Life In Chronic Kidney Disease Patients Research Articles

The Importance of Biochemical Parameters, Immunonutritional Status, and Social Support for Quality of Life in Chronic Hemodialysis Patients.

Background and Objectives: Chronic kidney disease (CKD) is a growing public health problem and one of the leading causes of premature death worldwide. The progressive nature of CKD is associated with serious complications that can reduce the quality of life in CKD patients. Additional factors that can worsen well-being include dialysis treatment, malnutrition, inflammation, and lack of social support. The aim of our study was to analyze the quality of life of CKD patients undergoing hemodialysis and its association with certain biochemical and immunonutritional parameters, as well as with social support. Materials and Methods: This research was conducted as a cross-sectional study that included 170 patients, divided into two groups: a group of patients undergoing hemodialysis (HD group) (n = 85), and a control group of non-hemodialysis patients (group with CKD stage 3-4) (n = 85). The Health-Related Quality of Life (HRQoL) score was used to assess the quality of life of the study population. Measurement of biochemical and immunonutritional parameters was also performed in all patients. The Oslo-3 Social Support Scale (OSSS-3) was used to analyze social support. Results: The HRQoL score was significantly lower in HD patients compared to patients with CKD stage 3-4 (0.701 ± 0.137 vs. 0.832 ± 0.122, p < 0.001). It declined significantly as the concentrations of urea (β = -0.347, p < 0.001), creatinine (β = -0.699, p = 0.005), uric acid (β = -0.184, p = 0.016), β2-microglobulin (β = -0.432, p < 0.001), and parathormone (β = -0.209, p = 0.006) increased in HD patients. In addition to uremic toxins, an increase in glucose (β = -0.278, p = 0.010) and triglyceride (β = -0.354, p = 0.001) concentrations was associated with poor HRQoL in patients with CKD stage 3-4. There was a significant connection between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and HRQoL in HD patients (β = 0.229, p = 0.035). Additionally, C-reactive protein (β = -0.361, p < 0.001) and neutrophil-to-lymphocyte ratio (β = -0.288, p < 0.001), as markers of systemic inflammation, directly affected HRQoL in HD patients. In both study groups, perceived social support positively influenced the HRQoL scores (β = 0.192, p = 0.012 for hemodialysis; β = 0.225, p = 0.038 for non-hemodialysis). Conclusions: There is a decline in HRQoL in chronic hemodialysis patients, significantly affected by certain biochemical and immunonutritional parameters, along with perceived social support.

Correlation Between RET-He and Quality of Life in Chronic Kidney Disease Patients with Routine Hemodialysis: A Study at Ulin General Hospital Banjarmasin

Background: The 2018 Riskesdas report revealed that the incidence of chronic kidney disease (CKD) affects 0.38% of Indonesia’s population. Anemia frequently complicates CKD, especially in patients undergoing regular hemodialysis. Reticulocyte hemoglobin equivalent (RET-He) assesses hemoglobin content in reticulocytes, indicating iron availability for erythropoiesis in the bone marrow. CKD significantly impacts patients' socio-economic status, heightening morbidity and mortality while diminishing quality of life. The relationship between RET-He and the quality of life in CKD patients on routine hemodialysis remains unclear. Objective: To investigate the correlation between RET-He and quality of life in CKD patients undergoing routine hemodialysis. Methods: A cross-sectional observational analytical study with data from medical records of CKD patients receiving routine hemodialysis between October 1st and October 30th, 2021. The Spearman correlation test was used for analysis. Results: This study included 92 patients, consisting of 40 males and 52 females, with a median age of 50 years and RET-He values at 31. Quality of life metrics included physical function (800, range: 0-1000), physical limitations (300, range: 0-400), body pain (175, range: 75-255), general health (475, range: 225-600), vitality (320, range: 200-400), social function (175, range: 75-200), emotional limitations (300, range: 100-300), and mental health (380, range: 160-500). The correlation analysis revealed no significant relationships: physical function (p=0.359), physical limitations (p=0.813), body pain (p=0.373), general health (p=0.547), vitality (p=0.616), social function (p=0.828), emotional limitations (p=0.482), and mental health (p=0.136). Conclusion: There is no significant correlation between RET-He levels and the quality of life in CKD patients undergoing regular hemodialysis.

Risk Factors and Drug Therapy Monitoring in CKD Patients (Chronic Kidney Disease)

Chronic Kidney Disease (CKD) is a global health problem that affects millions of people, characterized by a progressive decline in kidney function. This study aims to determine Drug Related Problems (DRPs) in the treatment management of CKD (Chronic Kidney Disease) patients. This study used the literature review method. The research results from the collected literature will be summarized and presented in the form of descriptive analysis. Researchers will conduct literature searches through online sites such as Google Scholar, PubMed, ResearchGate, Elsevier, and NCBI. The keywords used are “CKD risk factors” and “drug therapy for CKD patients”. The results of the search for relevant literature will be collected and selected according to the inclusion criteria. The research results from the collected literature will be presented in the form of a descriptive table. The table will include information such as author, year of publication, article title, and summary of the study results. The prevalence of drug-related problems (DRP) in CKD patients ranges from 12% to 87%. Commonly found problems include ineffective treatment, inappropriate drug selection, and drug dosing issues. Regular drug monitoring and dose adjustment are essential to reduce adverse drug reactions and improve patient outcomes. Effective drug therapy management and patient education are essential to improve the quality of care and life of CKD patients. In conclusion, this study emphasizes the importance of identifying and addressing drug-related problems (DRPs) to improve treatment effectiveness in CKD patients. Close drug monitoring and comprehensive patient education are key components in the optimal management of CKD.

Improving well-being and enhancing awareness in patients undergoing hemodialysis through the person-centered IARA model: an exploratory study.

Chronic kidney disease (CKD) globally represents a significant health challenge, particularly among patients undergoing chronic hemodialysis. A careful nutritional and pharmacological prescription plays a key role in the effective management of these patients to optimize serum electrolytes, such as potassium, phosphorus, and protein intake. Furthermore, these patients can suffer psychological distress due to dietary restrictions and tight medication schedules. The present study explores the effectiveness of the person-centered IARA model in improving physiological markers and quality of life in CKD patients undergoing hemodialysis treatment. To demonstrate the effectiveness of the IARA model, 60 patients (M = 40; F = 20; 60.5 ± 9.9 years) undergoing thrice-weekly hemodialysis sessions were enrolled and randomly and blindly assigned to the Control or IARA group. The reduction in abnormal blood potassium, phosphorus, and total protein levels was investigated, alongside the psychological state through the SF-12 questionnaire. Preliminary findings showed a discernible reduction in the frequency of abnormal blood K (> 5.0 mmol/L) and P (> 4.5 mmol/L) levels in the IARA group compared to the Control group. In particular, such reductions were approximately 40% for K (OR = 0.57; 95% CL = 0.23/1.46) and about 15% for P (OR = 0.86; 95% CL = 0.27/2.74). A similar tendency was also observed for patient fluid intake during each hemodialysis session, with the frequency of higher-risk patients in the IARA group being 50% lower (OR = 0.50; 95% CL = 0.07/3.79) than that of the Control group. Although preliminary findings from this study suggest that the IARA model may have a positive effect on CKD patients' subjective wellbeing and quality of life (QoL), further research is needed to understand the long-term impact of the IARA intervention.

Factors associated with risk analysis for asymptomatic left ventricular diastolic dysfunction in nondialysis patients with chronic kidney disease

Heart failure (HF) constitutes a major determinant of outcome in chronic kidney disease (CKD) patients. The main pattern of HF in CKD patients is preserved ejection fraction (HFpEF), and left ventricular diastolic dysfunction (LVDD) is a frequent pathophysiological mechanism and specific preclinical manifestation of HFpEF. Therefore, exploring and intervention of the factors associated with risk for LVDD is of great importance in reducing the morbidity and mortality of cardiovascular disease (CVD) complications in CKD patients. We designed this retrospective cross-sectional study to collect clinical and echocardiographic data from 339 nondialysis CKD patients without obvious symptoms of HF to analyze the proportion of asymptomatic left ventricular diastolic dysfunction (ALVDD) and its related factors associated with risk by multivariate logistic regression analysis. Among the 339 nondialysis CKD patients, 92.04% had ALVDD. With the progression of CKD stage, the proportion of ALVDD gradually increased. The multivariate logistic regression analysis revealed that increased age (OR 1.237; 95% confidence interval (CI) 1.108–1.381, per year), diabetic nephropathy (DN) and hypertensive nephropathy (HTN) (OR 25.000; 95% CI 1.355–48.645, DN and HTN vs chronic interstitial nephritis), progression of CKD stage (OR 2.785; 95% CI 1.228–6.315, per stage), increased mean arterial pressure (OR 1.154; 95% CI 1.051–1.268, per mmHg), increased urinary protein (OR 2.825; 95% CI 1.484–5.405, per g/24 h), and low blood calcium (OR 0.072; 95% CI 0.006–0.859, per mmol/L) were factors associated with risk for ALVDD in nondialysis CKD patients after adjusting for other confounding factors. Therefore, dynamic monitoring of these factors associated with risk, timely diagnosis and treatment of ALVDD can delay the progression to symptomatic HF, which is of great importance for reducing CVD mortality, and improving the prognosis and quality of life in CKD patients.

Mental Health and Quality of Life in Chronic Kidney Disease Patients with Mild-to-Moderate Depression: A Retrospective Cohort Study of Mindfulness-Based Stress Reduction Therapy.

Chronic kidney disease (CKD) patients may experience pessimism, and even despair, due to long-term nature of the condition, which increases the risk of depression. Mindfulness-based stress reduction (MBSR) can relieve depression. This retrospective cohort study aimed to investigate the effects of MBSR on mental health and quality of life in CKD patients with mild-to-moderate depression, so as to provide guidance for clinical nursing programs. The clinical data of 100 CKD patients with mild-to-moderate depression who were treated in Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences from January 2021 to March 2023 were retrospectively analyzed. Based on nursing method received, the patients were divided into the conventional group (conventional management) and the MBSR group (MBSR therapy was implemented in addition to conventional management). After matching, there were 35 cases in each group. The scores for the self-rating depression scale (SDS), Connor-Davidson Resilience Scale (CD-RISC), Five-factor Mindfulness Questionnaire (FFMQ), Pittsburgh Sleep Quality Index (PSQI), and 36-item Short Form Health Survey (SF-36) were compared between the two groups. After management, the SDS and PSQI scores of the MBSR group were lower than those of the conventional group, and the CD-RISC, FFMQ and SF-36 scores were higher than those of the conventional group (p < 0.05). MBSR can improve the mental health, sleep quality, and quality of life of CKD patients with mild-to-moderate depression, and improve psychological resilience and mindfulness.

Impact of Oral Nutritional Supplementation in Chronic Kidney Disease Patients on Maintenance Hemodialysis: An Open-label, Single-arm Study among Indian Patients.

Protein-energy wasting (PEW) affects about 50-75% of patients with chronic kidney disease (CKD), particularly those who are on maintenance hemodialysis (MHD). This study evaluated the efficacy and tolerability of an oral nutritional supplement in Indian patients receiving MHD. This was a 3-month, prospective, open-label, and single-centered study. Eligible participants supplemented their regular diet with one sachet (40 gm) of oral nutritional supplement powder twice daily for 90 days. The study efficacy endpoints were mean change in acute phase proteins (albumin and prealbumin), anthropometric measurements [weight, body mass index (BMI), and triceps skin fold thickness], handgrip strength, hemoglobin, total iron binding capacity (TIBC), potassium, and phosphorus levels, malnutrition score (MS)-modified subjective global assessment (modified SGA), malnutrition inflammation score (MIS), and nutritional status. The study population comprised 36 (42.9%) men and 48 (57.1%) women with a mean age of 54.85 ± 15.50 years. A paired sample t-test was used to compare the baseline with end-of-study values for continuous variables. Serum albumin, prealbumin, hemoglobin, and phosphorus levels remained stable throughout the study period. The mean change in weight, BMI, triceps skin fold thickness, handgrip strength, and TIBC for the overall study population was 1.11 kg (1.82%, p < 0.0001), 0.46 kg/m2 (1.98%, p < 0.0001), 3.47 mm (30.78%, p < 0.0001), 6.05 kg (44.98%, p < 0.0001) and 11.80 µg/dL (6.06%, p < 0.0001), respectively. At the end of the study period, there was a significant (p < 0.0001) improvement in the SGA and MIS scores. Further, there was a significant improvement in nutritional status as demonstrated by the overall intake of calories (p < 0.001), proteins (p < 0.0001), carbohydrates (p = 0.003, and fats (p < 0.0001). Protein-energy malnutrition is a strong predictor of morbidity, mortality, and poor outcomes in CKD patients. A scientifically designed formula in accordance with KDOQI standards was able to improve the nutritional status, overall body composition, sarcopenia, and quality of life in CKD patients on MHD.

Effect of psychosocial interventions for depression in adults with chronic kidney disease: a systematic review and meta-analysis

BackgroundPeople with chronic kidney disease (CKD) treated with dialysis are frequently affected by depression. Psychotherapy has been reported to decrease depressive symptoms in various chronic diseases and is a potential treatment option for depression. We aimed to perform a systematic review and meta-analysis to evaluate the effect of psychotherapy on depression in adults with CKD.MethodsWe searched MEDLINE, Embase, Web of Science, and Cochrane for published studies up to October 31, 2023. Two investigators independently reviewed the included studies and extracted relevant data. Randomized controlled trials (RCTs) assessing the impact of interventions that provide psychological, emotional, or social support without the use of pharmacological substances on depressive symptoms in people with CKD were included and summarized. Scores on different tools for depressive assessment and quality of life were pooled.ResultsA total of 19 RCTs published between 2004 and 2023 were included and analyzed. The weighted mean difference (WMD) for all included studies with regard to depression was − 2.32 (95%CI=-3.83, -0.80, P = 0.003). The WMD for Beck Depression Inventory (BDI) score of depression was − 3.27 (95%CI=-7.81, 1.27, P = 0.158) with significant heterogeneity (I2 = 95.1%). Significant WMD was detected for the Hospital Anxiety and Depression Scale (HADS) tool: WMD=-1.90, 95%CI=-2.91, -0.90, P < 0.001. The WMD for all included studies regarding quality of life was 1.21 (95%CI=-0.51, 2.93, P = 0.168). The WMD for Kidney Disease Quality of Life Short Form (KDQOL-SF) score was 4.55 (95%CI = 0.50, 8.60, P = 0.028). The WMD for SF-36 score was 0.02 (95%CI=-10.33, 10.36, P = 0.998). Significant difference on outcomes of S-PRT scale was observed (WMD = 2.42, 95%CI = 1.07, 3.76, P < 0.001).ConclusionsPsychosocial interventions probably reduce the depression level among CKD patients. Preliminary evidence suggests that psychosocial interventions might be beneficial for the quality of life in CKD patients. Our results provide medical facilities with an evidence-based basis for establishing psychosocial interventions in kidney care settings.

A Prospective Observational Study to Assess Medication Adherence and Health Related Quality of Life in Chronic Kidney Disease Patients in a Tertiary Care Hospital

Chronic Kidney Disease(CKD) patients belong to the group of subjects with large burden of daily pill intake. Failure of adherence to these medications can lead to increased morbidity, mortality, cost, and burden on health care system. Therefore, good medication adherence is important to obtain desired therapeutic outcome which in turn improves the quality of life.&#x0D; The objective of this study is to assess medication adherence and health related quality of life in CKD patients.&#x0D; A prospective observational study was conducted for 6 months at Indiana Hospital and Heart Institute, Mangalore. Total 100 participants diagnosed with CKD were enrolled for the study. Permission from the Ethical Committee was taken and informed consent was obtained from the study subjects before initiating the study. Demographic, clinical and treatment details were collected in a specially designed data collection forms. Patient’s adherence to the medication was assessed with the help of Brief Medication Questionnaire (BMQ) and patient’s quality of life was assessed using Kidney Disease Quality of Life Short Form (KDQOL-SF). The data was expressed using descriptive statistics and analyzed using Chi square test, Mann Whitney test, and Spearman Correlation Statistics.&#x0D; Out of 100 patients enrolled in the study, 63 were male and 37 were female. The average number of medicines taken in a day by each patient was 10. 12% of the study population was completely adherent to the drug therapy. BMQ had 3 domains in which 39% of the patients were adherent and 61% were non adherent to the Regimen screen, 68% were adherent and 32% were non adherent to the Belief screen, and 31% were adherent and 69% were non adherent to the Recall screen. High cost of medicine (69%), Complex dosing schedule (68%), and Unaware about seriousness of condition or use of medicine (63%) were most common reasons for Non-adherence. Using KDQOL questionnaire, mean scores for Dialysis staff encouragement (96.25±9.31) and Quality of social interaction (87.86±17.48) were high whereas Physical role (4.75±16.92) and Emotional role (13.03±31.44) were found to be low.&#x0D; These results indicate that non adherence to medications leads to deteriorating quality of life and high therapeutic complexity.

Neural Drive Impairment in Chronic Kidney Disease Patients Is Associated with Neuromuscular Fatigability and Fatigue.

Chronic kidney disease (CKD) patients have a high degree of fatigue relating to neuromuscular symptoms. There is a lack of evidence regarding the etiology of neuromuscular fatigability in elderly CKD patients. Inclusion criteria are as follows: age ≥60 yr, glomerular filtration rate (GFR) <45 mL·min -1 per 1.73 m 2 in CKD patients, and GFR >60 mL·min -1 ·1.73 m -2 in controls. The fatigability protocol consisted in a submaximal handgrip task at 40% peak force. Fatigue was assessed using the Multidimensional Fatigue Inventory-20 items (MFI-20) and the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaires. Peak rate of force development (RFD peak , normalized: NRFD peak ) and rate of EMG rise (RER) were measured during explosive contractions; peak force and mean surface EMG were measured during maximum voluntary contractions. Multilevel models tested neuromuscular parameters adjusted for clinical and Multidimensional Fatigue Inventory-20 items subscales. Neuromuscular fatigability contribution to fatigue description was tested using model comparison. The study included 102 participants; 45 CKD patients and 57 controls. CKD mainly affected the mental and the reduced motivation subscales of fatigue. CKD was associated with greater neuromuscular fatigability assessed using NRFD peak (group-time interaction, -16.7 % MVF·s -1 , P = 0.024), which increased with fatigue severity ( P = 0.018) and with a higher rate of decrement in RER compared with controls (RER at 50 ms: β = -121.2 μV·s -1 , P = 0.016, and β = -48.5 μV·s -1 , P = 0.196, respectively). Furthermore, these patients show an association between the reduced motivation subscale and the RER (e.g., 30 ms: β = -59.8% EMG peak ·s -1 , P < 0.001). Only peak force fatigability contributed to fatigue variance, whereas RFD peak did not. In CKD patients, the neuromuscular fatigability assessed using RFD peak is related to an impairment in motor-unit recruitment or discharge rates, whereas only peak force fatigability was related to fatigue. This suggests that targeting exercise interventions might lessen fatigue and improve quality of life in CKD patients.

Factors Affecting Quality of Life in Hemodialysis Patients.

BackgroundHemodialysis is one of the main therapies for patients with end-stage renal disease. Quality of life is essential in the management of chronic kidney disease (CKD) patients undergoing hemodialysis. Factors that influence the quality of life in hemodialysis patients must be identified.PurposeThis research evaluated the quality of life in CKD patients undergoing hemodialysis and determined factors affecting the quality of life.Patients and MethodsThis study used an analytical survey method with a cross-sectional design. The Subjective Global Assessment (SGA) questionnaire was used to evaluate nutritional status, and the KDQOL-SFTM questionnaire was used to evaluate quality of life. The bivariate statistical test applied was the Student’s t-test or the Mann–Whitney U-test. Multivariate analysis was done using logistic regression.ResultsThe total number of hemodialysis patients in the study was 124. Their median age was 44 years. The patients consisted of 66 (53%) men and 58 (47%) women. Overall, 84 patients had good quality of life (67.7%), and 40 (32.3%) reported poor quality of life. Our study showed a relationship between economic status and quality of life (p = 0.029) and between the number of comorbid factors and quality of life (p = 0.014). No relationship was found between nutritional status and quality of life (p = 0.121). Multivariate analysis using logistic regression analysis showed that the number of comorbidities was a significant factor in quality of life (p = 0.004, OR = 3.4 [1.67–7.46]).ConclusionThe majority of hemodialysis patients had good quality of life. Logistic regression analysis found that the number of comorbidities was a significant factor in the quality of life of hemodialysis patients. Comorbidities in hemodialysis patients must be managed to improve their quality of life.

Quality of Life in CKD Patients on Low-Protein Diets in a Multiple-Choice Diet System. Comparison between a French and an Italian Experience.

Prescribing a low-protein diet (LPD) is part of the standard management of patients in advanced stages of chronic kidney disease (CKD). However, studies on the quality of life (QoL) of patients on LPDs are lacking, and the impact these diets have on their QoL is often given as a reason for not prescribing one. We, therefore, decided to assess the QoL in a cohort of CKD stage 3–5 patients followed up by a multiple-choice diet approach in an outpatient nephrology clinic in France. To do so, we used the short version of the World Health Organization’s quality of life questionnaire and compared the results with a historical cohort of Italian patients. We enrolled 153 patients, managed with tailored protein restriction in Le Mans, and compared them with 128 patients on similar diets who had been followed in Turin (Italy). We found there were no significant differences in terms of age (median 73 vs. 74 years, respectively), gender, CKD stage, and comorbidities (Charlson’s Comorbidity Index 7 vs. 6). French patients displayed a greater body mass index (29.0 vs. 25.4, p < 0.001) and prevalence of obesity (41.2 vs. 15.0%, p < 0.001). Baseline protein intake was over the target in France (1.2 g/kg of real body weight/day). In both cohorts, the burden of comorbidities was associated with poorer physical health perception while kidney function was inversely correlated to satisfaction with social life, independently of the type of diet. Our study suggests that the type of LPD they follow does not influence QoL in CKD patients and that a personalized approach towards protein restriction is feasible, even in elderly patients.

Hubungan Anemia dengan Kualitas Hidup Pasien PGK yang Menjalani Hemodialisis

Chronic Kidney Disease (CKD) is a progressive and irreversible disorder of renal function, in which the body's ability to fail to maintain metabolism and balance of fluids and electrolytes, causing uremia. The purpose of this study in general was to determine the relationship between hemoglobin levels and quality of life in chronic kidney disease patients undergoing hemodialysis at dr. M. Yunus Bengkulu. This type of research is descriptive analytic with cross sectional approach. The study sample was 64 patients with CKD who underwent hemodialysis at the hemodialysis installation with accidental sampling technique. The results showed that most patients with chronic kidney disease who underwent haemodialysis (71.9%) had severe anemia and most (56.3%) had a poor quality of life. Chi square test results obtained ρ value 0,000 (α = 0.05). Conclusion, There is a statistically significant correlation between anemia and quality of life in CKD patients undergoing hemodialysis in the RDUD Dr. Hemodialysis room. M. Yunus. Suggested to Dr. Hospital M. Yunus Bengkulu to control the incidence and symptoms of anemia experienced by CKD patients. Keywords: Anemia, Hemodialysis, quality of life, CKD

CKDNET, a quality improvement project for prevention and reduction of chronic kidney disease in the Northeast Thailand

BackgroundThe incidence of chronic kidney disease (CKD) is high in the Northeast Thailand compared to other parts of the country. Therefore, a broad program applying all levels of care is inevitable. This paper describes the results of the first year trial of the Chronic Kidney Disease Prevention in the Northeast Thailand (CKDNET), a quality improvement project collaboratively established to curb CKD.MethodsWe have covered general population, high risk persons and all stages of CKD patients with expansive strategies such as early screening, effective CKD registry, prevention and CKD comprehensive care models including cost effectiveness analysis.ResultsThe preliminary results from CKD screening in general population of two rural sub-districts show that 26.8% of the screened population has CKD and 28.9% of CKD patients are of unknown etiology. We have established the CKD registry that has enlisted a total of 10.4 million individuals till date, of which 0.13 million are confirmed to have CKD. Pamphlets, posters, brochures and other media of 94 different types in the total number of 478,450 has been distributed for CKD education and awareness at the community level. A CKD guideline that suits for local situation has been formulated to deal the problem effectively and improve care. Moreover, our multidisciplinary intervention and self-management supports were effective in improving glomerular filtration rate (49.57 versus 46.23 ml/min/1.73 m2; p < 0.05), blood pressure (129.6/76.1 versus 135.8/83.6 mmHg) and quality of life of CKD patients included in the program compared to those of the patients under conventional care. The cost effectiveness analysis revealed that lifetime cost for the comprehensive health services under the CKDNET program was 486,898 Baht compared to that of the usual care of 479,386 Baht, resulting in an incremental-cost effectiveness ratio of 18,702 Baht per quality-adjusted life years gained.ConclusionCKDNET, a quality improvement project of the holistic approach is currently applying to the population in the Northeast Thailand which will facilitate curtailing of CKD burden in the region.

Manajemen Diet dan Kualitas Hidup Pasien Penyakit Ginjal Kronik Yang Menjalani Hemodialisis di Rumah Sakit

Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) experience a decrease in physical health status that affects their quality of life. CKD patients need proper self-care management, including diet management to manage and maintain their health status. The purpose of this paper is to analyze the differences in the quality of life of CKD patients undergoing hemodialysis between the various dietary management they undertake. Method: cross-sectional study design, samples of all CKD patients undergoing hemodialysis were 60 respondents. Dietary management measures are the subscale Hemodialysis Patient's Self-care Management Scale (HPSMS): dietary regulatory; food safety; and therapeutic diet implementation. Quality of life using the Kidney Disease Quality of Life (KDQOL) SF 1.3 instrument. The univariate analysis uses the central tendency and proportion, and bivariate analysis uses the Fisher-exact test. Results: the average age of 47.3 years, 53.3% of men, the median value of HD 10.5 months long, 58.3% did not work. 83.3% poor diet management, safe 83.3% poor food, 68.3% poor therapeutic diet implementation, and 81.7% poor quality of life of CKD patients. There was a significant difference in the quality of life of CKD patients between various dietary arrangements, (p=0.0001), safe food (p=0.013), and implementation of a therapeutic diet (p=0.027). Conclusion: A good diet management has the opportunity to improve the quality of life of CKD patients.

P1549TREATMENT BURDEN AND ITS IMPACT ON QUALITY OF LIFE AMONG CHRONIC KIDNEY DISEASE PATIENTS WITH DIABETES MELLITUS IN QATAR

Abstract Background and Aims Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) and on of its top comorbidities. Its management places significant burden on patients and results in impairment of their health-related quality of life (HR-QOL). Little is known about diabetes mellitus treatment-related burden in patients with CKD. This study aimed to investigate the impact of diabetes mellitus on treatment-related burden and HR-QOL among CKD patients in Qatar. Method This was a mixed-method, sequential explanatory study conducted at Fahad Bin Jassim Kidney Center in Qatar on hemodialysis and pre-dialysis (GFR&amp;lt;20 but not on dialysis yet) patients. Treatment-related burden and HR-QOL were assessed quantitatively using the Treatment Burden Questionnaire (TBQ) and the Kidney Disease Quality of Life (KDQOL™) questionnaire, respectively. To gain a deeper insight, qualitative one-to-one semi-structured interviews were conducted among the CKD patients. Quantitative data were analyzed descriptively and inferentially using SPSS version 24. Thematic content analysis was performed for the qualitative data. Results Two hundred-eighty CKD patients (hemodialysis = 223 and pre-dialysis (GFR &amp;lt;20) = 57) were included. 157 has DM and 66 were non-DM (in hemodialysis) while 32 patients had DM vs 25 non-DM (in pre-dialysis). In general, 35% of patients reported moderate to high burden. Hemodialysis patients experienced significantly higher treatment burden compared to pre-dialysis patients with median (IQR) of 45 (36) versus 25 (33), respectively (p&amp;lt;0.001). DM patients expressed significantly higher TBQ score compared to non-DM (47(40) vs. 36(27) p&amp;lt;0.001). Retinopathy was associated with worsened treatment burden (TBQ 46.5(29) vs. 40(38) p=0.019). Medication burden and lifestyle change burden were the highest perceived treatment-related burden, followed by administrative, social, and financial burden. The presence of antidiabetic medications correlated with worse TBQ score (0.207 p&amp;lt;0.001). There was a strong, negative correlation between TBQ score and KDQOL-36™ score [rs (251) = -0.616, p &amp;lt;0.001]. Presence of DM was associated with worse KDQOL (2110(1055) vs. 2685(1170) p&amp;lt;0.001). Thematic content analysis identified religion and faith in God as well as quality of the care provided as factors that reduce perceived treatment burden and improve patients’ HR-QOL. Conversely, medication burden, lifestyle changes, challenges with international travelling, financial burden, and empathy were factors that worsen perceived treatment-related burden and HR-RQOL. Conclusion This study suggests that diabetes mellitus and its treatment negatively impacts treatment-related burden and quality of life in CKD patients. This result should be considered in management strategies when designing healthcare interventions directed to CKD patients with diabetes mellitus.

P0664CKDSENS, A NOVEL HEALTHCARE PLATFORM FOR CHRONIC KIDNEY DISEASE

Abstract Background and Aims The 10% of the global adult population, more than 730 million people, suffers from some degree of chronic kidney disease (CKD). From that population, a 30% is suffering from an advanced stage of the disease. Approximately 38 million of the European population is affected by an advanced stage renal disease with 1 million of new cases every year. These patients require close monitoring, which increase the burden of the disease. New tools and methods are required to improve the patients’ well-being, the perception and management of their disease, decrease the impact of the complications, as well as to delay of the progression of the disease. Method Seven partners have joined in the CKDSens consortium and are contributing to the project with different expertise and technical resources (medical, technological, educational, business and management): CreatSens Health SL, Hospital Clínic de Barcelona – Fundació Privada Clínic per a la Recerca Biomèdica, Genesis Biomed, Eurecat, Universitat de Barcelona, Universidad Politécnica de Madrid, and Madopa. This consortium is a novel and unique technological platform, combining in vitro diagnostic devices and software components, that connects patients with CKD and healthcare professionals to improve the well-being of people and the efficiency of the healthcare system by monitoring relevant biomarkers out of the hospital in a simple and cost- effective connected paper-based sensors. The proposal aims to increase the quality of life of CKD patients through early diagnostics, real time monitoring and personalization of therapies. Results The CKDSens consortium is developing a novel technological platform for real-time and low-cost diagnostics for two key biomarkers in renal diseases (creatinine and potassium), which include a new point-of-care device that allows monitoring by remote control these biomarkers. The technology has been patented for both biomarkers, and it has been transferred to CreatSens, a spinoff from Universitat Rovira i Virgili. The product integrates paper-based sensors in a drop of blood analysis, wireless connectivity and a digital platform as data analytics. The aim of the consortium is to validate the use of a new medical device as a product that can fit and truly generate value and business. Through that perspective, the optimization, manufacturing and validation of the tool and the business case will be performed as a first step, while usability, end user interaction and regulatory pathway will be developed in the second step. CKDSens will afford a novel approach to embed healthcare in daily life and routine. This new strategy implies production and commercialization for prevention and diagnose where markets are well known and validated. The aim is to mimic a well-known business model such as glucometer, translating this one into renal diseases. CKDSens has risen funding for this purpose through a grant of the European Institute of Innovation and Technology (EIT Health, ID Project 19579), and it is working to have validated this device at the end of the year. This requires also a clinical validation, which will be performed in a clinical trial in the second half of the year. Conclusion CKDSens consortium has been created as a novel technological platform to develop and validate a new medical device for a remote control of patients with CKD, in order to increase the quality of life of CKD patients through early diagnostics, real time monitoring and personalization of therapies. It is expected to have this device designed and validated by the end of the year 2020 and ready for further commercialization.

A Single Arm Trial in Treatment of CKD Patients with Sodium Copper Chlorophyllin Formulation

In a prospective, single arm study of 34 Chronic Kidney Disease (CKD) patients in a trial of 90 days wherein patients got standard-of-care treatment and liquid composition containing Sodium Copper Chlorophyllin, the Investigational Product (IP), as add-on treatment for first 60 days and patients were ‘off’ the IP for last 30 days. Significant reduction in serum creatinine, Blood Urea and Uric acid level and significant improvement in estimated Glomerular Filtration Rate (eGFR), and Health related criteria for quality of life were observed in 60 days’ period of administration. eGFR remained significantly higher on 90th day than 0 day despite withdrawal of IP after 60 days. These observations suggest partial/limited reversal of lost kidney function as a lingering effect of the IP. Both these are first observations opening up new avenues for improving life of CKD patients. This is first clinical trial report of an orally consumed product that decreases serum creatinine and also actually improved health related quality of life within 60 days and a surprising evidence that suggests significant degree of restoration of kidney function in the progressively degenerative disease CKD. This clinical trial opens opportunities for managing CKD that were never available so far.

Prevalence of Depression in Patients with CKD 5 on Hemodialysis at A Tertiary Care Center in Nepal

Introduction: Co-morbid depression impacts negatively on quality of life in Chronic Kidney Diseasepatients. It is unclear if self-reported depression rating scales can be used accurately for screening.The aim of this study was to estimate prevalence of depression in patients on hemodialysis usingPatient Health Questionnaire-9 and compare Patient Health Questionnaire-9, Max Hamilton Ratingscale and International Classification of Disease-10 for diagnosis of depression.&#x0D; 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. Informedand written consent was taken. Patients undergoing hemodialysis at Nepal Medical College for &gt;3 months duration were included in study. Patients on hemodialysis were asked to fill validatedNepali translated version of Patient Health Questionnaire -9. Psychiatrist administered MaxHamilton Rating scale for diagnosis and categorization of depression and confirmed depressionbased on International Classification of Disease -10. Statistical Package for Social Sciences version 20was used for statistical analysis.&#x0D; Results: Total of 100 patients completed study. Median age was 47.5 years. Prevalence of depressionwas 78 (78%) using Patient Health Questionnaire-9 and 65 (65%) using Max Hamilton Rating scaleand 51 (51%) using International Classification of Disease -10. Mean depression in males using PatientHealth Questionnaire -9 was 7±4.33 and in females was 11.04±5.90. The most common symptom wasfatigue among 82 (82%).&#x0D; Conclusions: There is a high prevalence of depression in patients with Chronic Kidney Disease onhemodialysis compared to general population.

Prevalence of Depression, Anxiety and Insomnia in Chronic Kidney Disease Patients and their Co-Relation with the Demographic Variables.

Chronic kidney disease (CKD) is an emerging health problem in both developed and developing countries. Depression, anxiety and sleep disturbances are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patients' health. Assessment of key components of mental health early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life in CKD patients. We did a cross sectional study in 200 patients of CKD stage III to V-D fulfilling the eligibility criteria who were on follow up in a single tertiary care center in the state of Haryana, India. We assessed the prevalence of anxiety, depression and insomnia and their correlation with demographic variables in these patients. The structured questionnaire used in this study gathered information on respondent demographic and disease characteristics, and information obtained from the HADS and PSQI questionnaire. Factors associated with anxiety, depression and insomnia were examined by a multiple logistic regression analysis. The prevalence of anxiety, depression and insomnia were found to be 71%, 69% and 86.5% respectively. As the CKD stage advanced, the prevalence as well as severity of these parameters increased. Anxiety, depression and sleep quality were found to be significantly correlated to unemployment, low income, low education, urban residence and presence of co-morbidities. The anxiety, depression and insomnia scores were found to have a strong negative correlation with eGFR, hemoglobin, serum calcium (p <0.01) and a positive correlation with TLC, blood urea, serum creatinine and serum phosphate (p <0.05). We observed a high prevalence of anxiety, depression and insomnia in CKD patients. There is a need to develop strategies to accurately identify "high risk" subjects who may benefit from preventive measures before complications occur. By identifying CKD patients with high risk of developing these mental health related issues, healthcare provider may be better able to ensure the provision of appropriate rehabilitation to this population.