Quality Of Life In Hemodialysis Research Articles

Comparison of quality of life in hemodialysis and pre dialysis patients: A cross sectional study

To evaluate and compare quality of life in pre dialysis (CKD stage4) and patients with End stage renal disease (ESRD) on maintenance hemodialysis and to analyze the correlation of sociodemographic, clinical and laboratory parameters with quality of lifeThis was a cross-sectional study in which 100 pre dialysis(CKD stage4) and 100 ESRD patients on maintenance hemodialysis were enrolled. SF 36 questionnaire was used to assess quality of life. Quality of life was compared between the two groups and the correlation of quality of life with sociodemographic ,clinical and laboratory parameters was assessed.Pre dialysis group had better SF 36 scores than patients on hemodialysis (64.93±13.05 vs. 59.55±13.29 p=0.004). Erythropoietin use, higher albumin and more frequent dialysis emerged as independent predictors of better quality of life.Perceived quality of life was worse for patients on hemodialysis when compared to pre dialysis patients. Use of erythropoietin, higher albumin levels, and more frequent dialysis were independent predictors of better quality of life.

Relationship between sociodemographic factors and quality of life in hemodialysis patients

Introduction: chronic kidney disease (CKD) is a progressive alteration that can lead to renal replacement therapy (hemodialysis, HD). This situation has an impact on the quality of life and is affected by the patient's sociodemographic factors.Objective: determine the relationship between sociodemographic factors and quality of life in hemodialysis patients.Methods: cross-sectional analytical study in a population of 92 patients with a diagnosis of CKD in stage V, with HD treatment. Biomedical data were collected with a dialysis record. Quality of life was estimated with the KDQOL-36 scale. Their scores were compared according to two or more groups with Mann-Whitney U tests, or Kruskal-Wallis, respectively. Spearman's correlation coefficient was used for ordinal variables. R-Studio was applied.Results: education is statistically related to “symptoms/problems” (p=0,0176), “effects of kidney disease” (p=0,0054), and “burden of kidney disease” (p=0,0200), with a tendency to observe higher scores in university studies; while economic income was the same with these last two factors (rho=0,24 and rho=0,23, respectively). Furthermore, the “symptoms/problems” score was statistically higher in men than women (74.3 versus 64.1; p=0,00417) and in the case of the “physical component” summary, patients treated in a center public hospital presented statistically higher scores compared to patients treated in private centers (38,1 versus 32,0; p=0,00607).Conclusions: there are aspects of quality of life that are linked to sociodemographic factors that health professionals can consider to focus efforts of the health team and improve this important variable

Sex, Gender, and Quality of Life in Hemodialysis

Sex, Gender, and Quality of Life in Hemodialysis

Factors Affecting Quality of Life in Hemodialysis Patients

Purpose: The purpose of this study was to investigate factors affecting quality of life in hemodialysis patients.Methods: In this descriptive study, the subjects were 127 hemodialysis patients at four dialysis clinics in Pusan and Daegu metropolitan cities. Data were analyzed with descriptive statistics, independent t-test, one-way analysis of variance, Pearson’s correlation coefficients, and stepwise multiple regression analysis using SPSS/WIN version 26.0.Results: The average scores for social support, symptom experience, physical function, self-care compliance, and quality of life were 3.97±0.66, 38.50±27.94, 2.24±0.60, 3.43±0.49, and 3.02±0.57, respectively. Fifty-five (43.3%) subjects had a type D personality. Quality of life showed significant differences according to educational background (F=6.44, <i>p</i><.001), job (t=2.52, <i>p</i>=.013), and type D personality (t=4.39, <i>p</i><.001). Social support (r=.32, <i>p</i><.001), physical function (r=.45, <i>p</i><.001), self-care compliance (r=.24, <i>p</i>=.005), albumin (r=.09, <i>p</i>=.027), and phosphorous (r=.27, <i>p</i>=.002) were positively correlated with quality of life. Symptom experience (r=-.40, <i>p</i><.001) was negatively correlated with quality of life. The factors affecting quality of life were social support (β=.31, <i>p</i><.001), physical function (β=.30, <i>p</i><.001), educational background (β=.20, <i>p</i>=.007), type D personality (β=-.19, <i>p</i><.001), and symptom experience (β=-.18, <i>p</i>=.019), with a total explanatory power of approximately 43%.Conclusion: Quality of life in hemodialysis patients was affected by social support, physical function, educational background, type D personality, and symptom experience. These factors should be considered in nursing interventions to improve quality of life of hemodialysis patients.

Böbrek nakli ve hemodiyaliz hastalarında yaşam kalitesini etkileyen faktörler farklılık göstermektedir

Aim: Renal replacement therapies (RRT), including dialysis modalities and renal transplantation (RT), affect patients’ quality of life (QoL) differently. This study aimed to determine the factors affecting the QoL in hemodialysis (HD) and RT patients.
 Material and Method: One hundred patients in each RT and HD group were included in the study. Socio-demographic data was determined with a questionnaire. Laboratory information and other medical information of the patients were obtained from the medical records. Short Form-36 (SF-36) and Nottingham Health Profile (NHP) scales were used to assess the QoL.
 Results: The mean ages in HD and RT patients were 58.28±15.21 and 47.92±12.01 years. Most patients were male (53% HD, 68% RT). RT patients had a higher QoL than HD patients in all components. On the NHP scale, RT patients had higher QoL in all parts except social isolation and emotional reactions. Male gender, non-smoker status, high education level, being employed and living in the city, and some laboratory parameters (hemoglobin, ferritin, sodium, calcium, magnesium, and albumin) positively affected the QoL in the HD group; diabetes and CVD had a negative impact on the QoL. In the RT group, male gender, high education level, being employed; normal potassium, phosphorus, and parathormone levels affect QoL positively while hypertension and CVD negatively affect the QoL.
 Conclusion: Factors affecting QoL in patients receiving RRT are different. Efforts to correct laboratory parameters may impact the quality of life in HD patients. Returning to working life could increase the QoL in RT patients.

The effects of synbiotics on indoxyl sulphate level, constipation, and quality of life associated with constipation in chronic haemodialysis patients: a randomized controlled trial

BackgroundGut microbiota dysbiosis in patients with chronic kidney disease on haemodialysis (CKD-HD) creates an increase in proteolytic bacteria activity, leading to an increase in the production of uraemic toxins, such as indoxyl sulphate, worsening of constipation symptoms and reducing patients’ quality of life. Improving gut microbiota dysbiosis is expected to improve this condition. This study aimed to evaluate the effect of synbiotics on indoxyl sulphate levels, constipation symptoms, and constipation-related quality of life in haemodialysis patients.MethodsThis was a double-blinded randomized controlled clinical trial with a parallel design involving haemodialysis patients. We included chronic haemodialysis patients with gastrointestinal complaints, difficulty defecating, faeces with hard consistency, or a bowel movement frequency of fewer than three times per week. Patients were randomly divided into two groups (synbiotics (Lactobacillus acidophilus and Bifidobacterium longum 5x109 CFU) and placebo) for 60 days of oral intervention. All participants, caregivers, and outcome assessors were blinded to group assignment. The primary outcome was a decrease in indoxyl sulphate toxin levels. Meanwhile, improvement in constipation symptoms (measured using the Patient Assessment of Constipation: Symptoms (PAC-SYM) questionnaire) and improvement in constipation-related quality of life (measured using the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire) were assessed as secondary outcomes.ResultsWe included 60 patients (30 intervention; median age of 51.23 (13.57) years, 33.3% male; 30 control; median age of 52.33 (11.29) years, 36.7% male). There was no significant difference in terms of pre- and postintervention indoxyl sulphate toxin levels in the synbiotics group compared to the placebo group (p=0.438). This study found an improvement in constipation symptoms (p = 0.006) and constipation-related quality of life (p=0.001) after synbiotic administration.ConclusionTwo months of synbiotic supplementation did not lower indoxyl sulphate toxin levels. Nevertheless, it had a major effect in improving constipation and quality of life affected by constipation in patients undergoing chronic haemodialysis.Trial registrationNCT04527640 (date of first registration: 26/08/2020)

Association of Physical Performance, Muscle Strength and Body Composition with Self-Assessed Quality of Life in Hemodialyzed Patients: A Cross-Sectional Study.

(1) Patients on chronic hemodialysis (HD) experience impaired quality of life (QoL). We analyzed HD’s relationship with physical performance, body composition, and muscle strength; (2) QoL was assessed with the Short Form-36, composed of physical (PCS) and mental (MCS) health dimensions. Physical performance was assessed with the Short Physical Performance Battery (SPPB), body composition (lean tissue mass% (LTM%), fat tissue mass% (FTM%), and skeletal muscle mass% (SMM%)) was assessed with bioelectrical impedance, and lower extremity strength was assessed with a handheld dynamometer; and (3) we enrolled 76 patients (27 F, 49 M), age 62.26 ± 12.81 years, HD vintage 28.45 (8.65–77.49) months. Their QoL score was 53.57 (41.07–70.64); their PCS and MCS scores were 52.14 (38.69–65.95) and 63.39 (44.64–76.79) and strongly correlated (p < 0.0001, R = 0.738). QoL correlated positively with SPPB (R = 0.35, p ≤ 0.001), muscle strength (R from 0.21 to 0.41, p < 0.05), and LTM% (R = 0.38, p < 0.001) and negatively with FTM% (R = −0.32, p = 0.006). PCS correlated positively with SPPB (R = 0.42 p < 0.001), muscle strength (R 0.25–0.44, p < 0.05), and LTM% (R = 0.32, p = 0.006) and negatively with FTM% (R = −0.25, p = 0.031). MCS correlated positively with SPPB (R = 0.23, p = 0.047), SMM% (R = 0.25; p = 0.003), and LTM% (R = 0.39, p < 0.001) and negatively with FTM% (R = −0.34; p = 0.003). QoL was unrelated to sex (p = 0.213), age (p = 0.157), HD vintage (p = 0.156), and BMI (p = 0.202); (4) Better physical performance, leaner body composition, and higher muscle strength are associated with better mental and physical QoL in HD.

Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status.

To identify relationships between health-related quality of life (HRQOL) and nutritional status in hemodialysis (HD) patients. Secondary data from a cross-sectional survey was utilized. HRQOL was assessed for 379 HD patients using the generic Short Form 36 (SF-36) and disease-specific Kidney-Disease Quality of Life-36 (KDQOL-36). Malnutrition was indicated by malnutrition inflammation score (MIS) ≥ 5, and presence of protein-energy wasting (PEW). The individual nutritional parameters included the domains of physical status, serum biomarkers, and dietary intake. Multivariate associations were assessed using the general linear model. MIS ≥ 5 was negatively associated with SF-36 scores of physical functioning (MIS < 5 = 73.4 ± 8.0 SE vs MIS ≥ 5 = 64.6 ± 7.7 SE, P < 0.001), role-limitation-physical (MIS < 5 = 65.3 ± 14.3 SE vs MIS ≥ 5 = 52.9 ± 14.0 SE, P = 0.006), general health (MIS < 5 = 53.7 ± 7.5 SE vs MIS ≥ 5 = 47.0 ± 7.1 SE, P = 0.003), and PCS-36 (MIS < 5 = 40.5 ± 3.3 SE vs MIS ≥ 5 = 35.9 ± 3.1 SE, P < 0.001); and KDQOL-36 score of symptoms/problems (MIS < 5 = 78.9 ± 5.6 SE vs MIS ≥ 5 = 74.8 ± 5.4 SE, P = 0.022), but not with PEW by any tool. Of individual nutritional parameters, underweight (68.1 ± 5.4 SE, P = 0.031), normal weight (63.8 ± 2.8 SE, P = 0.023), and overweight (64.3 ± 2.9 SE, P = 0.003) patients had significantly higher physical functioning scores compared to obese patients (44.8 ± 5.5 SE). Serum albumin levels were positively associated with physical functioning (P = 0.041) score. HGS was also positively associated with physical functioning (P = 0.036), and vitality (P = 0.041) scores. Greater dietary phosphorus intakes were significantly associated with lower scores for role limitation-physical (P = 0.008), bodily pain (P = 0.043), and PCS-36 (P = 0.024). Malnutrition diagnosis by MIS, but not PEW, indicated associations with HRQOL in HD patients. Individual nutritional parameters that related to higher HRQOL were BMI < 30kg/m2, better dietary phosphorus control, greater muscle strength and higher visceral protein pool.

Quality of Life in Maintenance Hemodialysis; Stakeholders’ Perspectives – A Qualitative Inquiry

Quality of life is a major concept in the arena of healthcare, especially in chronic diseases. ESRDpatients undergoing maintenance hemodialysis experience unique issues involving varying aspects.Using a qualitative approach, the current study explored the perspectives of stakeholders on qualityof life. Thematic analysis done and three major themes - Dialysis - the life line, Global impact of thedisease and strategies to be made, were emerged. Quality of life in hemodialysis patients is markedlyimpaired due to a variety of factors and a comprehensive and tailored approach will be beneficial.

Locomotive syndrome in hemodialysis patients and its association with quality of life\u2014a cross-sectional study

BackgroundLocomotive syndrome (LS) is defined as impairment of mobility function.This study aimed to clarify LS and its association with quality of life in hemodialysis patients.MethodsThis is a cross-sectional study. The subjects were chronic kidney disease patients undergoing maintenance hemodialysis treatment. LS was assessed using two physical tests (two-step test, stand-up test) and one self-reported test (Geriatric Locomotive Function Scale-25). LS has two stages of severity; the beginning of the decline in mobility function is known as Locomo stage 1, and the progression of the decline of mobility function is known as Locomo stage 2. We used SF-36 to assess quality of life and examined their relationships with the Locomo stages. Chi-square test, Kruskal-Wallis test, Jonckheere-Terpstra test, and Mantel-Haenszel test were used for analysis. Multiple linear regression was used to model the cross-sectional association of Locomo stages with each component and summary score of SF-36.ResultsA total of 76 hemodialysis patients were included. The number of subjects with Locomo stage 1 and stage 2 were 19 (25%) and 53 (70%), respectively, while only four (5%) subjects did not have mobility dysfunction. Each component and summary score of the SF-36 for physical function, role emotional, physical component summary, and mental component summary were significantly associated with Locomo stages.ConclusionA high prevalence and severity of LS in hemodialysis patients was found, and the severity was associated with quality of life.

Validity and reliability of the Arabic-translated kidney disease quality of life survey among long-term dialysis patients in Saudi Arabia.

One of the tools used to measure the quality of life in hemodialysis (HD) patients is the Kidney Disease Quality of Life (KDQOL) survey. The KDQOL has been through several developmental processes, with the most recent one being the KDQOL-36™. Our study evaluated the validity and reliability of the Arabic-translated KDQOL-36™ survey in Saudi chronic dialysis patients. This cross-sectional study was conducted at four HD centers in Saudi Arabia. The KDQOL-36™ survey was translated into Arabic according to the RAND Corporation's basic guidelines for translating surveys. The validation process was achieved by assessing reliability and validity. The reliability of the translated survey was established by Cronbach's alpha to measure internal consistency and the intra-class correlation coefficient (ICC) to measure the test-retest reliability. The validity of the translated survey was established based on content validity and convergent validity. The study included 184 patients (36-65 years; 60.9% of men). Regarding reliability, Cronbach's alpha for the subscales ranged from 0.63 to 0.89, and ICCs ranged from 0.60 to 0.88. For content validity, an expert panel reviewed the questions in depth. In addition, we found a positive relationship between all sub- and overall health-rated scores (P <0.01). The Arabic-translated version of the KDQOL-36™ survey is reliable and valid for evaluating the quality of life in Saudi chronic dialysis patients.

Patient Knowledge, Adherence to the Therapeutic Regimen, and Quality of Life in Hemodialysis : Knowledge, Adherence, and Quality of Life in Hemodialysis.

The aim of this study was to investigate the effect of patients' knowledge on adherence to the hemodialysis regimen and Quality of Life (QoL) of patients undergoing hemodialysis as well as the effect of adherence on QoL. Also, the effect of demographic and clinical characteristics on the above three variables was studied. In this cross-sectional study conducted between March and May 2017, 321 patients on hemodialysis from six hemodialysis units completed the Kidney Disease Questionnaire, the GR-Simplified Medication Adherence Questionnaire and the Missoula Vitas Quality of Life Index-15 to measure the patient knowledge, the adherence to hemodialysis regimen, and the QoL, respectively. The statistical analysis was performed via the Statistical Program SPSS 19.0. The statistical significance level was set up at 0.05. The knowledge was independently associated with the overall QoL and its dimension-transcendence-with total adherence and its dimension-diet/fluid adherence. The total adherence was independently associated with overall QoL and its dimensions-symptoms and interpersonal. The educational level, the type of vascular access, and the daily number of pills were independently associated with the total adherence and the overall QoL. Patient knowledge may have an important effect on adherence and QoL. Adherence may have an important effect on QoL. Demographic and clinical characteristics play, also, a crucial role in the above variables. The findings can help nephrology nurses to quantify the extent of non-adherence in hemodialysis and poor quality of life.

P1565THE COMBINATION OF MALNUTRITION-INFLAMMATION AND LIMITATIONS IN FUNCTIONAL STATUS IS ASSOCIATED WITH A HIGH RISK OF MORTALITY IN HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY

Abstract Background and Aims The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in haemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients. Method We analysed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (&amp;lt;3.8 g/dL) and high serum C-reactive protein (&amp;gt;3mg/L in Japan; &amp;gt;10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (score ranges from 0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, haemoglobin level, and time on dialysis therapy. Results The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to this reference group, the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups. Conclusion The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS status may plausibly help to direct interventions to improve patients’ experiences and lessen adverse clinical outcomes in the HD setting.

Effects of intradialytic resistance training on physical activity in daily life, muscle strength, physical capacity and quality of life in hemodialysis patients: a randomized clinical trial

Purpose: We evaluated the effects of supervised intradialytic resistance training on physical activity in daily life (PADL), muscle strength, physical capacity and quality of life (QoL) in hemodialysis patients.Methods: Twenty-four hemodialysis patients were randomly assigned to either a 12-weeks moderate-intensity resistance training or a control period. An accelerometer evaluated PADL for seven consecutive days, measuring the time spent in different activities and positions of daily routine and the number of steps taken. Muscle strength, physical capacity and QoL were evaluated.Results: After 12 weeks of training, we did not find significant difference (post-pre values) in walking time (−1.2 ± 18.3 vs. −9.2 ± 13.1 min/day); standing time (−10.2 ± 28.6 vs. 3.2 ± 20.1 min/day); sitting time (20.8 ± 58.9 vs. −30.0 ± 53.0 min/day); lying down time (−9.3 ± 57.9 vs. 34.6 ± 54.0 min/day); number of steps taken [−147 (1834) vs. −454 (2066)] and muscle strength in training and control group, respectively. There was a significant increase in the six-minute walking test distance (48.8 ± 35.9 vs. 6.9 ± 45.9 m, p < 0.05) and some domains of QoL in the training compared to the control group.Conclusions: PADL was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients. However, the exercise program was able to increase the physical capacity and some domains of QoL.Implications for rehabilitationPhysical activity in daily life was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients.The exercise program was able to increase the physical capacity, efficacy of dialysis and some domains of quality of life in hemodialysis patients.The protocol used in this study was safe since no complications were observed during and after resistance training.These results should be interpreted with caution because we applied a moderate resistance training in both lower limbs and in the contralateral arteriovenous fistula upper limb, using perceived exertion by Borg scale to exercise prescription. Moreover, the safety protocol evaluation was not conducted.

Is there a relationship between plantar foot sensation and static balance, physical performance, fear of falling, and quality of life in hemodialysis patients?

This study was conducted to investigate the relationship between plantar foot sensation and static balance, physical performance, fear of falling, and quality of life in hemodialysis patients. The study involved 24 hemodialysis patients and 20 healthy volunteers. Light touch-pressure sensation (Semmes Weinstein Monofilament test kit), two-point discrimination sensation (esthesiometer) and vibration sensation (128 Hz diapason) were used to evaluate plantar foot sensation. Static balance was assessed by the one-leg standing balance test, physical performance by the Timed Up and Go test, fear of falling with the Fall Efficacy Scale, and quality of life with the Ferrans and Powers Quality of Life Index Dialysis Version. There was a significant difference in plantar foot sensation, static balance, and physical performance of the patients compared to the healthy controls (P < 0.05). There was a strong correlation between static balance and physical performance with foot sensation in the hemodialysis patients (P < 0.05). There was also a strong correlation between static balance, physical performance, and fear of falling in hemodialysis patients (P < 0.05). The correlation between static balance, physical performance, and quality of life in the hemodialysis patients was strong (P < 0.05). The most important result of this study is that light touch-pressure sensation, vibration sensation, two-point discrimination sensation, static balance, and physical performance, all of which involve the activity of cutaneous sensory receptors on the sole of the foot, are reduced in individuals who undergo hemodialysis. The findings of this study suggest potential rehabilitation strategies that could be applied to this patient group.

The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients.

One of the most important factors affecting the quality of life of chronic kidney disease (CKD) patients is nutrition. Prevention of malnutrition increases patients' quality and length of life. In this study, we aimed to determine the frequency of malnutrition, quality of life, and the relationship between them in patients with end-stage renal disease (ESRD). The study was conducted with a total of 60 CKD patients including 50 haemodialysis patients and 10 peritoneal dialysis patients. Patients' data associated with socio-demographics, body mass index (BMI), waist circumference, triceps skin-fold thickness (TSFT), pre-dialysis systolic and diastolic blood pressure, Kt/V and urea reduction ratio (URR) values, laboratory parameters, Mini-Nutritional Assessment-Short Form (MNA-SF) and European Quality of Life 5-Dimensions (EQ5D) scale were recorded. Of the total 60 patients; 27 were male (45%), 33 were female (55%), 83.3% were receiving haemodialysis treatment (HD), and 16.7% were receiving peritoneal dialysis treatment (PD). The mean MNA-SF score was 10.4 ± 2.8 in the HD group and 10.5 ± 2.9 in the PD group; there was no difference between the scores of the HD and PD groups. The mean EQ5D score was 0.60 ± 0.29 in the HD group and 0.68 ± 0.33 in the PD group, no significant difference was found between the HD group and the PD group. The quality of life was found lower in malnourished group (p=0.001). The quality of life needs to be increased by early diagnosis and treatment of malnutrition in patients at risk.

Association of Serotonin 1A Receptor Polymorphism with Variation in Health-Related Quality of Life in Korean Hemodialysis Patients.

ObjectiveHemodialysis patients may have psychological distress and reduced quality of life (QoL) related to chronic physical health problems. Genetic polymorphisms associated with reduced QoL in hemodialysis patients. The aim of this study was to investigate the relationship between genetic polymorphisms and variation in health-related QoL in Korean hemodialysis patients.MethodsThe 36-item Short-Form Health Survey and the Korean Hospital Anxiety and Depression Scale were used to assess health-related QoL and psychological distress, respectively. Twenty hundred and five clinically stable patients from 6 hemodialysis centers have participated with informed consents. Sociodemographic factors, clinical factors, and genotypes of serotonin 1A receptor, brain-derived neurotrophic factors, and glucocorticoid receptor were assessed. Independent t-tests, correlation analyses, multiple regression analyses were performed for statistical analyses.ResultsThe serotonin 1A receptor CC genotype group showed significantly higher physical and mental QoL levels than those with the GG/GC genotypes. In the final linear regression analysis, serotonin 1A receptor CC genotype was significantly associated with positive physical and mental QoL levels.ConclusionConclusionaaSerotonin 1A receptor polymorphism, as well as age and depression, were significantly associated with mental and physical QoL in hemodialysis patients. Functional activity in the serotonin receptor system may have a modulating effect on health-related QoL in hemodialysis patients.

Stress, coping mechanisms and quality of life in hemodialysis patients

&lt;b&gt;Introduction: &lt;/b&gt;The aims of the study were to identify the impact of coping mechanisms on quality of life in hemodialysis (HD) patients and to establish the associations between stress factors and coping mechanisms, to evaluate coping mechanisms as significant predictors of physical and mental health, and to identify the effects of demographic and socioeconomic factors on coping mechanisms.&lt;br /&gt; &lt;b&gt;Material and methods: &lt;/b&gt; The study included a group of 70 HD patients, 38.6% males and 61.4% females, mean age of 54.55 ±11.70. Data were collected by means of the Hemodialysis Stressors Scale for estimating stress, the &lt;i&gt;Jalowiec Coping Scale &lt;/i&gt;(JCS) for identifying coping mechanisms, and the Short Form 36 Health Survey Questionnaire for assessing quality of life (QoL).&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: The frequency of using coping mechanisms is: optimism (M = 2.26 ±0.48), support (M = 2.16 ±0.57), confrontational coping (M = 1.96 ±0.47), one’s own strength (M = 1.94 ±0.46), palliative coping (M = 1.44 ±0.54), emotive coping (M = 1.40 ±0.61), evasive coping (M = 1.39 ±0.46), fatalism (M = 1.23 ±0.74). Emotion-focused coping correlates with the following stressors: role ambiguity (r = 0.33; p = 0.004), dependence on staff (r = 0.25, p = 0.03) and daily activity (r = 0.27, p = 0.02).&lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;: Optimism is the most commonly used defense mechanism, assessed as the most effective one. The fatalistic coping mechanism is a significant predictor of mental health, while optimism and palliative coping are significant predictors of physical health.

Clinical utility of far-infrared therapy for improvement of vascular access blood flow and pain control in hemodialysis patients

BackgroundMaintenance of a well-functioning vascular access and minimal needling pain are important goals for achieving adequate dialysis and improving the quality of life in hemodialysis (HD) patients. Far-infrared (FIR) therapy may improve endothelial function and increase access blood flow (Qa) and patency in HD patients. The aim of this study was to evaluate effects of FIR therapy on Qa and patency, and needling pain in HD patients. MethodsThis prospective clinical trial enrolled 25 outpatients who maintained HD with arteriovenous fistula. The other 25 patients were matched as control with age, sex, and diabetes. FIR therapy was administered for 40 minutes during HD 3 times/wk and continued for 12 months. The Qa was measured by the ultrasound dilution method, whereas pain was measured by a numeric rating scale at baseline, then once per month. ResultsOne patient was transferred to another facility, and 7 patients stopped FIR therapy because of an increased body temperature and discomfort. FIR therapy improved the needling pain score from 4 to 2 after 1 year. FIR therapy increased the Qa by 3 months and maintained this change until 1 year, whereas control patients showed the decrease in Qa. The 1-year unassisted patency with FIR therapy was not significantly different from control. ConclusionFIR therapy improved needling pain. Although FIR therapy improved Qa, the unassisted patency was not different compared with the control. A larger and multicenter study is needed to evaluate the effect of FIR therapy.

Nalfurafine hydrochloride to treat pruritus: a review.

Uremic pruritus has a great negative influence on quality of life in hemodialysis (HD) patients and, importantly, negatively affects mortality risk. Recently, nalfurafine hydrochloride, an opioid κ-selective agonist, has been officially approved for resistant pruritus in HD patients on the basis of a well-evidenced clinical trial in Japan. From clinical observation, it has been suggested that the upper neuron system plays a role in its pathogenesis. According to previous experimental results, using mice injected with opioids, dynorphin suppresses itch through binding κ-opioid receptors, suggesting that κ-opioid opioid receptor agonists act as potential therapeutic reagents for pruritus in HD patients. In Japan, a large-scale placebo-controlled study was performed to examine the efficacy and safety of oral nalfurafine hydrochloride for intractable pruritus in 337 HD patients. Two daily doses of 2.5 or 5 μg nalfurafine or placebo were orally administered for 2 weeks, and clinical responses were analyzed. The results showed that the mean decrease in the visual analog scale for pruritus from baseline was 22 mm in the 5 μg nalfurafine hydrochloride group (n=114) and 23 mm in the 2.5 μg group (n=112). These reductions were statistically significant compared with 13 mm, which is the mean decrease of visual analog scale in the placebo group (n=111), demonstrating that nalfurafine is an effective and safe drug for uremic pruritus in HD patients. Moreover, another open-label trial (n=145) examining the long-term effect of 5 μg oral nalfurafine revealed the maintenance of the antipruritic effect of nalfurafine for 52 weeks. In addition, on the basis of recent data showing κ-opioid receptor expression in the epidermis of atopic dermatitis and psoriasis, nalfurafine hydrochloride also can be potentially used for these two skin diseases.