with better mental health. Given that poor mental health among dialysis patients is significantly associated with a decreased likelihood to adhere to treatment plans, it may lead to a significant risk to therapeutic compliance. As such, patients may experience detrimental consequences, such as death. This study showed that in order to maintain healthy mental well-being, developing resilience is a vital factor for hemodialysis patients.


Assuntos
Relações Familiares/psicologia , Diálise Renal/psicologia , Resiliência Psicológica , Adaptação Psicológica , Idoso , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários
7.
Health Qual Life Outcomes ; 18(1): 234, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680521

RESUMO

BACKGROUND: Functional dependence is highly prevalent in maintenance hemodialysis (MHD) settings. Also, poor health-related quality of life (HRQoL) and high levels of depressive symptoms have been reported by MHD patients. We investigated associations between functional status and mental aspects of quality of life in Brazilian MHD patients. METHODS: Cross sectional study of 235 patients enrolled in two of the four participating MHD clinics of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, BA, Brazil. Data were collected from September 2016 to August 2017. The Katz's questionnaire was used for basic activities of daily living (ADL) and the Lawton-Brody's questionnaire for instrumental activities of daily living (IADL). ADL and IADL scores were combined to create 3 functional status groups: highly dependent (n = 47), moderately dependent (n = 109) and independent (n = 82). The validated Brazilian version of the Kidney Disease Quality of Life Short Form (KDQOL-SF) was used for scores of two distinct HRQoL measures, i.e., the mental component summary (MCS) and the 5-item mental health inventory (MHI-5). We used linear regression to estimate differences in scores with adjustment for possible confounders: months of dialysis, age, gender, other sociodemographic variables, body mass index, type of vascular access, dialysis dose by Kt/V, laboratory variables (albumin, blood hemoglobin, calcium, phosphorus, urea, creatinine and parathyroid hormone) and nine comorbid conditions. RESULTS: Mean age was 51.2 ± 12.4 yr (median age = 51.0 yr), 59.1% were male, 93.2% were non-White. The prevalence of self-reported functional status differed by age: 54.4% for age < 45 yr, 67.8% for age 45-60 yr and 73.9% for age ≥ 60 yr. Using functionally independent as reference, lower scores were observed for highly dependent patients in MCS (difference: -4.69, 95% CI: -8.09, -0.29) and MHI-5 (difference: -5.97, 95% CI: -8.09, -1.29) patients. These differences changed slightly with extensive adjustments for covariates. CONCLUSIONS: Our results call attention to a high prevalence of functional dependence in younger and older MHD patients. The results suggest that the lower self-reported mental quality of life in functionally dependent MHD patients cannot be explained by differences in age and comorbidities.


Assuntos
Atividades Cotidianas/psicologia , Qualidade de Vida , Diálise Renal/psicologia , Atividades Cotidianas/classificação , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional , Estudos Prospectivos , Inquéritos e Questionários
8.
Health Qual Life Outcomes ; 18(1): 191, 2020 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-32552800

RESUMO

OBJECTIVE: End-stage renal disease (ESRD) leads to renal replacement therapy and certainly has an impact on patients' health-related quality of life (HRQoL). This study aimed to review and compare the HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) patients using the 36-Item Short Form Health Survey (SF-36), EuroQoL-5-dimension (EQ-5D) and the Kidney Disease Quality of Life Instrument (KDQOL). METHODOLOGY: Systematic review was conducted by identify relevant studies through MEDLINE and SCOPUS up to April 2017. Studies were eligible with following criteria: studied in ESRD patients, compare any pair of renal replacement modalities, and reported HRQoL. The unstandardized mean differences (USMD) of HRQoL among modalities were calculated and pooled using a random-effect models if heterogeneity was present, otherwise a fixed-effect model was applied. RESULTS: A total of twenty-one studies were included with 29,000 participants. Of them, mean age and percent male were 48.1 years and 45.1, respectively. The pooled USMD (95% CI) of SF-36 between PD and HD (base) were 1.86 (0.47, 3.24) and 0.42 (- 1.99, 2.82) for mental component and physical component summary scores, respectively. For EQ-5D, the pooled USMD of utility and visual analogue scale (VAS) score were 0.02 (- 0.06, 0.10) and 3.56 (1.73, 5.39), respectively. The pooled USMD of KDQOL were 9.67 (5.67, 13.68), 6.71 (- 5.92, 19.32) 6.30 (- 0.41, 12.18), 2.35 (- 4.35, 9.04), 2.10 (0.07, 4.13), and 1.21 (- 2.98, 5.40) for burden of kidney disease, work status, effects of kidney disease, quality of social interaction, symptoms, and cognitive function. CONCLUSION: Patients with chronic kidney disease (CKD) stage 5 or ESRD treated with PD had better generic HRQoL measured by SF-36 and EQ-5D than HD patients. In addition, PD had higher specific HRQoL by KDQOL than HD patients in subdomain of physical functioning, role limitations due to emotional problems, effects and burden of kidney disease.


Assuntos
Diálise Peritoneal/psicologia , Qualidade de Vida , Diálise Renal/psicologia , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Renal/efeitos adversos , Inquéritos e Questionários
9.
Medicine (Baltimore) ; 99(24): e20401, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541461

RESUMO

Depression may hamper the immune system and nutritional status, which leads to poor outcomes of treatment. It is very common in dialysis patients. There are the numbers of parameters affected by the depression of patients and available studies are not enough to define the association between biological parameters and depression in the dialysis population. The purposes of the study were to find the prevalence of depression and association of it with the biochemical abnormalities in the dialysis patients.The selected battery of tests (clinician-administered questionnaires) were applied to dialysis patients (test cohort, n = 298) and caregivers (control cohort, n = 202) for establishing depression. The demographic and clinical conditions of participants were also collected. Univariate analysis followed by multiple regression analysis was performed for demographical parameters, clinical conditions, and laboratory results for the detection of association of them with depression. The abnormal test considered as more than 2 SD of mean below the normal value. Out of all tests, at least 2 abnormal tests were considered as mild depression. More than half of abnormal parameters among all tests were considered as moderate depression and all abnormal parameters were considered as severe depression.There was a significant difference for all the test between dialysis patients and the caregivers (P < .0001 for all). The half (153 out of 298) of dialysis patients were depressive and clinically asymptomatic. 70 (23%) dialysis patients were mild depressive, 45 (15%) dialysis patients were moderate depressive, and 38 (13%) dialysis patients were severely depressive. Serum phosphate (P = .023), level of parathyroid hormone (P = .021), and urea reduction rate (P = .048) were directly associated with depression.Biochemical abnormalities (serum phosphate level, parathyroid hormone, and urea reduction rate) were independent predictors of depression in the dialysis population.Level of evidence: III.


Assuntos
Depressão/psicologia , Diálise Renal/psicologia , Uremia/terapia , Adulto , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Cuidadores/psicologia , Estudos de Casos e Controles , China/epidemiologia , China/etnologia , Estudos de Coortes , Depressão/sangue , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Prevalência , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Uremia/complicações
10.
Psicooncología (Pozuelo de Alarcón) ; 17(1): 149-164, ene.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196989

RESUMO

OBJETIVOS: El objetivo de este trabajo es estudiar las propiedades psicométricas de un cuestionario multidimensional de adaptación a la enfermedad para pacientes con enfermedad renal en diálisis (CMAE-RD). MÉTODOS: Esta herramienta está diseñada para ser administrada por un profesional de la psicología en forma de entrevista semiestructurada y fue diseñado a partir de un cuestionario previo para pacientes oncohematológicos. Un total de 113 pacientes en hemodiálisis fueron entrevistados mediante el CMAE-RD y completaron dos cuestionarios adicionales con propósitos de validación: el HADS (para evaluar ansiedad y depresión) y el CDRISC-2 (para evaluar resiliencia). RESULTADOS: La consistencia interna para las áreas del CMAE-RD estuvo comprendida entre 0,53 y 0,70, y se obtuvieron evidencias de validez relacionada con un criterio externo y concurrente especialmente para las áreas que evaluaban el grado en que el paciente está informado y su estado de ánimo. CONCLUSIONES: CMAE-RD presenta niveles adecuados de fiabilidad y validez, siendo una herramienta útil desde el punto de vista clínico, pues permite evaluar las necesidades y recursos de los pacientes, guiando la intervención psicológica


OBJECTIVES: The present study aims to explore the psychometric properties of a multidimensional questionnaire to assess adaptation to illness in patients with end stage renal disease under hemodialysis (CMAE-RD for its Spanish acronym). METHODS: This instrument was developed to be administered by a psychologist as a semi structured interview and it was adapted from a previous questionnaire for patients with oncohaematologic diseases. A total of 113 patients receiving hemodialysis treatment were interviewed with the CMAE-RD and completed two additional questionnaires with validation purposes: the HADS (to assess anxiety and depression) and the CDRISC-2 (to assess resilience). RESULTS: Internal consistency scores for the areas of the CMAE-RD was comprised between.53 and.70. Evidences of validity related to an external criterion and concurrent validity were obtained for the areas which assess the level of information of the patient and their emotional state. CONCLUSIONS: We conclude that the CMAE-RD shows adequate levels of reliability and validity, being a useful measurement tool from the standpoint of health care, as it allows psychologist the needs and resources of renal patients, providing guidance for psychological intervention


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/terapia , Inquéritos e Questionários , Adaptação Psicológica , Diálise Renal/psicologia , Depressão/psicologia , Ansiedade/psicologia , Fatores Socioeconômicos , Psicometria
11.
Transplant Proc ; 52(5): 1552-1555, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32402457

RESUMO

INTRODUCTION: Despite the well-known benefits of exercise during the pretransplantation and post-transplantation phases, adherence to active lifestyles is still reduced. The aim of the present study is to evaluate how many patients who have received organ transplants and candidates for organ transplantation carry out physical or sports activities in order to increase adherence to an active lifestyle. METHODS: The patients who agreed to participate in the study were interviewed about their lifestyle habits by the staff at the nephrology, dialysis, and hepatology units of the Emilia-Romagna region. The interview investigated the patient's lifestyle (active or sedentary) and type of physical activity (walking, cycling, gardening, gym at least 3 to 40 minutes, 2 to 3 times per week) or sport (training > 2 times per week) routinely practiced. RESULTS: We collected 1138 interviews from patients on the waiting list (n = 159) for organ transplant, those with kidney transplants (n = 756), and those with liver transplants (n = 223) monitored in the Emilia-Romagna hospitals (regional patients 67%, extraregional 33%). Eighty-four patients on the waiting list for a transplant (kidney) were sedentary, 75 practiced physical activity, and 10 of 75 physically active patients practiced sport. Four hundred fifteen patients with kidney transplants were sedentary, 341 practiced physical activity, and 31 of 341 physically active patients practiced sport. Among patients with liver transplants, 56 were sedentary, 167 practiced physical activity, and 20 of 167 physically active patients played sport. CONCLUSIONS: In-line with the general population, we confirmed a high tendency toward a sedentary lifestyle (44% of respondents) among patients with organ transplants and those on waiting lists for organ transplants. Including a prescription for physical exercise as part of the therapeutic regimen can be useful for changing lifestyles during the pre- and post-transplantation period.


Assuntos
Exercício Físico/psicologia , Comportamentos Relacionados com a Saúde , Estilo de Vida , Transplante de Órgãos/psicologia , Cooperação do Paciente/psicologia , Adulto , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/reabilitação , Período Pós-Operatório , Período Pré-Operatório , Diálise Renal/psicologia , Estudos Retrospectivos , Comportamento Sedentário , Esportes , Listas de Espera
12.
Qual Life Res ; 29(9): 2345-2354, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32356278

RESUMO

PURPOSE: The aim of this study is to assess patient-reported outcome measures (PROMs) related to symptoms among maintenance hemodialysis patients (MHDp). METHODS: This cross-sectional study was conducted between 2013 and 2015, with 336 MHDp from five hospital hemodialysis units. It included a comprehensive assessment of the prevalence and intensity of 30 common dialysis-related symptoms quality of life and daily function of MHDp, by using the Dialysis Symptom Index (DSI), Quality of Life Short Form (KDQOL-SF), and demographic and clinical characteristics. RESULTS: The five most commonly reported symptoms were identified as tiredness (80%), difficulty becoming sexually aroused (72%), decreased interest in sex (72%), worrying (67%), trouble staying asleep (65%), and trouble falling asleep (64%). Based on the DSI, the mean Overall Burden of Symptoms (OBS), on a scale of 0-30, was 15.4 ± 6.7, while the mean Overall Symptom Severity Score (OSSS), on a scale of 0-150, was 54.8 ± 29.8. Multivariate quantile regression models indicated that major depression is consistently associated with both the OBS and OSSS across different quantiles, whereas time on dialysis > 24 months was associated with the OBS only. Both the OBS and OSSS were inversely associated with KDQOL-SF: the kidney-related (KDCS), physical (PCS) and mental aspects (MCS), across multiple quantiles in multivariate quantile regression models. CONCLUSIONS: MHDp bear a heavy burden of symptom which are associated with time spent on dialysis as well as depression. Clinical and research resources should be directed at controlling symptoms, improving daily function, detecting depression, and bettering quality of life.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Adulto , Idoso , Ansiedade/psicologia , Estudos Transversais , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Psicometria/métodos
13.
Medicine (Baltimore) ; 99(20): e20202, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443343

RESUMO

AIM: Maintenance hemodialysis (MHD) frequency is associated with survival and complication rates. Achieving the optimal balance between healthcare, quality of life (QOL), and medical costs is challenging. We compared complications, inflammatory status, nutritional status, and QOL between patients with different MHD frequencies. MATERIAL AND METHODS: This was a multicenter randomized trial of patients treated between May 2011 and August 2017 at 3 tertiary hospitals in Wenzhou. Patients were grouped according to their treatment schedule over 1 year: twice-weekly or 3-times-weekly. Complications, biochemistry parameters, and QOL (KDQOL-SFTM 1.3 scale) were assessed. RESULTS: One hundred forty patients were included aged 29 to 68 years (mean age, 50.9 ±â€Š4.3 years). There were no significant differences in infection, heart failure, or cerebral hemorrhage complications between the 2 groups (P = .664). Pre-dialysis hemoglobin, high-sensitivity C-reactive protein, serum albumin, total cholesterol, triglyceride, calcium, phosphate, parathyroid hormone, and ejection fraction were similar in both groups (P > .05). After 1 year of MHD, both groups exhibited significant improvements in these parameters (all P < .05) with no significant differences between groups. Serum creatinine, blood urea nitrogen (BUN), and weekly standard hemodialysis treatment adequacy did not improve after treatment (all P > .05), although a difference in BUN was observed between the 2 groups (P < .001). QOL was superior in the twice-weekly group than in the 3-times-weekly group (all P < .05), except for social support, which was slightly better in the 3-times-weekly group than in the twice-weekly group. CONCLUSIONS: Twice- and 3-times-weekly MHD resulted in comparable inflammatory and nutritional clinical outcomes and adverse events. QOL was better for the twice-weekly schedule. Even for patients with economic constraints, twice- or 3-times-weekly MHD should be selected with caution after consideration of BUN levels at baseline.


Assuntos
Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Diálise Renal/tendências , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa/análise , Cálcio/sangue , Hemorragia Cerebral/epidemiologia , China/epidemiologia , Colesterol/sangue , Creatinina/sangue , Feminino , Insuficiência Cardíaca/epidemiologia , Hemoglobinas/análise , Humanos , Infecções/epidemiologia , Inflamação/epidemiologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Qualidade de Vida/psicologia , Diálise Renal/economia , Diálise Renal/psicologia , Albumina Sérica , Volume Sistólico/fisiologia , Triglicerídeos/sangue
14.
Clin Nephrol ; 93(6): 275-282, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32271146

RESUMO

OBJECTIVE: This study aims to compare the effect of pure aerobic exercise and combined aerobic resistance exercise on dialysis adequacy and quality of life in patients on maintenance hemodialysis. MATERIALS AND METHODS: A total of 45 patients on maintenance hemodialysis were divided into three groups: pure aerobic exercise group, combined aerobic resistance exercise group, and control group. Patients in the control group were only given the usual treatment, which included dietary guidance, drug therapy, and hemodialysis. The other training groups underwent 12-week exercise intervention therapy on the basis of the usual treatment. Blood samples were collected before and after the hemodialysis, at the beginning and end of the intervention for these three groups. Then, the blood urea nitrogen (BUN) concentration was determined, the urea clearance index (Kt/v) and urea degradation rate (URR) were calculated, the dialysis adequacy was evaluated, and the short form-36 (SF-36) scale was used to evaluate the life quality. RESULTS: Before intervention, there was no significant difference in general health condition (GH), Kt/v, URR, SF-36 total score, and the score of each dimension in the three groups. After the intervention therapy, the Kt/v, URR, GH, vitality (VT), and SF-36 total score markedly improved in the pure aerobic exercise group, while the Kt/v, URR, GH, VT, physical functioning (PF), and SF-36 total score significantly increased in the combined aerobic resistance exercise group. Furthermore, compared with the pure aerobic exercise group, the improvement effect of body function (PF score) was better in the combined aerobic resistance exercise group. CONCLUSION: Both pure aerobic exercise and combined aerobic resistance exercise can significantly improve the dialysis adequacy and quality of life of maintenance hemodialysis patients. Compared with the pure aerobic exercise group, the effect of combined aerobic resistance exercise on PF was better.
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Assuntos
Exercício Físico , Falência Renal Crônica/terapia , Qualidade de Vida , Diálise Renal , Treinamento de Resistência , Adulto , Feminino , Humanos , Falência Renal Crônica/psicologia , Masculino , Pessoa de Meia-Idade , Diálise Renal/psicologia
15.
J Clin Nurs ; 29(15-16): 2834-2848, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32320513

RESUMO

AIMS AND OBJECTIVES: To examine the influence of psycho-social and educational interventions on improving adherence to dialysis for patients with end-stage renal disease. BACKGROUND: Adherence to the complex regimen is poor, contributing to avoidable hospitalisation and morbidity. Psycho-social and educational interventions may be beneficial coping strategies. DESIGN: Systematic literature review and meta-analysis were conducted. METHODS: We conducted a systematic search of 8 databases from their inceptions to 16 January 2019 to identify relevant articles. Only randomised controlled trials (RCTs) were included in the analysis. The PRISMA checklist was used. RESULTS: A total of forty RCTs were included to evaluate the effect. The aggregated results of the studies showed that psycho-social and educational interventions elevated adherence rate in both peritoneal dialysis (PD) and haemodialysis (HD) patients. For physiological and biochemical indicators, meta-analysis revealed that significant post-treatment effects were evident for interdialytic weight gain (IDWG), IDWG/dry weight, serum potassium, phosphate, creatinine and blood urea nitrogen (BUN), except for albumin. In particular, subgroup analysis indicated that only the interventions carried out individually exerted significant combined effect for lowering IDWG. As for subjective measures, meta-analysis also revealed small but significant combined effects. CONCLUSIONS: The results of this meta-analysis suggest that psycho-social and educational interventions were associated with significant effects on adherence in patients receiving dialysis regimen. RELEVANCE TO CLINICAL PRACTICE: The analysis suggests that psycho-social and educational interventions should be considered as effective strategies for enhancing adherence to dialysis in adults with end-stage renal disease. The potential utility of these interventions should focus on how best to promote individually implementation in clinical practice.


Assuntos
Cooperação do Paciente , Educação de Pacientes como Assunto/métodos , Diálise Renal/psicologia , Adulto , Feminino , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino
16.
Medicine (Baltimore) ; 99(17): e19951, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332677

RESUMO

In recent years, nursing has come to be considered a high-risk and high-pressure profession, given the fast-paced working environment and constant need to handle emergencies, especially for nurses working in hemodialysis centers. Nearly every day, nurses are confronted with life and death situations and are required to provide skilled, high quality care for their patients, in fast-paced and demanding environments. Thus, nurses are susceptible to both psychological stress and other mental health problems, making them more vulnerable to burnout when compared against other healthcare professions.An anonymous online questionnaire was completed by a group of participating nurses, using the web-based survey platform WeChat. Registered nurses working in hemodialysis centers were randomly selected from 5 comprehensive tertiary level hospitals in Sichuan Province, China. The data collection instrument comprised two parts: demographic data and a nurse burnout questionnaire-the Maslach Burnout Inventory. Overall, 70 nurses were invited to participate, with 65 returning completed questionnaires, giving a response rate of 92.9%. In this survey, the burnout level was set at28.15 ±â€Š12.39 for emotional exhaustion (EE), 10.23 ±â€Š5.47 for depersonalization (DP), and 37.19 ±â€Š8.31 for personal accomplishment (PA)-EE and DP levels are found to be high at the level of burnout.Job burnout was found to exist widely among the nurses of hemodialysis centers, which may then result in adverse effects on their physical and mental health. Active interventions can significantly reduce job burnout and also help maintain the stability of nursing workforce levels.


Assuntos
Adaptação Psicológica , Esgotamento Profissional/classificação , Enfermeiras e Enfermeiros/psicologia , Diálise Renal/psicologia , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Esgotamento Profissional/psicologia , China , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Diálise Renal/efeitos adversos , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/normas
17.
Soins ; 65(842): 14-19, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32245551

RESUMO

When a patient with renal failure goes on dialysis, the question that arises is when they will be discharged. Dialysis treatment causes a biographical break with multiple psychological implications. In this context, the presence of a psychologist is indispensable. The fact that dialysis is a chronic illness does not mean that the patient does not experience acute psychological crises. If it is important to accompany the patient, caregivers who are regularly exposed to the psychological assaults of patients must also be considered.


Assuntos
Psicoterapia , Diálise Renal/psicologia , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Cuidadores/psicologia , Humanos , Insuficiência Renal/terapia
18.
J Psychosom Res ; 133: 109995, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32272296

RESUMO

OBJECTIVE: Symptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes. METHODS: This study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding. RESULTS: In total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45-2.06) p = .007 and Hazard Ratio 1.65 (1.15-2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life. CONCLUSION: This study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes.


Assuntos
Ansiedade/complicações , Hospitalização/estatística & dados numéricos , Qualidade de Vida , Diálise Renal/mortalidade , Diálise Renal/psicologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Componente Principal , Estudos Prospectivos , Inquéritos e Questionários
19.
Nefrología (Madrid) ; 40(2): 160-170, mar.-abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199104

RESUMO

ANTECEDENTES Y OBJETIVOS: Apenas existen estudios que hayan investigado el papel que la inflexibilidad psicológica (IP) pudiera tener en el contexto de la IRC. El objetivo primario de este estudio fue analizar las propiedades psicométricas, la fiabilidad y la validez de la versión española del Acceptance and Action Questionnaire-II adaptada al contexto de pacientes en tratamiento de hemodiálisis. El objetivo secundario fue analizar la relación entre IP y parámetros relacionados con la adhesión al tratamiento y calidad de vida en este tipo de pacientes. MATERIALES Y MÉTODOS: Estudio transversal prospectivo con pacientes en hemodiálisis (n = 186). RESULTADOS: El índice de tejido graso (15,56 ± 5,72 vs. 18,99 ± 8,91; p = 0,033), los niveles de fósforo (3,92 ± 1,24 vs. 4,66 ± 1,38; p = 0,001) y la ganancia de peso interdiálisis (1,56 ± 0,69 vs. 1,89 ± 0,93; p = 0,016) fueron mayores en los pacientes con más puntuación en IP. Los niveles de fósforo (p = 0,013) explicaron de forma significativa la variabilidad de los niveles de IP, la cual también se mostró como un predictor significativo (p = 0,026) de la variabilidad de los niveles de fósforo. CONCLUSIONES: La adaptación del cuestionario Acceptance and Action Questionnaire-II al contexto de hemodiálisis da lugar a una medida válida y fiable de la IP para este tipo de pacientes, y los resultados de este estudio parecen apoyar el papel de la IP con relación a parámetros de salud y calidad de vida en el ámbito de las enfermedades crónicas


BACKGROUND AND OBJECTIVES: Few studies have investigated the role psychological inflexibility (PI) could have in the context of chronic renal failure. The primary objective of this study was to analyse the psychometric features, the reliability and the validity of the Spanish version of the Acceptance and Action Questionnaire-II (AAQ-II) adapted to the context of patients undergoing haemodialysis (HD). The secondary objective was to assess the relationship between PI and parameters related to the adherence to treatment and quality of life in these types of patients. MATERIALS AND METHODS: Prospective cross-sectional study with patients on haemodialysis (n = 186). RESULTS: The fat tissue index (15.56 ± 5.72 vs. 18.99 ± 8.91, P = .033), phosphorus levels (3.92 ± 1.24 vs. 4.66 ± 1.38; P = .001) and interdialytic weight gain (1.56 ± 0.69 vs. 1.89 ± 0.93, P = .016) were higher in patients with a higher PI score. Phosphorus levels (P = .013) significantly explained the variability of PI levels. PI was also shown as a significant predictor (P = .026) of the variability of phosphorus levels. CONCLUSIONS: The adaptation of the AAQ-II questionnaire to the HD context led to a valid and reliable measurement of PI in these types of patients and our results also seem to support the relationship between PI and health and quality of life parameters in patients with chronic conditions


Assuntos
Humanos , Masculino , Feminino , Idoso , Adaptação Psicológica , Insuficiência Renal Crônica/psicologia , Diálise Renal/psicologia , Inquéritos e Questionários , Adiposidade , Estudos Transversais , Insuficiência Renal Crônica/terapia , Cooperação do Paciente , Fósforo , Estudos Prospectivos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Ganho de Peso
20.
J Clin Nurs ; 29(13-14): 2293-2305, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32160346

RESUMO

AIM AND OBJECTIVE: To explore how working-age adults experience patient participation in hospital haemodialysis. BACKGROUND: End-stage kidney disease is a progressive, chronic condition imposing patients with high treatment burdens and low health-related quality of life. Patients face multiple medical decisions related to living with kidney failure. Given their frequent interaction with health services, patient participation may be of special value. DESIGN: Qualitative design with a narrative approach. METHODS: In 2018, eleven patients aged 35-64 years undergoing hospital haemodialysis participated in individual interviews. All interviews were analysed using a narrative approach. Reporting followed the Consolidated criteria for Reporting Qualitative Research guidelines. FINDINGS: The patients' narratives of participation comprised three themes following their healthcare trajectory: Informed, but not involved in treatment choices; Duality of care and control; and Frail trust reflecting collaborative deficiencies. The patients received good information about dialysis, but were not involved in choice of treatment modality. Professional work, as well as the nature of treatment, contributed to restricted patient autonomy. Patients' trust suffered from collaborative deficiency generating delays in their treatment trajectories, and patients extended their responsibility into the coordination of transitions as a way of coping with these issues. CONCLUSIONS: The study identified challenges related to patient involvement and interdisciplinary collaboration. Involving patients through dialogue and acknowledging their experiences, preferences and lifestyles may strengthen the mutual patient-professional understanding of treatment. Despite increased focus on seamless trajectories, patients face obstacles regarding interdisciplinary collaboration and coordination of health services. RELEVANCE TO CLINICAL PRACTICE: The findings indicate a want of individually customised care for people requiring dialysis. Patients need to be involved in the choice of treatment modality as well as decisions related to the current treatment. Information must include potential consequences of the different treatment modalities. Health services need to strengthen collaboration in order to secure treatment continuity and patient involvement.


Assuntos
Participação do Paciente , Qualidade de Vida , Diálise Renal/psicologia , Adaptação Psicológica , Adulto , Tomada de Decisões , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Pesquisa Qualitativa , Diálise Renal/enfermagem
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