Life In Dialysis Patients Research Articles

Residual Urine Output and Mortality in a Prospective Hemodialysis Cohort

IntroductionAlthough residual urine output (UOP) is associated with better survival and quality of life in dialysis patients, frequent measurement by 24-hour urine collection is burdensome. We thus sought to examine the association of patients’ self-reported residual UOP, as an alternative proxy of measured residual UOP, with mortality risk in a prospective hemodialysis cohort study.MethodsAmong 670 hemodialysis patients from the prospective multicenter Malnutrition, Diet, and Racial Disparities in Kidney Disease study, we examined associations of residual UOP, ascertained by patient self-report, with all-cause mortality. Patients underwent protocolized surveys assessing presence and frequency of UOP (absent, every 1–3 days, >1 time per day) every 6 months from 2011 to 2015. We examined associations of baseline and time-varying UOP with mortality using Cox regression.ResultsIn analyses of baseline UOP, absence of UOP was associated with higher mortality in expanded case-mix adjusted Cox models (ref: presence of UOP): hazard ratio (HR), 1.78 (95% confidence interval [CI], 1.16–2.72). In analyses examining baseline frequency of UOP, point estimates suggested a graded association between lower frequency of UOP and higher mortality, although estimates for UOP every 1 to 3 days did not reach statistical significance (reference: UOP >1 time per day): HR, 1.29 (95% CI, 0.82–2.05) and HR, 1.97 (95% CI, 1.24–3.12) for UOP every 1 to 3 days and absence of UOP, respectively. Similar findings were observed in analyses of time-varying UOP.ConclusionIn hemodialysis patients, there is a graded association between lower frequency of self-reported UOP and higher mortality. Further studies are needed to determine the clinical impact of more frequent assessment of residual UOP using self-reported methods.

Routinely measuring symptom burden and health-related quality of life in dialysis patients: first results from the Dutch registry of patient-reported outcome measures.

BackgroundThe use of patient-reported outcome measures (PROMs) is becoming increasingly important in healthcare. However, incorporation of PROMs into routine nephrological care is challenging. This study describes the first experience with PROMs in Dutch routine dialysis care. MethodsA pilot study was conducted in dialysis patients in 16 centres. Patients were invited to complete PROMs at baseline and 3 and 6 months. PROMs consisted of the 12-item short-form and Dialysis Symptom Index to assess health-related quality of life (HRQoL) and symptom burden. Response rates, HRQoL and symptom burden scores were analysed. Qualitative research methods were used to gain insight into patients’ views on using PROMs in clinical practice.ResultsIn total, 512 patients (36%) completed 908 PROMs (24%) across three time points. Response rates varied from 6 to 70% among centres. Mean scores for physical and mental HRQoL were 35.6 [standard deviation (SD) 10.2] and 47.7 (SD 10.6), respectively. Patients experienced on average 10.8 (SD 6.1) symptoms with a symptom burden score of 30.7 (SD 22.0). Only 1–3% of the variation in PROM scores can be explained by differences between centres. Patients perceived discussing their HRQoL and symptom scores as insightful and valuable. Individual feedback on results was considered crucial.ConclusionsThe first results show low average response rates with high variability among centres. Dialysis patients experienced a high symptom burden and poor HRQoL. Using PROMs at the individual patient level is suitable and may improve patient–professional communication and shared decision making. Further research is needed to investigate how the collection and the use of PROMs can be successfully integrated into routine care to improve healthcare quality and outcomes.

Behavioral Changes During Development of Chronic Kidney Disease in Rats.

Decreased renal function due to chronic kidney disease (CKD) is associated with anxiety and cognitive decline. Although these mental disorders are often obvious in late stage renal disease patients, they might be unnoticeable or are neglected in early stages of the CKD development. Associations between renal and cognitive dysfunction have been indicated by studies performed mainly in patients undergoing dialysis, which itself represents a stress and decreased quality of life. However, experimental and causal studies are scarce. Our aim was to investigate dynamic changes in behavioral traits during the progression of CKD in an animal model. Thirty 12-week old male rats were used in this experiment. CKD was induced by a subtotal (5/6) nephrectomy. Two, 4, and 6 months after surgical induction of CKD, the open field, the light-dark box and the novel object recognition tests were conducted to assess the locomotor activity, anxiety-like behavior and the memory function of rats. Blood urea nitrogen (BUN), plasma concentration of creatinine (CREAT), albumin to creatinine ratio in urine (ACR) along with the renal histology were assessed to monitor the development and severity of CKD. In comparison to control rats, 5/6 nephrectomized rats had by 46–66% higher concentration of BUN during the whole follow-up period, as well as by 52% and by 167% higher CREAT and ACR, respectively, 6 months after surgery. Although the effect of time was observed in some behavioral parameters, nephrectomy did not significantly influence either locomotor activity, or anxiety-like behavior, or memory function of animals. Two and 4 months after surgery, animals moved shorter distance and spent less time in the center zone. However, the open-field ambulation returned back to the baseline level 6 months after CKD induction. Although nephrectomized rats displayed impaired kidney function as early as 2 months after surgery, no significant differences were found between the CKD and the control rats in any of the observed behaviors. Further studies are needed in order to evaluate whether behavioral abnormalities are related to severity of CKD or might be attributed to psychosocial aspect of end-stage renal disease and decreased quality of life in dialysis patients.

Calidad de vida de los pacientes en diálisis. Revisión sistemática

calidad de vida relacionada con la salud en pacientes en diálisis, identificando los instrumentos de medida más utilizados. Material y Método: Se ha realizado una revisión sistemática en las bases de datos PubMed, Scopus, Google Académico y Scielo. Se han incluido artículos científicos en inglés y español. Se han analizado artículos que tratan la calidad de vida relacionada con la salud en pacientes en diálisis, excluyendo aquellos artículos que no aportaban resultados concluyentes, en población pediátrica y en los que se analizaba este parámetro exclusivamente en pacientes trasplantados. Resultados: Se han incluido 36 artículos publicados entre 2009-2019. La calidad de vida relacionada con la salud aparece disminuida en todos los pacientes en diálisis, más concretamente en hemodiálisis. Las variables más influyentes en la disminución de la calidad de vida relacionada con la salud del paciente en diálisis, son: sexo femenino, edad avanzada, no poseer un núcleo familiar, estudios primarios, y afectación de la situación laboral en pacientes en edad para trabajar; además de comorbilidad asociada a la patología renal, ansiedad y depresión, presencia de dolor y con grado de dependencia alto. Conclusiones: La disminución de la calidad de vida está presente en la mayoría de los pacientes de diálisis, con más frecuencia en hemodiálisis. Respecto a los instrumentos de evaluación empleados, el más utilizado es el KDQOL-SF. Esta pérdida de la calidad de vida se relaciona con ser mujer, edad avanzada, comorbilidad asociada, dolor con limitaciones, presencia de ansiedad y/o depresión y mayor dependencia.

Improving Depression, Hope, and Quality of Life in Dialysis Patients Using Health Promotion Education Groups

Taiwan has the highest incidence and prevalence of dialysis in the world. The literature suggests that severity of depression at the beginning of dialysis treatment is an independent predictor of survival. Depression significantly worsens the condition of chronic renal disease patients, with the adverse consequences of depression including increased mortality and hospitalization rates as well as poor compliance and quality of life. Given the importance of this problem, providing safe and effective information and good nursing care to dialysis patients is urgently needed. The purpose of this study was to explore the effects of implementing health promotion education groups on self-perceived depression, hope, and quality of life in dialysis patients. Dialysis patients who met the study criteria and had provided consent to participate in the health promotion education group were randomly assigned to either the treatment group (20 persons) or the control group (20 persons). In the control group, routine dialysis treatment and nursing care were maintained. In addition to receiving routine dialysis treatment and nursing care, the experimental group participated in health promotion education group activities for 90 minutes, twice a week for a total of 8 sessions. The quantitative data from both groups and the qualitative data analysis of the experimental group were used to assess the effects of the intervention. The results showed that the intervention had significantly improved self-perceived depression, hope, and quality of life in the experimental group. The participants indicated that the health promotion education group had helped them learn to adapt to their physical conditions, change their mindset, learn to regard happiness as the purpose of life, and maintain hope and increase mutual support in the face of difficulties. This study demonstrated that the cross-disciplinary integrated care provided through health promotion education groups is able to significantly improve depression, hope, and quality of life in dialysis patients. Thus, health promotion education groups arranged by the case management nurses for dialysis patients have the potential to promote mental health and quality of life in these patients. Therefore, continuing education is recommended to strengthen the awareness and knowledge of dialysis case management nurses with regard to applying integrated cross-disciplinary care in health promotion education groups and to promoting the implementation of these groups in the holistic care of dialysis patients.

Dimensions of Depressive Symptoms and Their Association With Mortality, Hospitalization, and Quality of Life in Dialysis Patients: A Cohort Study

Unraveling specific dimensions of depressive symptoms may help to improve screening and treatment in dialysis patients. We aimed to identify the best-fitting factorial structure for the Beck Depression Inventory-II (BDI) in dialysis patients and to assess the relation of these structure dimensions with quality of life (QoL), hospitalization, and mortality. This prospective study included chronic dialysis patients from 10 dialysis centers in five hospitals between 2012 and 2017. Dimensions of depressive symptoms within the BDI were analyzed using confirmatory factor analysis. To investigate the clinical impact of these dimensions, the associations between symptom dimensions and QoL, hospitalization rate, and mortality were investigated using logistic, Poisson, and Cox proportional hazard regression models. Multivariable regression models included demographic, social, and clinical variables. In total, 687 dialysis patients were included. The factor model that included a general and a somatic factor provided the best-fitting structure of the BDI-II. Only the somatic dimension scores were associated with all-cause mortality (hazard ratio of 1.7 [1.2-2.5], p < .007) in the multivariable model. All dimensions were associated with increased hospitalization rate and reduced QoL. The somatic dimension of the BDI-II in dialysis patients was associated with all-cause mortality, increased hospitalization rate, and reduced QoL. Other dimensions were associated with hospitalization rate and decreased QoL. These findings show that symptom dimensions of depression have differential association with adverse clinical outcomes. Future studies should take symptom dimensions into account when investigating depression-related pathways, screening, and treatment effects in dialysis patients.

SP687Association between Care Satisfaction and Quality of Life in Dialysis patients: a Further Weapon for Nephrologists?

SP687Association between Care Satisfaction and Quality of Life in Dialysis patients: a Further Weapon for Nephrologists?

Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis

BackgroundHealth related quality of life (HRQOL) is an important predictor of clinical outcomes for End Stage Renal Disease (ESRD) patients and to establish quality adjusted life years (QALYs) for economic evaluation studies. This study aims to measure the health utilities and to identify socio-demographic and clinical factors associated with HRQOL for haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) in Malaysia.MethodsA total of 141 patients (77 HD and 64 CAPD) from 1 federal and four state hospitals participated in this cross-sectional study. Patients were randomly selected from the National Renal Registry (NRR) using a stratified random sampling. The EQ-5D-3 L questionnaire was used to measure HRQOL. Variables investigated include dialysis modalities, sociodemographic characteristics, co-morbidities and biochemical markers. Utilities are measured on an ordinal scale of 0–1, where 1 indicates full health and 0 indicates death.ResultsThe mean utility scores were 0.854 ± 0.181 and 0.905 ± 0.124 (p > 0.05) and the mean Visual Analogue Scale (VAS) scores were 76.2 ± 12.90 and 77.1 ± 10.26 (p > 0.05) for HD and CAPD patients respectively. There was a significant difference in problems reported between HD (35.1%) and CAPD (15.6%) on usual activities dimension (p = 0.009). The proportion of patients having problems in the pain/discomfort domain in both modalities was high (34.0%). Haemoglobin (< 10 g/dL) (p = 0.003), number of co-morbidities ≥3 (p = 0.004) and wheelchair-bound status (p < 0.001) were significant predictors of poor HRQOL.ConclusionsThe present cross-sectional study shows that CAPD patients have a higher utility index score than HD patients but this was not statistically significant. The utilities index score may be used to calculate QALYs.

C-reactive protein as a marker of pediatric hemodilaysis adequacy

Objective To compare the C-reactive protein (CRP) levels with the delivered dose of dialysis in terms of index of hemodialysis adequacy (Kt/V) in patients undergoing maintenance hemodialysis (HD). Background According to different studies, the target Kt/V should be 1.2 per session, while weekly Kt/V should be 4.5 for thrice-weekly HD patients to maintain adequate HD. Patients and methods This is a comparative, cross-sectional survey study. Patients who fulfilled the inclusion and exclusion criteria were enrolled in the present study. The delivered dose of HD, Kt/V was assessed by online clearance module (OCM) in Fresenius machines at the end of every session of dialysis and the weekly Kt/V was determined by adding all the three Kt/V values. On the other hand, serum CRP was determined after each session of HD. Both weekly Kt/V and CRP values were entered in a predesigned proforma. Results Of 30 patients on maintenance HD, high serum CRP level (>6 mg/dl) was found in nine patients. When the Kt/V was compared with the CRP level, there was a negative correlation between the two parameters (r = −0.4, P Conclusion Low Kt/V means dialysis inadequacy, and is associated with chronic inflammatory state resulting in high CRP levels. To reduce the rate of morbidity and mortality, we concluded that the quality of life of dialysis patients can be improved by offering an adequate dose of HD reflected by Kt/V of at least 4.5 per week in all patients with end-stage renal disease.

Effects of sleep disorders and sedative–hypnotic medications on health-related quality of life in dialysis patients

Sleep disorders are very common among dialysis patients, leading patients to frequently take sedative-hypnotic medications; however, the effects of sleep disorders and the use of such drugs on health-related quality of life (HRQOL) have rarely been investigated. The Pittsburgh Sleep Quality Index and Short Form-12 were used to assess sleep quality and patient health situations, respectively. Logistic regression was employed to identify factors associated with deterioration of the mental component summary (MCS) score and the physical component summary (PCS) score. A total of 461 patients undergoing dialysis were recruited. The prevalence of sleep disorders was 67.0%. Among the study population, 30.4% of patients took sedative-hypnotic medications to improve their sleep quality. Both the PCS (81.25 vs. 71.88, p < 0.001) and MCS scores (78.63 vs. 74.63, p < 0.001), which indicate HRQOL, were decreased among patients with sleep disorders compared with good sleepers. However, neither the PCS nor MCS scores showed any significant difference between patients with sleep disorders who used sedative-hypnotic medications and those who did not. Sleep disorders were closely associated with deterioration of both mental HRQOL and physical HRQOL. Sedative-hypnotic medication use did not affect HRQOL among patients with sleep disorders undergoing dialysis.

Relationship Between Duration of Dialysis and Quality of Life in Hemodialysis Patients

Background: The number of patients with chronic renal failure is increasing in Iran. Quality of life is an important indicator that reveals the sense of well-being, positive understanding of their, and the effectiveness of health care in patients undergoing dialysis, which could be affected by duration of dialysis. Objectives: This study aimed at investigating the relationship between quality of life and duration of dialysis in hemodialysis patients. Methods: In this descriptive correlational study, 246 patients with chronic kidney failure were selected by Single-stage stratified cluster sampling. Hemodialysis patients were put into 2 groups with a duration of hemodialysis less than and more than 36 months and were then compared with each other. The quality of life was measured using the kidney disease quality of life short form (KDQOL- SF36). Data analysis was performed by the Pearson correlation coefficient, independent t-test, and ANOVA Results: The mean duration of hemodialysis patients was 34.03 months. There was no significant relationship between the quality of life in patients and duration of hemodialysis. Poor quality of life had a significant correlation with old age (P < 0.001), educational level (P < 0.001), job, and income (P < 0.001). Conclusions: The findings showed poor quality of life in patients on dialysis. The length of the disease and other accompanying diseases reduced the quality of life in dialysis patients as their age increased. It is evident that educated people who have better access to sources of support and are able to cope with disease complications have a higher quality of life.

透析患者における唾液分泌量低下と健康関連Quality of Lifeの関連

透析患者における唾液分泌量低下と健康関連Quality of Lifeの関連

The Effect of Depression and Perceived Social Support Systems on Quality of Life in Dialysis Patients

The Effect of Depression and Perceived Social Support Systems on Quality of Life in Dialysis Patients

Impact of Hepatitis C on Health Related Quality of Life in Dialysis Patients

Impact of Hepatitis C on Health Related Quality of Life in Dialysis Patients

How Can We Improve the Quality of Life of Dialysis Patients?

As medical advances are made in the care of persons with chronic illnesses including those with end-stage renal disease (ESRD), patients are not only experiencing increasing life expectancy but also bearing the burden of illness and treatment for a longer duration of time. With this in mind, it is increasingly important for health care providers to pay close attention to their individual patient's perceptions of their health, fitness, life satisfaction, and well-being. This assessment of Health-Related Quality of Life (HRQOL) also includes an evaluation of the patient's level of satisfaction with treatment, outcome, and health status, also taking into account their perspective on future prospects. In addition to improving patient-provider communication by helping in the identification and prioritization of problems, it is important to note that high HRQOL has been shown to be associated with better medical outcomes, including reduction in hospitalizations and death. In this review, we outline several validated tools that are used to quantitatively measure HRQOL in the ESRD population and incorporate these instruments in a review of specific, evidence-based measures by which we can measurably improve health-related quality of life in dialysis patients.

Assessment of Anemia and Quality of Life in Patients With Renal Transplantation

PurposeAnemia is associated with poor quality of life in dialysis patients. However, data on this association are scarce on transplant patients. We aimed to find the frequency of anemia, and the effect of anemia on the quality-of-life parameters in patients who have undergone kidney transplantation. MethodsAnemia was defined by a hemoglobin (Hgb) level of <12 g/dL and severe anemia by a Hgb level of <10 g/dL. All patients were evaluated with the Kidney Disease Quality of Life (KDQOL-SF) scale forms. ResultsTwo hundred patients (128 male and 72 female; mean age, 39.2 ± 11.5 years) were examined. Anemia was found in 19% and severe anemia was found in 4.5% of all patients. Low glomerular filtration rate, young age, and female gender were demographic parameters associated with anemia. Parathormone levels were higher in the anemic group. The use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and mammalian target of rapamycin inhibitors was significantly higher in the anemic group. In addition, patients with anemia had a lower KDQOL-SF mental health component score than that of the patients without anemia. ConclusionsAnemia was related to the degree of renal function in posttransplant patients. Anemia had an important influence on mental health in renal transplant patients.

Depression, anxiety and stress among patients with dialysis and the association with quality of life.

Studies addressing the nature of relationship between psychological symptoms and quality of life among dialysis patients in Malaysia are scarce. Hence, this study is intended to investigate the association between psychological symptoms such as depression, anxiety and stress on the quality of life in dialysis patients. A cross sectional multicentre study was conducted from May to October 2012 at 15 centres that provide haemodialysis and/or peritoneal dialysis. Apart from socio-demographic profile data collection, WHOQOL-BREF and DASS21 questionnaires were administered to study subjects. All three psychological symptoms had significant impact on quality of life domains of physical health, psychological health, social impact, perceived environment and overall quality of life. These findings suggest that subjects with symptoms of depression, anxiety and stress had poorer quality of life than those without, highlighting the negative impact of psychological symptoms.

Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review.

Chronic kidney disease (CKD) is a public health problem. Although physical activity is essential for the prevention and treatment of most chronic diseases, exercise is rarely prescribed for CKD patients. The objective of the study was to search for and appraise evidence on the effectiveness of exercise interventions on health endpoints in CKD patients. A systematic review was performed of randomized clinical trials (RCTs) designed to compare exercise with usual care regarding effects on the health of CKD patients. MEDLINE, EMBASE, Cochrane Central, Clinical Trials registry, and proceedings of major nephrology conference databases were searched, using terms defined according to the PICO (Patient, Intervention, Comparison and Outcome) methodology. RCTs were independently evaluated by two reviewers. A total of 5489 studies were assessed for eligibility, of which 59 fulfilled inclusion criteria. Most of them included small samples, lasted from 8 to 24 weeks and applied aerobic exercises. Three studies included only kidney transplant patients, and nine included pre-dialysis patients. The remaining RCTs allocated hemodialysis patients. The outcome measures included quality of life, physical fitness, muscular strength, heart rate variability, inflammatory and nutritional markers and progression of CKD. Most of the trials had high risk of bias. The strongest evidence is for the effects of aerobic exercise on improving physical fitness, muscular strength and quality of life in dialysis patients. The benefits of exercise in dialysis patients are well established, supporting the prescription of physical activity in their regular treatment. RCTs including patients in earlier stages of CKD and after kidney transplantation are urgently required, as well as studies assessing long-term outcomes. The best exercise protocol for CKD patients also remains to be established.

Quality of Life in Dialysis Patients: A Retrospective Cohort Study

Background/Aim: Physical component summary (PCS) and mental component summary (MCS) scores are associated with hospitalization and mortality in patients with end-stage renal disease. Most studies in these patients are cross-sectional in nature. This study aimed to assess the dynamics of health-related quality of life (HRQOL) over time, as well as determinants of changes in HRQOL. Also, the relation between changes in HRQOL with respect to both hospitalization and mortality was assessed. Methods: A cross-sectional analysis was performed in 77,848 hemodialysis (HD) patients whereas changes in HRQOL were assessed in 8,339 patients over a 1-year time period. HRQOL measurements were assessed with Kidney Disease Quality of Life-36 questionnaires. Also, relevant biomarkers (albumin, creatinine, hemoglobin, sodium) and equilibrated normalized protein catabolic rate (enPCR) were measured. Results: HRQOL were found to be decreased in HD patients. Nutritional indices like creatinine (r = 0.23; p < 0.0001) and serum albumin (r = 0.21; p < 0.0001) positively correlated with PCS scores. An increase in levels of albumin, creatinine, hemoglobin, enPCR and serum sodium over time are significantly (p < 0.0001) associated with positive changes in PCS scores. Changes in PCS scores were found to be predictive for hospitalization and mortality. The correlates of predictors for MCS scores were less strong compared to that of PCS scores. The strongest positive predictors of MCS scores were age (r = 0.08; p < 0.0001), albumin (r = 0.05; p < 0.0001) and sodium (r = 0.05; p < 0.0001). Conclusions: Nutritional factors are strongly associated with changes in HRQOL, especially with regard to PCS scores (change over time in HRQOL was an independent predictor of hospitalization and mortality). Increased scores of HRQOL over time are positively associated with survival.

Assessment of Quality of Life and Fatigue among Haemodialysis Patients

Fatigue is one of the most common symptoms of haemodialysis patients and is associated with poor quality of life. Purpose: To investigate the levels of fatigue and its correlation with quality of life of haemodialysis patients. Results: Of the 134 haemodialysis patients, the majority of patients (52,9%) seemed to have low rates of fatigue (10 <FAS <= 20). However, 15% of these patients seemed to appear high to very high levels of fatigue (30 <FAS <= 50). Studying the quality of life of these patients we can observe a correlation between fatigue and quality of life. In particular , patients who experience higher rates of fatigue seem to have worse quality of life (MVQOLI total score 2.90) than those experiencing lower rates of fatigue (MVOQLI total score 3.67) (p <0,005). Conclusions: The analysis of the results enable us to understand the correlation between fatigue and quality of life among haemodialysis patients with ESRD and the importance of prevention, diagnosis and treatment of fatigue in order to optimize the quality of life in dialysis patients with ESRD.