Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.912
Filtrar
1.
JNMA J Nepal Med Assoc ; 57(217): 172-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477957

RESUMO

INTRODUCTION: Co-morbid depression impacts negatively on quality of life in Chronic Kidney Disease patients. This study was done to calculate prevalence of depression in patients on hemodialysis (HD) using Patient Health Questionnaire-9, Hamilton Rating Scale for Depression-17 and International Classification of Disease-10 classification of mental and behavioural disorders. METHODS: It was descriptive cross-sectional study conducted from November 2017 till June 2018. Ethical approval was taken from Ethical Review Board, Nepal Health Research Council. Informed and written consent was taken. Patients undergoing hemodialysis at Nepal Medical College for more than 3 months duration were included in study. Patients on hemodialysis were asked to fill validated Nepali translated version of Patient Health Questionnaire-9. Psychiatrist administered Max Hamilton Rating scale for diagnosis and categorization of depression and confirmed depression based on International Classification of Disease-10. Statistical Package for Social Sciences version 20 was used for statistical analysis. RESULTS: The study was done among 100 patients. Prevalence of depression was 78 (78%) using Patient Health Questionnaire-9 and 65 (65%) using Max Hamilton Rating scale and 51 (51%) using International Classification of Disease -10. Mean depression in males using Patient Health Questionnaire -9 was 7±4.33 and in females was 11.04±5.90. Median age was 47.5 years. The most common symptom was fatigue among 82 (82%). CONCLUSIONS: There is a high prevalence of depression in patients with Chronic Kidney Disease stage 5 on hemodialysis compared to general population.


Assuntos
Depressão/epidemiologia , Falência Renal Crônica/psicologia , Qualidade de Vida , Diálise Renal , Adulto , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Questionário de Saúde do Paciente , Prevalência , Escalas de Graduação Psiquiátrica , Centros de Atenção Terciária , Adulto Jovem
2.
Transplant Proc ; 51(7): 2250-2253, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474290

RESUMO

BACKGROUND: Kidney transplantation (KT) is the optimal treatment for chronic end-stage renal failure. However, it is experiencing a huge delay in Morocco, and the lack of information on this alternative treatment could contribute to this delay. The purpose of our work is to evaluate the knowledge of hemodialysis (HD) on renal transplantation and to propose sensitization and information strategies. METHODS: This is a multicenter study conducted in 4 hemodialysis centers in Marrakesh from November to December 2017. An individual questionnaire was submitted to 310 patients concerning sociocultural status, willingness to be transplanted, the main benefits and risks of renal transplantation, knowledge of religious attitudes toward organ donation and transplantation, cost, and survival of the KT. RESULTS: Of the 310 patients, 56% were men, with a mean age of 49.43 ± 10.3 years. The mean duration of hemodialysis was 6.7 ± 5.3 years. Only 18% were in school, and 57% had moderate economic status. Of the 310 respondents, 71% said they wanted to be transplanted, and 15.5% believed that Islam was unfavorable by encouraging them to accept the fate that God chose for them. The rest were afraid of multiple complications and returning to dialysis. However, 41.7% thought transplantation was more expensive than hemodialysis. Only 65.8% believed that renal transplantation provided a better quality of life. CONCLUSIONS: Raising the awareness of hemodialysis patients and their families is essential to promote KT in Morocco.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Falência Renal Crônica/psicologia , Transplante de Rim/psicologia , Diálise Renal/psicologia , Adulto , Conscientização , Medo , Feminino , Humanos , Islamismo/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Marrocos , Qualidade de Vida , Inquéritos e Questionários
3.
BMC Public Health ; 19(1): 1107, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412824

RESUMO

BACKGROUND: As the incidence and prevalence rates of end stage renal disease (ESRD) rise globally, a disproportionate increase has been observed in the elderly population. Singapore has the fifth highest incidence of treated ESRD worldwide, with the upward trend of ESRD being most apparent among those aged 70 years and older. Although it is well-documented that ESRD patients suffer an impaired quality of life compared to the general population, there is limited research focusing on the unique experiences and needs of elderly ESRD patients in Asian populations. To address the knowledge gap, this study seeks to explore the impact of ESRD and dialysis on the quality of life of elderly (≥70 years old) ESRD patients in Singapore and examine the coping strategies utilised by these patients. METHODS: This qualitative study involved semi-structured, in-depth interviews with 7 peritoneal dialysis patients, 5 haemodialysis patients, 4 patients on non-dialysis supportive care and 7 caregivers in Singapore. Interviews were conducted in English, Chinese, and Malay and fully transcribed. QSR NVivo 11 software was used for analysis. RESULTS: Participants reported that ESRD and dialysis had an impact on three highly interconnected areas of their quality of life: (a) biological/physical (general symptoms, neuromuscular problems, skin problems and poor sleep quality); (b) psychological (depressive symptoms, anxiety and fears, stress and negative self-perceptions); and (c) social (increased dependence on family and loss of social life). There were four key strategies that participants used to cope with these biopsychosocial challenges: (a) family support (financial, practical and emotional support); (b) religious/spiritual support (experiencing gratitude/contentment, the power of prayer and belonging to a faith community); (c) avoidance (cognitive avoidance and distraction techniques); and (d) acceptance (positive thinking and problem solving). CONCLUSIONS: This study has provided insights into the biopsychosocial impact of ESRD and dialysis, as well as cultural and religious factors that shape the experiences and coping mechanisms of elderly ESRD patients and caregivers in Singapore, which can be used to further the development and implementation of more holistic and person-centred services to help each patient achieve a better quality of life.


Assuntos
Adaptação Psicológica , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Diálise Renal/psicologia , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Feminino , Saúde Holística , Humanos , Masculino , Assistência Centrada no Paciente , Pesquisa Qualitativa , Qualidade de Vida , Singapura
4.
Saudi J Kidney Dis Transpl ; 30(4): 905-912, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464248

RESUMO

Current guidelines recommend arteriovenous fistula (AVF) as the preferred method of access for hemodialysis (HD) patients; however, its utilization remains low. The attitudes of Jordanian HD patients and perceived barriers toward AVF are unknown and have not been well studied. In-center HD patients in the Jordan Ministry of Health largest dialysis unit were interviewed, and a questionnaire was administered inquiring about their experiences, attitudes, and perceived barriers toward AVF. Of 104 total patients, 93 met the inclusion criteria. Mean age was 50 ± 16 years, with 44% being female. Average body mass index was 25 ± 5. The cause of end-stage renal disease was diabetes mellitus in 28 (30%), hypertension in 28 (30%), and polycystic kidney disease in three (3%). Patients had an average time on dialysis of 72 months (range 1-240). Current method of HD access was AVF in 45 (48%) and central venous catheter in 30 (32%). The most reported perceived cause of no AVF was delayed referral to surgical evaluation in 19 (40%), refusal to undergo AVF surgical procedure in 16 (33%), and poor understanding of disease in 13 (27%). Of the total studied group, only 29 (31%) indicated that they received sufficient education/information about AVF prior to creation of HD access. Seventy-eight patients (84%) reported that they would recommend AVF as method of access for other HD patients. The reason why majority of patients preferred AVF was reported as: easier to care for 51 (65%), better associated hygiene 26 (33%), and perceived less infection risk 24 (31%). In conclusion, in this sample population from HD patients in Jordan, majority would recommend an AVF as mode of access. Perceived barriers include lack of timely referral for vascular surgical evaluation and poor understanding of disease. A systematic assessment of the process that precedes the creation of AVF, with focus on areas of reported barriers may allow for better utilization of AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica , Conhecimentos, Atitudes e Prática em Saúde , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Compreensão , Feminino , Humanos , Jordânia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/psicologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Preferência do Paciente , Diálise Renal/efeitos adversos , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Tempo para o Tratamento
5.
Saudi Med J ; 40(8): 840-843, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423523

RESUMO

OBJECTIVES: To record pediatric end stage renal disease (ESRD) patients' quality of life (QOL) in relation to peritoneal dialysis (PD) and hemodialysis (HD). Chronic kidney disease is a rising global epidemic yielding worldwide prevalence of 11-13%. It could possibly lead to ESRD, thus imposing serious burdens on patients and reducing their QOL. These burdens may affect their family members as well. Methods: This cross-sectional study examined 23 pediatric ESRD patients aged 2-18 years who were undergoing peritoneal dialysis and hemodialysis at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, in July 2018. Data were collected using the validated Pediatric Quality of Life InventoryTM 3.0 ESRD Module questionnaire. Results: The sample included HD (n=9, 40.9%) and PD (n=14, 60.9%) patients. According to the parent-proxy report, we found that the QOL among PD pediatric patients was significantly higher than HD patients (p=0.045). Also, male HD patients had a significantly better QOL on the interaction subscale (70.83±15.95 compared to 30.00±24.00 for females [p=0.023]). Conclusion:   Quality of life was found to be better among PD pediatric patients in King Abdulaziz University Hospital, Kingdom of Saudi Arabia.


Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Diálise Renal/métodos , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/psicologia , Masculino , Pais , Qualidade de Vida , Arábia Saudita , Fatores Sexuais
6.
Sao Paulo Med J ; 137(2): 137-147, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31314874

RESUMO

BACKGROUND: Depression and anxiety are the most prevalent psychological disorders among end-stage renal disease patients and are associated with various conditions that result in poorer health outcomes, e.g. reduced quality of life and survival. We aimed to investigate the prevalences of depression and anxiety among patients undergoing renal replacement therapy. DESIGN AND SETTING: Cross-sectional study in Belo Horizonte, Brazil. METHODS: Patients' depression and anxiety levels were assessed using the Beck Inventory. The independent variables were the 36-Item Short-Form Health Survey (SF-36), Charlson Comorbidity Index and Global Subjective Assessment, along with sociodemographic and clinical characteristics. RESULTS: 205 patients were included. Depression and anxiety symptoms were detected in 41.7% and 32.3% of dialysis patients and 13.3% and 20.3% of transplantation patients, respectively. Lower SF-36 mental summary scores were associated with depression among transplantation patients (odds ratio, OR: 0.923; 95% confidence interval, CI: 0.85-0.99; P = 0.03) and dialysis patients (OR: 0.882; 95% CI: 0.83-0.93; P ≤ 0.001). Physical component summary was associated with depression among dialysis patients (OR: 0.906; 95% CI: 0.85-0.96; P = 0.001). Loss of vascular access (OR: 3.672; 95% CI: 1.05-12.78; P = 0.04), comorbidities (OR: 1.578; 95% CI: 1.09-2.27; P = 0.01) and poorer SF-36 mental (OR: 0.928; 95% CI: 0.88-0.97; P = 0.002) and physical (OR: 0.943; 95% CI: 0.89-0.99; P = 0.03) summary scores were associated with anxiety among -dialysis patients. CONCLUSIONS: Depression and anxiety symptoms occurred more frequently among patients undergoing dialysis. Quality of life, comorbidities and loss of vascular access were associated factors.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Falência Renal Crônica/terapia , Transplante de Rim/psicologia , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/psicologia , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
7.
BMC Palliat Care ; 18(1): 64, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349844

RESUMO

BACKGROUND: Patients with end-stage kidney disease (ESKD) on hemodialysis have limited life expectancy, yet their palliative care needs often go unmet. The aim of this study was to identify barriers and facilitators for implementation of "Shared Decision Making and Renal Supportive Care" (SDM-RSC), an intervention to improve advance care planning (ACP) for patients with ESKD on hemodialysis. METHODS: The Consolidated Framework for Implementation Research (CFIR) was the organizing framework for this study. CFIR is a theory-based implementation framework consisting of five domains (Intervention Characteristics, Inner Setting, Outer Setting, Characteristics of Individuals, and Process), each of which has associated constructs. Potential barriers and facilitators to implementation of the SDM-RSC intervention were identified through observation of study procedures, surveys of social workers nephrologists, study participants, and family members, and assessment of intervention fidelity. RESULTS: Twenty-nine nephrologists and 24 social workers, representing 18 outpatient dialysis units in Massachusetts (n = 10) and New Mexico (n = 8), were trained to conduct SDM-RSC intervention sessions. A total of 102 of 125 patient enrolled in the study received the intervention; 40 had family members present. Potential barriers and facilitators to implementation of the SDM-RSC intervention were identified in each of the five CFIR domains. Barriers included complexity of the intervention; challenges to meeting with patients on non-dialysis days; difficulties scheduling intervention sessions due to nephrologists' and social workers' caseloads; perceived need for local policy change regarding ACP; perceived need for additional ACP training for social workers and nephrologists; and lack of endorsement of the intervention by some staff members. Facilitators included: training for social workers, national dialysis chain leadership engagement and the institution of social worker/nephrologist clinic champions. CONCLUSIONS: ACP for patients on hemodialysis can have a positive impact on end-of-life outcomes for patients and their families but does not take place routinely. The barriers to effective implementation of interventions to improve ACP identified in this study might be addressed by: adapting the intervention for local contexts with input from clinicians, dialysis staff, patients and families; providing nephrologists and social workers additional training prior to delivering the intervention; and developing policy that routinizes ACP for hemodialysis patients. TRIAL REGISTRATION: Clinicaltrials.gov NCT02405312. Registered 04/01/2015.


Assuntos
Planejamento Antecipado de Cuidados , Falência Renal Crônica/psicologia , Nefrologistas/psicologia , Diálise Renal/métodos , Assistentes Sociais/psicologia , Adulto , Idoso , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nefrologistas/estatística & dados numéricos , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Diálise Renal/psicologia , Assistentes Sociais/estatística & dados numéricos , Inquéritos e Questionários
8.
Clin Ter ; 170(4): e301-e320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31304520

RESUMO

BACKGROUND AND AIMS: Given the rising prevalence of end-stage renal disease and subsequent progressive increase of patients starting renal replacement therapy, a great attention is given by scientific community to the assessment of life perception and Quality of Life (QoL) in dialysis patients. A broad literature review was conducted on PubMed and PsyInfo databases for articles published between January 2000 and July 2016 in order to understand the biological and psychosocial variables potentially affecting the QoL of the patients under artificial substitution of kidney function. METHODS: Five domains related to the concepts of physical functions, mood, sleep, spirituality, and social support have been identified. RESULTS: The findings in this review suggest that the variables related to physical activity and depression seem to have a direct impact on QoL and Health-Related Quality of Life (HRQoL). Others, such as anxiety, awareness, empowerment, the presence of sleep disorders, satisfaction, support from the staff, social support, spirituality and religion have a clear correlation with the QoL dimensions. CONCLUSIONS: These results suggest the primary importance of the assessment biological and psychosocial variables by specific tools and the inclusion of effective interventions targeted to patients and their caregivers.


Assuntos
Falência Renal Crônica/psicologia , Qualidade de Vida , Depressão/psicologia , Humanos , Falência Renal Crônica/terapia , Qualidade de Vida/psicologia , Religião , Apoio Social
9.
Holist Nurs Pract ; 33(4): 222-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192834

RESUMO

The aim of this study was to examine the effect of the application of lavender oil on fatigue and anxiety levels in patients undergoing hemodialysis treatment. This randomized controlled study was conducted with 60 patients (30 patients in intervention group, 30 patients in control group) in a province located in southeastern Turkey. After the patients in both groups were informed about the study, a questionnaire, the Fatigue Severity Scale, and the Beck Anxiety Inventory were applied to the patients. In the intervention group, a statistically significant difference was found between pretest and posttest scores of the Fatigue Severity Scale (t = 7.177, P = .001) and the Beck Anxiety Inventory (t = 10.371, P = .001). Mean scores of fatigue and anxiety decreased significantly following aromatherapy and also fatigue and anxiety levels declined. Lavender aromatherapy can be applied as an effective nursing intervention to reduce fatigue and anxiety of patients with chronic renal failure and undergoing hemodialysis treatment.


Assuntos
Ansiedade/terapia , Aromaterapia/normas , Fadiga/terapia , Diálise Renal/efeitos adversos , Adulto , Idoso , Ansiedade/etiologia , Ansiedade/psicologia , Aromaterapia/métodos , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Óleos Voláteis/administração & dosagem , Óleos Voláteis/uso terapêutico , Óleos Vegetais/administração & dosagem , Óleos Vegetais/uso terapêutico , Diálise Renal/psicologia , Inquéritos e Questionários , Turquia
10.
Nephrol Nurs J ; 46(3): 293-336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31199096

RESUMO

Pediatric kidney failure is a relatively rare but devastating medical condition associated with a high degree of disease-related burden, but little is known about children's lived experiences. Finding ways to better understand their experiences can lead to improvement in direct patient care, health-related quality of life (HRQoL), and long-term functioning. Arts in Health (AIH) may be one means of understanding children's lived experiences. A retrospective review of a creative, writing-based AIH project by pediatric patients on hemodialysis was conducted. A qualitative directed-content analysis identified five main themes, including physical shackle, feeling mental and emotional distress, relying on a hemodialysis machine, dealing with problems, and feeling different. This study elucidates the lived experiences of children with chronic kidney failure by validating patients' experiences and highlighting their resilience.


Assuntos
Falência Renal Crônica , Qualidade de Vida , Redação , Criança , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Diálise Renal , Estudos Retrospectivos
11.
Int Urol Nephrol ; 51(7): 1249-1260, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161521

RESUMO

PURPOSE: Patients with end-stage renal disease (ESRD) seem to have a negative attitude towards physical activity, which is mainly favored by the lack of counseling provided by the medical and nursing staff. The aim of this study was to investigate the attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity and identify the obstacles that discourage patients' involvement in intervention programs. STUDY DESIGN: Subjective assessment questionnaires and the International Physical Activity Questionnaire were administrated to hemodialysis patients and medical staff, to investigate the association between patient's barriers to physical activity, the total intensity level of physical activity, and attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity. RESULTS: A total of 103 ESRD patients (61 men, 59.2%), 20 nephrologists (12 men, 60.0%), and 72 nurses (61 women, 84.7%) participated in the study. Most commonly reported patient's barriers were fatigue on dialysis (97.4%) and non-dialysis days (55.1%). Healthcare staff showed positive attitude towards renal rehabilitation exercise programs. However, most of physicians (85.0%) and nurses (83.3%) did not have previous experience with interventional exercise rehabilitation programs. Binary logistic regression revealed significant association between patients' inactivity, demographic data, and barriers towards physical activity, such as fatigue and pain in dialysis and non-dialysis days (p < 0.05), family's and physician's concern (p < 0.05), too many medical problems (p < 0.05), the fear of getting hurt (p = 0.01), and unwillingness for exercise (p < 0.05). Interestingly, healthcare staff's negative attitudes toward patient's physical activity seem to be strongly associated with patient's inactivity status. CONCLUSION: Healthcare staff negative attitudes and multiple related barriers especially fatigue on dialysis and non-dialysis days, towards ESRD patient's physical activity, suppress desire for exercise and active patients' status, leading them to abstain from it.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Terapia por Exercício , Exercício , Falência Renal Crônica , Participação do Paciente/psicologia , Diálise Renal , Adulto , Aconselhamento , Exercício/fisiologia , Exercício/psicologia , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/reabilitação , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nefrologistas/psicologia , Recursos Humanos de Enfermagem/psicologia , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Diálise Renal/psicologia , Comportamento Sedentário
12.
Clin Exp Nephrol ; 23(10): 1221-1234, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31250148

RESUMO

BACKGROUND: Cognitive impairment (CI) is common among patients on peritoneal dialysis (PD), but it is under-recognized and systematic review on its prevalence and impact across different geographical locations or patient characteristics is lacking. METHODS: A search of the literature on CI in PD patients published between 1 Jan 1980 and 25.April 2019 was conducted. Meta-analysis using a random effects model was performed to determine the pooled estimate of the prevalence of CI. Meta-regression was performed to identify factors contributing to the variance of prevalence rate. A systematic review was also performed to study risk factors of CI and its impact on clinical outcomes. RESULTS: Eight studies were included and the relevant data from 1736 patients were extracted for analysis. Meta-analysis revealed a pooled prevalence of CI at 28.7% (95% CI 15.9-46%). Meta-regression analyses showed that the prevalence of CI was unrelated to patient's age, gender, duration of PD, healthcare policy of dialysis modality, the prospective or retrospective nature of studies, or year of publication. Systematic review of 20 studies showed that older age, female sex and lower education were risk factors for CI. Potential reversible factors for CI include electrolytes disturbances, depression and vitamin D deficiency. Also, CI was associated with a higher risk of hospitalization, mostly due to PD-related peritonitis. CONCLUSIONS: CI is common in patients on long-term PD. Screening for CI should be considered in PD patients with increased risk.


Assuntos
Disfunção Cognitiva/epidemiologia , Diálise Peritoneal/efeitos adversos , Disfunção Cognitiva/complicações , Disfunção Cognitiva/psicologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/psicologia , Diálise Peritoneal/psicologia , Prevalência
13.
PLoS One ; 14(6): e0218335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31194838

RESUMO

BACKGROUND: Depression is common in dialysis patients, but the clinical impact of this condition is poorly defined. METHODS: Out of 57,703 patients starting dialysis during 2000-2007 recorded in the National Health Insurance Research Database of Taiwan, we identified 2,475 patients with a clinical diagnosis of depression, and compared them with 1:5 age- and sex-matched patients without a depression diagnosis (n = 12,375). Patients were followed up for hospitalisation due to severe infections, major adverse cardiovascular events (MACE) and death. Multivariable Cox regression and competing risk analyses (accounting for death when appropriate) were used to estimate risk associations. RESULTS: Patients with depression had a higher frequency of comorbidities. During a mean follow-up of 3.2 years, 1,140 severe infections, 806 MACE, and 1,121 deaths were recorded. Compared to controls, patients with depression were at increased risk of death (adjusted hazard ratio 1.24; 95%CI 1.16-1.33). Patients with depression were also at higher risk of severe (1.14; 1.06-1.22) and fatal infections (death within 30 days, 1.22; 1.09-1.35), attributed mainly to sepsis (1.19; 1.08-1.31), septic shock (1.36; 1.13-1.62) and pneumonia (1.19; 1.07-1.33). Conversely, no association was observed between depression and the MACE risk (1.04; 0.94-1.15). CONCLUSION: Dialysis patients with depression are associated with increased risk of infections and death.


Assuntos
Depressão/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Depressão/etiologia , Feminino , Humanos , Falência Renal Crônica/psicologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan , Adulto Jovem
14.
Health Qual Life Outcomes ; 17(1): 78, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053092

RESUMO

BACKGROUND: Older patients with end-stage renal disease (ESRD) have experienced diminished quality of life and debilitating symptoms. Conservative management may be a potential treatment option. Currently, limited studies have been conducted about the main outcome of conservative management, including quality of life, symptoms and sleep quality. The aim of this systematic review was to examine the quality of life, symptoms and sleep quality of elderly patients with ESRD undergoing conservative management. METHODS: Evidence-based medicine database (JBI and Cochrane) and original literature database (PubMed, Medline, EMbase, Web of Science) were searched up to March 12, 2018. The quality of included papers was evaluated with the Newcastle-Ottawa Scale. RESULTS: Eight studies met the inclusion criteria. The total of 1229 patients were involved with an average age of 60.6 ~ 82 years. Patients choosing conservative management were older and more functionally impaired compared to those opting for dialysis. 55% patients undergoing conservative management had stable or improved quality of life and symptoms in prospective cohort study. However, the results revealed that there were no significant differences in quality of life and symptom between conservative management and renal replacement therapy. Only one study assessed quality of life of older patients using SF-36, with a lower score in physical health subscale of conservative management patients than those of renal replacement therapy. Although more than 40% of the patients had poor sleep quality, no significant difference was found between conservative management and renal replacement therapy. Sleep disorders were associated with fatigue and other symptoms. CONCLUSIONS: Although there is a limited literature, conservative management is likely to improve quality of life and alleviate symptoms of end-stage renal disease patients with considerable clinical implications mainly in elderly patients. Future study should pay more attention to the various treatment outcomes of conservative management, providing abundant evidence.


Assuntos
Tratamento Conservador/psicologia , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Fadiga/etiologia , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Diálise Renal/psicologia , Transtornos do Sono-Vigília/etiologia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(19): e15570, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083229

RESUMO

BACKGROUND: Intradialytic resistance training (IRT) protects patients' muscle mass and functions against protein-energy wasting, malnutrition and cachexia. However, the evidence of the effects of such an intervention in haemodialysis patients is limited and not conclusive. To improve the applicability of such interventions, we need a better understanding of molecular, functional and psycho-social adaptation in dialysed patients following a physical training. Therefore, the aim of this study is to investigate the effects of IRT on lower extremity muscle functions, quality of life, and anxiety and depression, clinical outcomes and circulatory micro-ribonucleic acid (miRNA) profiles in patients on chronic haemodialysis therapy. METHODS: We will perform a quasi-experimental study in 3 dialysis centres. Patients will be recruited via their nephrologists and will be allocated to an experimental and a control group based on the location of the patients' dialysis centre. Patients allocated to the experimental group will undergo a 12-week IRT, while the control group will remain physically inactive during dialysis. The primary outcome is the change in the maximal force produced during an isometric contraction of lower extremity muscles. Secondary outcomes regard quality of life, anxiety and depression, clinical outcomes and circulatory miRNA profiles. Patients' level of health literacy defined as the ability to get and understand health information will be also measured in the study as a potential modifier of effects. DISCUSSION: This quasi-experimental study can add in an important way to our understanding of the effects of resistance training on dialysis patients' muscle strength, quality of life and disease-specific outcomes.


Assuntos
Estudos Clínicos como Assunto , Falência Renal Crônica/terapia , Diálise Renal , Treinamento de Resistência , Ansiedade/terapia , Depressão/terapia , Humanos , Contração Isométrica , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/psicologia , MicroRNAs/sangue , Estudos Multicêntricos como Assunto , Força Muscular , Qualidade de Vida , Treinamento de Resistência/métodos , Resultado do Tratamento
16.
BMC Public Health ; 19(1): 531, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072378

RESUMO

BACKGROUND: Even though depression is one of the most common psychiatric disorders, it is under-recognized in hemodialysis (HD) patients. Existing literature does not provide enough information on evaluation of predictors of depression among HD patients. The objective of the current study was to determine the prevalence and predictors of depression among HD patients. METHODS: A multicenter prospective follow-up study. All eligible confirmed hypertensive HD patients who were consecutively enrolled for treatment at the study sites were included in the current study. HADS questionnaire was used to assess the depression level among study participants. Patients with physical and/or cognitive limitations that prevent them from being able to answer questions were excluded. RESULTS: Two hundred twenty patients were judged eligible and completed questionnaire at the baseline visit. Subsequently, 216 and 213 patients completed questionnaire on second and final follow up respectively. The prevalence of depression among patients at baseline, 2nd visit and final visit was 71.3, 78.2 and 84.9% respectively. The results of regression analysis showed that treatment given to patients at non-governmental organizations (NGO's) running HD centers (OR = 0.347, p-value = 0.039) had statistically significant association with prevalence of depression at final visit. CONCLUSIONS: Depression was prevalent in the current study participants. Negative association observed between depression and hemodialysis therapy at NGO's running centers signifies patients' satisfaction and better depression management practices at these centers.


Assuntos
Falência Renal Crônica/psicologia , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Índice de Gravidade de Doença , Adulto , Idoso , Depressão/epidemiologia , Feminino , Seguimentos , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Prevalência , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
17.
PLoS One ; 14(4): e0216045, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034497

RESUMO

BACKGROUND: The hemodialysis regimen is an inevitable and mandatory treatment for patients with end-stage renal disease (ESRD). During the dialysis journey, patients may experience maladaptation in terms of sleep disturbances, depressive symptoms, and reduced health-related quality of life (HRQOL). Psychosocial resources such as social support may have beneficial influences on health outcomes, but studies have rarely analyzed the integrated relationships among risk factors which include pain, sleep disturbances, duration since diagnosis and various health outcomes in Taiwan. This study aimed to bridge this gap by investigating the relationships among related risk factors, social support, sleep disturbances, depressive symptoms, and HRQOL, which is composed of physical quality of life (PQOL) and mental quality of life (MQOL), in ESRD patients. METHOD: A correlational design was used, and 178 patients aged 20 years or older were recruited via convenience sample. The relationships among the risk factors, the mediators, depressive symptoms, PQOL, and MQOL were analyzed using structural equation modeling. RESULTS: The findings showed that more than 70% of the participants reported poor sleep quality, and 32% reported depressive symptoms. When participants had greater pain and more sleep disorders, they were more likely to be depressed. When participants had more appraisal support; they had better PQOL and fewer depressive symptoms. Overall, the structural equation model explained 31.8% of the variance in self-reported depressive symptoms, 29.4% of the variance in PQOL, and 5.7% of the variance in MQOL. Moreover, appraisal support enhanced PQOL and reduced depressive symptoms by exerting its two mediating effects on sleep disturbances. CONCLUSION: Our findings indicate that patients with ESRD who have more social support have better PQOL and MQOL and fewer depressive symptoms than those with less social support.


Assuntos
Depressão/psicologia , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Transtornos do Sono-Vigília/psicologia , Apoio Social , Depressão/epidemiologia , Humanos , Falência Renal Crônica/psicologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
18.
Qual Life Res ; 28(8): 2081-2090, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30937731

RESUMO

PURPOSE: Quality-of-life is poor in end-stage kidney disease; however, the relationships between earlier stages of chronic kidney disease (CKD) and are poorly understood. This study explored longitudinal quality-of-life changes in a community-based CKD cohort and assessed associations between CKD and quality-of-life over time, and between baseline quality-of-life and CKD outcomes. METHODS: We used the Australian diabetes, obesity and lifestyle study-a nationally representative, prospective cohort with data collected at baseline, year 5 and year 12-to examine the relationships between CKD stage, quality-of-life and outcomes. Linear mixed regression, cox proportional hazards, Kaplan-Meier and competing risks analyses were used. RESULTS: Of 1112 participants with CKD and baseline quality-of-life data, the physical component summary (PCS) score was significantly lower than for the general population (p = 0.01 age and sex adjusted), while the mental component summary (MCS) score was no different (p = 0.9 age and sex adjusted). In our unadjusted mixed effects model, more advanced kidney disease was associated with lower PCS and higher MCS at baseline (p < 0.001 and p < 0.01, respectively); however, this effect was no longer significant after adjustment for demographic and clinical variables. The rate of decline in PCS over the period of follow-up was greatest for those with more advanced kidney disease (p < 0.001 in unadjusted model, p = 0.007 in adjusted model). There was no association between change in MCS over the period of follow-up and severity of kidney disease in either the unadjusted or adjusted model (p = 0.7 and p = 0.1, respectively). Lower PCS, but not MCS, was associated with increased cardiovascular and increased all-cause mortality even after adjustment for key demographic and clinical variables (p < 0.001). CONCLUSIONS: Physical, but not mental, quality-of-life is significantly impaired in CKD, and continues to decline with disease progression.


Assuntos
Nível de Saúde , Falência Renal Crônica/psicologia , Qualidade de Vida/psicologia , Insuficiência Renal Crônica/psicologia , Adulto , Idoso , Austrália , Estudos de Coortes , Diabetes Mellitus/patologia , Progressão da Doença , Feminino , Humanos , Falência Renal Crônica/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/terapia
19.
Adv Clin Exp Med ; 28(7): 871-878, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30968610

RESUMO

BACKGROUND: Advances in the treatment of chronic kidney disease (CKD) resulted in expanding therapy goals from simple prolongation of life to a return to normal social functioning and having an active and satisfactory life after reaching adulthood. OBJECTIVES: The aim of the study was to evaluate life activity, disease acceptance (DA) and quality of life (QOL) in patients with end-stage renal disease (ESRD) treated with renal replacement therapy (RRT) since childhood. MATERIAL AND METHODS: We surveyed 117 patients aged .16 years on RRT since childhood. The control group included 25 healthy subjects. We used questionnaires that included a sociodemographic questionnaire (questions regarding education, work, family, and offspring), Acceptance of Illness Scale (AIS), Satisfaction With Life Scale, and Kidney Disease Quality of Life (KDQOL). RESULTS: A completed survey was returned by 45 respondents aged 27.16 }6.78 years, among whom 82.2% had a transplanted kidney and 17.8% were on hemodialysis (HD). Higher education was reported by 18.18% of respondents, secondary and primary by 63.64% and 18.18%, respectively. Employment was reported by 46.67% of the respondents. A family was started by 35% of women and 4% of men. Good DA was found in 28.9% of the respondents. Satisfaction with life was lower in the study group compared to the control group. We found statistically significant correlations between the age when the kidney disease was diagnosed and satisfaction with life (r = 0.33), and between the time since the last change of RRT modality and emotional well-being (r = 0.34). The number of kidney transplantations correlated negatively with emotional component of QOL (r = .0.66) and emotional well-being (r = .0.73). CONCLUSIONS: Patients treated with RRT were quite well adapted to their chronic disease but showed less ability to live independently. Young age at the diagnosis of kidney disease, loss of kidney transplant and living on social security benefit had a negative effect on their emotional well-being.


Assuntos
Falência Renal Crônica/terapia , Transplante de Rim/psicologia , Estilo de Vida , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Terapia de Substituição Renal/psicologia , Participação Social/psicologia , Adolescente , Adulto , Criança , Feminino , Humanos , Falência Renal Crônica/psicologia , Masculino , Inquéritos e Questionários
20.
Int J Palliat Nurs ; 25(3): 129-141, 2019 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-30892999

RESUMO

BACKGROUND:: There is limited understanding of the symptoms that older people living with cancer, chronic obstructive pulmonary disease and chronic kidney disease experience during the last year of life in Thailand, in addition to their health service preferences. AIMS:: To survey the symptom experiences and health service preferences at the end of life of older people with chronic illnesses from the perspective of bereaved carers. METHODS:: The study used a retrospective post-bereavement approach to collect quantitative data. Purposive sampling was used to select 76 bereaved relatives of older people living with chronic illnesses who had died in the previous 5 to10 months. Telephone interviews and a translated version of the Views of Informal Carers-Evaluation Services (VOICES) questionnaire were conducted. Data were analysed using the statistical package SPSS version 17. FINDINGS:: The overall quality of care received by older people living with chronic diseases during the last three months of life was described as 'good' (36%). However, in comparing the quality of care from different settings, most of the subjects (63%) thought that the quality of care at home should be rated as 'poor'. During the last twelve months, 35% of the respondents rated pain and poor appetite as the main symptoms, while 25% described experiencing 'worry' related to being at the end of life. The severity of many symptoms increased during the last three months of life; 21% of carers recommended that pain caused the most suffering to their relatives at 'all times', when compared with other symptoms of end of life. Around 21-35% reported that their relatives 'sometimes' experienced worry, low mood, breathlessness and oedema. During the last three days of life, it was reported by 97% of respondents that their relatives spent all of their time in hospital, and no respondents reported that their relatives had died at home. CONCLUSION:: The study indicates that older people living with chronic diseases in Thailand are less likely to access specialist palliative care and are more likely to have poor symptom control at the end of life. It indicates that health services may not be meeting patients' needs and that there was clearly insufficient healthcare provision at home for older people to help them to manage their symptoms such as pain and breathlessness.


Assuntos
Doença Crônica/enfermagem , Preferência do Paciente , Idoso , Doença Crônica/psicologia , Feminino , Serviços de Saúde para Idosos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Humanos , Entrevistas como Assunto , Falência Renal Crônica/enfermagem , Falência Renal Crônica/psicologia , Masculino , Neoplasias/enfermagem , Neoplasias/psicologia , Doença Pulmonar Obstrutiva Crônica/enfermagem , Doença Pulmonar Obstrutiva Crônica/psicologia , Tailândia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA