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Duan DF, Zhou XL, Yan Y, Li YM, Hu YH, Li Q, Peng X, Gu Q, Li XY, Feng H, Tang AJ, Liu P, Xu HH, Liao RX, Ma DY. Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis. Ren Fail 2024; 46:2349121. [PMID: 38916144 PMCID: PMC11207921 DOI: 10.1080/0886022x.2024.2349121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/02/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management. METHODS The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis. RESULTS In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients. CONCLUSIONS This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.
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Affiliation(s)
- Di-fei Duan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xue-li Zhou
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yu Yan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | | | - Yan-hua Hu
- Jianyang People’s Hospital, Nanchang, China
| | - Qin Li
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xiang Peng
- Panzhihua Central Hospital, Panzhihua, China
| | - Qin Gu
- West China Hospital, Sichuan University (for Huaxi Hospital in Meishan People’s Hospital), Chengdu, China
| | - Xiao-ying Li
- Xiquan People’s Hospital of Gansu Province, Lanzhou, China
| | - Hui Feng
- The Fifth People’s Hospital of Chengdu, Chengdu, China
| | | | - Pan Liu
- The Second People’s Hospital of Chengdu, Chengdu, China
| | - Hui-hui Xu
- The First People’s Hospital of Jiujiang City, Jiujiang, China
| | - Ruo-xi Liao
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Deng-yan Ma
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Tao LL, Zeng CH, Mei WJ, Zou YL. Sleep quality in middle-aged and elderly hemodialysis patients: Impact of a structured nursing intervention program. World J Clin Cases 2024; 12:5713-5719. [DOI: 10.12998/wjcc.v12.i25.5713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being. This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middle-aged and elderly hemodialysis patients.
AIM To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.
METHODS This cross-sectional study was conducted in a tertiary hospital, the First Affiliated Hospital of Nanchang University, in 2023. This study included 105 middle-aged and elderly hemodialysis patients aged ≥ 45 years who underwent maintenance hemodialysis for at least 3 mo, utilizing the Pittsburgh Sleep Quality Index (PSQI) to identify poor sleepers. Those identified underwent a 12-wk nursing intervention program focusing on education, relaxation techniques, and counseling. Post-intervention, sleep quality was reassessed using the PSQI.
RESULTS The study found that 68.6% of hemodialysis patients were poor sleepers. Following the 12-wk nursing intervention program, there was a significant decrease in the mean global PSQI score from 8.9 ± 3.2 to 5.1 ± 2.7 (P < 0.001), indicating improved sleep quality. This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.
CONCLUSION The structured nursing intervention program focusing on sleep hygiene education, relaxation techniques, and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients. The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population. These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.
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Affiliation(s)
- Ling-Ling Tao
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Cai-Hua Zeng
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wen-Juan Mei
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yan-Li Zou
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Al Sharji A, Alaloul F, Al Yazeedi B, Alharrasi M. Fatalistic and Optimistic Coping Strategies Predict Depression in Arab Muslim Patients With End-Stage Renal Disease. J Transcult Nurs 2024; 35:134-141. [PMID: 38140779 DOI: 10.1177/10436596231217696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Depression is one of the common psychological problems in patients on hemodialysis. We aimed to identify the predictors associated with depressive symptoms among patients on hemodialysis from a population under-represented in research and minoritized in countries like the United States. METHODS This cross-sectional study used a convenience sample of patients in Oman. Data were analyzed using linear multiple regression. RESULTS A total of 157 patients on hemodialysis participated in the study, with 40.5% reporting different levels of depressive symptoms. Higher stress levels (β = .643; p < .01) and higher perceived effectiveness of the fatalistic coping style (β = .144; p < .05) were significant predictors of depressive symptoms. Patients with a higher optimistic coping style (β = -.182; p < .01) had lower levels of depressive symptoms. CONCLUSION Arab Muslim hemodialysis patients have significant levels of depressive symptoms. Identifying predictors of depressive symptoms may help identify those at risk and provide culturally appropriate interventions.
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Affiliation(s)
- Amal Al Sharji
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Fawwaz Alaloul
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Basma Al Yazeedi
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Maryam Alharrasi
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
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Teimourzadeh M, Babamohamadi H, Yarmohamadi M, Ghorbani R, Koenig HG. The Effect of the Holy Quran Recitation on Inflammatory Markers in Hemodialysis Patients in Iran: A Randomized Clinical Trial. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-023-01989-z. [PMID: 38206560 DOI: 10.1007/s10943-023-01989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
Increased inflammation is a common complication in chronic hemodialysis (HD) patients. Addressing the psychological symptoms of patients may help reduce inflammation and its negative impact on the body. Considering the calming effects of listening to the Holy Quran, this may help reduce mental, psychological, and physical problems in Muslim patients. The present study sought to examine the effects of listening to Holy Quran recitation on the level of inflammatory markers in HD patients. This was a randomized controlled trial involving 50 HD patients at Kowsar Hospital in Semnan, Iran, in 2019-2020. The participants were divided into experimental and control groups using simple randomization by sealed envelopes. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels in blood were measured before the intervention. The participants in the experimental group listened by headphones to the Holy Quran being recited three times a week, 20 min each time, for one month. For those in the control group, headphones were placed but on silent mode. At the end of the intervention one month later, inflammatory markers were measured again for participants in both groups. Data were analyzed in SPSS-16 using descriptive and inferential statistics (t test, Wilcoxon, and Mann-Whitney U). Mean IL-6 level decreased by 20.2 pg/ml, mean ESR level by 16.8 mm/hr, and mean CRP level by 19.9 mg/dl in the experimental group, while these values increased in the control group. The between-group differences in the intervention and control groups at follow-up were significant for all three inflammatory markers (p < 0.05). Listening to the Holy Quran being recited is recommended as a complementary therapy for reducing systemic inflammation (as indicated by inflammatory markers) in Muslim HD patients.Trial registration: Iranian Registry of Clinical Trials, Trial No: IRCT20120109008665N9. Registered 4 Nov 2019.
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Affiliation(s)
- Maedeh Teimourzadeh
- Student Research Committee, Semnan University of Medical Sciences, 5 Kilometers of Damghan Road, Educational and Research Campus, PO Box: 3513138111, Semnan, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, 5 Kilometers of Damghan Road, Educational and Research Campus, PO Box: 3513138111, Semnan, Iran.
- Department of Nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, 5 Kilometers of Damghan Road, Educational and Research Campus, PO Box: 3513138111, Semnan, Iran.
| | - Maliheh Yarmohamadi
- Department of Internal Medicine, School of Medicine, Semnan University of Medical Sciences, 5 Kilometers of Damghan Road, Educational and Research Campus, PO Box: 3513138111, Semnan, Iran
| | - Raheb Ghorbani
- Social Determinant of Health Research Center, Semnan University of Medical Sciences, 5 Kilometers of Damghan Road, Educational and Research Campus, PO Box: 3513138111, Semnan, Iran
- Department of Social Medicine, School of Medicine, Semnan University of Medical Sciences, 5 Kilometers of Damghan Road, Educational and Research Campus, PO Box: 3513138111, Semnan, Iran
| | - Harold G Koenig
- Department of Psychiatry and Behavioral Sciences, and Department of Medicine, Center for Spirituality, Theology, and Health, Duke University Medical Center, Busse Building, Suite 0505, Box 3400, Durham, NC, 27710, USA
- Division of Psychiatry, Department of Medicine, King Abdulaziz University, Abdullah Sulayman Road, PO Box 80200, 21589, Jeddah, Saudi Arabia
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Tian M, Qian Z, Long Y, Yu F, Yuan J, Zha Y. Decreased Intracellular to Total Body Water Ratio and Depressive Symptoms in Patients with Maintenance Hemodialysis. Psychol Res Behav Manag 2023; 16:4367-4376. [PMID: 37908680 PMCID: PMC10615096 DOI: 10.2147/prbm.s436574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023] Open
Abstract
Objective Depression is a common psychiatric disorder and related to poor outcomes in patients undergoing maintenance hemodialysis (MHD). Previous studies have reported some associations between sarcopenia and depressive symptoms. Recently, intracellular water (ICW) and total body water (TBW) have been found to reflect muscle function and muscle mass. ICW/TBW ratio is a marker of sarcopenia that is simple to assess. However, the relationship between ICW/TBW ratio and depression has not been explored in MHD patients. Methods In our cross-sectional and multi-center study, 3300 adult MHD patients were included from June 1, 2021, to August 30, 2021. Depressive symptoms were evaluated using the Beck Depression Inventory-II (BDI-II). TBW and ICW were measured by Body Composition Monitor (BCM). Multivariable logistic regression, stratified analyses, and interactive analyses were conducted to assess the relationship between ICW/TBW ratio and depression. Results About 16.5% of the 3300 MHD patients were found to have depressive symptoms. The prevalence of depression increased with decreasing quartiles of ICW/TBW ratios, and decreased ICW/TBW ratio was independently associated with depression after adjusting for potential confounders. Patients in Quartile 1 of ICW/TBW ratios were more likely to have depressive symptoms (odds ratio 1.55, 95% confidence interval 1.07-2.22; p=0.002) than those in Quartile 4. History of diabetes and education status had interactive roles in the relationship between depression and ICW/TBW ratios (p < 0.05). The association of ICW/TBW ratios and depression existed in patients of both genders and different education levels, but only in non-diabetic patients. Conclusion In MHD patients, the decreased ratio of ICW/TBW was independently related to high depression rates.
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Affiliation(s)
- Maolu Tian
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
- Medical College, Guizhou University, Guiyang, Guizhou, People’s Republic of China
| | - Zuping Qian
- Clinical Medical College, Zunyi Medical University, Zunyi, Guizhou, People’s Republic of China
| | - Yanjun Long
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Fangfang Yu
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Jing Yuan
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
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González-Flores CJ, García-García G, Lerma A, Pérez-Grovas H, Meda-Lara RM, Guzmán-Saldaña RME, Lerma C. Resilience: A Protective Factor from Depression and Anxiety in Mexican Dialysis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11957. [PMID: 34831713 PMCID: PMC8620979 DOI: 10.3390/ijerph182211957] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
Depression and anxiety are highly prevalent psychological disorders in end-stage renal disease (ESRD) that have a negative clinical impact. The purpose of our study was to identify factors associated with the presence of depression and anxiety, in a sample of ESRD patients treated with hemodialysis. We included 187 patients from two dialysis facilities, age 18-65 years. Beck's depression and anxiety inventories, KDQOL36 questionnaire, the cognitive distortion scale and the Mexican scale of resilience were used. Socio-demographic and clinical information was obtained from medical records. Depression was present in 143 (76.4%) patients. Patient with depression were older (33 (26-52) years vs. 30 (24.43) years, p = 0.025), had a lower education level (36% vs. 9%, p = 0.001), used more medications (67% vs. 36%, p = 0.001), had a comorbidity (75% vs. 41%, p = 0.001), and a higher proportion were waiting for a kidney transplant. Anxiety was present in 112 (59.8%) cases. By multivariate analysis, depression was independently associated with lower education, absence of previous kidney transplant, anxiety, higher cognitive distortion, lower psychological resilience, and lower quality of life scores. In conclusion, lower psychological resilience, lower education level, and higher cognitive distortions are factors associated with depression and anxiety in ESRD patients.
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Affiliation(s)
| | - Guillermo García-García
- Nephrology Department, Civil Hospital de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Mexico;
| | - Abel Lerma
- Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, San Juan Tilcuautla 42160, Mexico; (A.L.); (R.M.E.G.-S.)
| | | | - Rosa M. Meda-Lara
- Departments of Basic Psychology and Medical Clinics, Health Sciences Center, University of Guadalajara, Guadalajara 44340, Mexico;
| | - Rebeca M. E. Guzmán-Saldaña
- Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, San Juan Tilcuautla 42160, Mexico; (A.L.); (R.M.E.G.-S.)
| | - Claudia Lerma
- National Institute of Cardiology Ignacio Chávez, México City 14080, Mexico;
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Abstract
PURPOSE OF REVIEW The aim of this study was to examine updated prevalence rates, risk factors and the prognosis, diagnosis and treatments for depression among dialysis patients. RECENT FINDINGS Depression influences prognosis, complications, quality of life (QOL), treatment and costs for dialysis patients worldwide. Reported prevalence of depression is 13.1-76.3%; it is higher for dialysis than transplant and higher post than predialysis. Reported depression rates with peritoneal dialysis (PD) compared with in-centre haemodialysis (HD) are inconsistent. Related medical factors are known, but suspected associated patient characteristics including gender and race remain unexplored. Associations between depression in dialysis and QOL, mortality, pathophysiological mechanisms of increased mortality, infection and pathways of inflammation-mediated and psychosocial factors require clarification. Several depression screening instruments are validated for dialysis patients - the Structured Clinical Interview for DSM disorders (SCID) remains the gold standard - but authors suggest the diagnostic standard should be higher than for the general population. Short-term studies indicate nonpharmacological therapy achieves clinical effects for depression in dialysis patients, but research on long-term effects is needed. SUMMARY Depression management through early screening and continuous care models emphasizing dynamic relationships between healthcare teams, patients and families should be encouraged. Large-scale studies of short-term and long-term benefits of pharmacological and nonpharmacological depression management are warranted.
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Affiliation(s)
- Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Na Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
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Ng MSN, Chan DNS, Cheng Q, Miaskowski C, So WKW. Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189541. [PMID: 34574463 PMCID: PMC8464840 DOI: 10.3390/ijerph18189541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis. METHODS A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists. RESULTS Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status. CONCLUSION Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.
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Affiliation(s)
- Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
- Correspondence: ; Tel.: +852-3943-8165
| | - Qinqin Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
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Erbay E, Arslan K, Hatipoğlu E, Yildirim T. The Quality of Life, Depression Levels and Coping Styles of Patients on Kidney Transplant Waiting List. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:432-447. [PMID: 33771077 DOI: 10.1080/19371918.2021.1903645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study aims to understand the coping strategies, depression levels, sociodemographic characteristics of Turkish patients with hemodialysis, and the other factors explain quality of life levels. This research is a cross-sectional study. The convenience sampling consisted of 292 patients with hemodialysis. The data were collected using the brief COPE, QOL, Beck Depression Inventory and sociodemographic form. According to the research results, patients show mild (score range 10-16) depression symptoms. One of the most important findings of this study is that the coping strategies and level of depression with chronic kidney patients accounted for a significant amount of variance in their quality of life. The relationship between emotion-focused coping strategy and quality of life was not statistically significant. In addition, high level of depression in chronic renal failure patients significantly reduce the quality of life. As a result of the study, the relationship between the high quality of life of patients who use problem-focused coping strategy more intensively and patients with low depression levels was determined. The findings point to the importance of taking individual coping strategies into account when evaluating the impact of a disease on psychosocial wellbeing. Delineation of coping strategies might be useful for identifying patients in need of particular counseling and support. These patients should have frequent contact with a multidisciplinary team of health care givers, possibly allowing for early diagnosis and prompt treatment. Results suggest targeted interventions to stimulate future research regarding the psychological care of patients with chronic kidney disease.
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Affiliation(s)
- Ercüment Erbay
- Faculty of Economics and Administrative Sciences, Department of Social Work, Hacettepe University, Ankara, Turkey
| | - Kübra Arslan
- Faculty of Health Sciences, Department of Social Work, Kırıkkale University, Kırıkkale, Turkey
| | - Ertuğrul Hatipoğlu
- Faculty of Economics and Administrative Sciences, Department of Social Work, Hacettepe University, Ankara, Turkey
| | - Tolga Yildirim
- Faculty of Medicine Department of Internal Diseases Nephrology Subdivision, Hacettepe University, Ankara, Turkey
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Endreddy A, Chennareddy L, Shaik S. Assessment of quality of life and psychiatric morbidity in patients undergoing hemodialysis at a tertiary care center. ARCHIVES OF MENTAL HEALTH 2021. [DOI: 10.4103/amh.amh_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Daniel SC, Azuero A, Gutierrez OM, Heaton K. Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients. Qual Life Res 2020; 30:759-768. [PMID: 33108580 DOI: 10.1007/s11136-020-02684-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Lifestyle changes associated with end-stage renal disease may be a factor in depression and quality of life (QOL) for patients receiving hemodialysis. This cross-sectional study examined the relationship between nutritional status, QOL, and depression in 124 hemodialysis patients. METHODS Nutritional markers included serum albumin, normalized protein catabolic rate (nPCR), body mass index (BMI), body fat percentage, and daily protein intake. Physical and Mental dimension scores of the Kidney Disease QOL-Short Form (KDQOL-SF), and the Center for Epidemiological Studies of Depression (CESD) survey were used to measure QOL and depression, respectively. Data were analyzed using regression analyses. Measures of effect size were used for interpretation. RESULTS Nutritional status indicators explained a moderate amount of the variability of the Physical dimension of QOL (crude R2 = .14, covariate-adjusted ΔR2 = .06) but had weak explanatory ability for the Mental dimension of QOL (crude R2 = .05, covariate-adjusted ΔR2 = .02) and CESD (crude R2 = .02, covariate-adjusted ΔR2 = .005). Additional findings suggested the presence of non-linear relationships between protein intake and both the Physical and Mental QOL dimension scores. Longer dialysis vintage was also correlated with lower psychosocial patient outcomes. CONCLUSION While nutritional status is an important element in predicting hemodialysis patient outcomes, its relationship to depression and QOL, in this sample, demonstrated only moderate explanatory ability. However, dialysis vintage and level of education had a significant relationship with depression and QOL. These findings suggest that patients with longer dialysis vintage and limited health literacy require unique plans of care. Future studies aimed at understanding the interrelationships between non-modifiable patient characteristics and psychosocial outcomes are imperative.
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Affiliation(s)
- Shawona C Daniel
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA.
| | - Andres Azuero
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA
| | | | - Karen Heaton
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA
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Lin KY, Lin YC, Wang HH. Differential effects of age on quality of sleep and depression in patients receiving maintenance haemodialysis. Psychogeriatrics 2019; 19:465-474. [PMID: 30767321 DOI: 10.1111/psyg.12424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/26/2017] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Poor quality of sleep and depression are common and highly associated with each other in patients on haemodialysis. We aimed to investigate whether they share common risk factors and how age may influence their development. METHODS Cross-sectional observation study on 120 haemodialysis patients with quality of sleep and depression assessed by Pittsburgh Sleep Quality Index (PSQI) and Taiwanese Depression Questionnaire (TDQ), respectively. RESULTS The prevalence of poor quality of sleep and depression was 92.5% and 43.3%, respectively. PSQI scores were associated with age, gender, education and monthly income while TDQ scores were associated with low serum creatinine and albumin levels. Elderly patients at ages older than 65 had the highest average PSQI score (12.26 ± 4.35) than the young group at age 20-44 (8.25 ± 4.39) (P = 0.028) but the average TDQ scores were similar across three age groups. The proportion of those who had high PSQI scores was significantly higher in the elderly group (54.4%, P = 0.017) and the 44-65-years group (51.9%, P = 0.028) than the young group (16.7%). The proportion of those who reported normal quality of sleep was much lower in the elderly group (0.0%) than the other two groups (25.0%, P < 0.001 and 11.7%, P < 0.01). The proportions of those who had different ranges of TDQ scores did not show such a pattern of strong age dependence. CONCLUSIONS Poor quality of sleep in haemodialysis patients is associated with socio-economic factors while depression is more related to biochemistry indicators. A majority of older patients suffer very poor quality of sleep while depression appears equally severe and common across different age groups.
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Affiliation(s)
- Kuan-Yu Lin
- Department of Nursing, School of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yi-Chun Lin
- Department of Nursing, School of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Department of Nursing, National Taiwan University Hospital Hsin-Chu Branch, Hsin Chu City, Taiwan
| | - Hsiu-Ho Wang
- Department of Nursing, School of Nursing, Yuanpei University of Medical Technology, Hsin Chu City, Taiwan
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Brito DCSD, Machado EL, Reis IA, Carmo LPDFD, Cherchiglia ML. Depression and anxiety among patients undergoing dialysis and kidney transplantation: a cross-sectional study. SAO PAULO MED J 2019; 137:137-147. [PMID: 31314874 PMCID: PMC9721231 DOI: 10.1590/1516-3180.2018.0272280119] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/28/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Depression and anxiety are the most prevalent psychological disorders among end-stage renal disease patients and are associated with various conditions that result in poorer health outcomes, e.g. reduced quality of life and survival. We aimed to investigate the prevalences of depression and anxiety among patients undergoing renal replacement therapy. DESIGN AND SETTING Cross-sectional study in Belo Horizonte, Brazil. METHODS Patients' depression and anxiety levels were assessed using the Beck Inventory. The independent variables were the 36-Item Short-Form Health Survey (SF-36), Charlson Comorbidity Index and Global Subjective Assessment, along with sociodemographic and clinical characteristics. RESULTS 205 patients were included. Depression and anxiety symptoms were detected in 41.7% and 32.3% of dialysis patients and 13.3% and 20.3% of transplantation patients, respectively. Lower SF-36 mental summary scores were associated with depression among transplantation patients (odds ratio, OR: 0.923; 95% confidence interval, CI: 0.85-0.99; P = 0.03) and dialysis patients (OR: 0.882; 95% CI: 0.83-0.93; P ≤ 0.001). Physical component summary was associated with depression among dialysis patients (OR: 0.906; 95% CI: 0.85-0.96; P = 0.001). Loss of vascular access (OR: 3.672; 95% CI: 1.05-12.78; P = 0.04), comorbidities (OR: 1.578; 95% CI: 1.09-2.27; P = 0.01) and poorer SF-36 mental (OR: 0.928; 95% CI: 0.88-0.97; P = 0.002) and physical (OR: 0.943; 95% CI: 0.89-0.99; P = 0.03) summary scores were associated with anxiety among -dialysis patients. CONCLUSIONS Depression and anxiety symptoms occurred more frequently among patients undergoing dialysis. Quality of life, comorbidities and loss of vascular access were associated factors.
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Affiliation(s)
- Daniela Cristina Sampaio de Brito
- MSc. Psychologist and Doctoral Student, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Elaine Leandro Machado
- MD, PhD. Psychologist and Professor, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Researcher, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Ilka Afonso Reis
- MD, PhD. Statistician and Professor, Department of Statistics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Researcher, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Lilian Pires de Freitas do Carmo
- MD, PhD. Doctor and Professor, Department of Internal Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Mariangela Leal Cherchiglia
- MD, PhD. Doctor and Professor, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Coordinator, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S. Prevalence and predictors of depression among hemodialysis patients: a prospective follow-up study. BMC Public Health 2019; 19:531. [PMID: 31072378 PMCID: PMC6507067 DOI: 10.1186/s12889-019-6796-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Even though depression is one of the most common psychiatric disorders, it is under-recognized in hemodialysis (HD) patients. Existing literature does not provide enough information on evaluation of predictors of depression among HD patients. The objective of the current study was to determine the prevalence and predictors of depression among HD patients. METHODS A multicenter prospective follow-up study. All eligible confirmed hypertensive HD patients who were consecutively enrolled for treatment at the study sites were included in the current study. HADS questionnaire was used to assess the depression level among study participants. Patients with physical and/or cognitive limitations that prevent them from being able to answer questions were excluded. RESULTS Two hundred twenty patients were judged eligible and completed questionnaire at the baseline visit. Subsequently, 216 and 213 patients completed questionnaire on second and final follow up respectively. The prevalence of depression among patients at baseline, 2nd visit and final visit was 71.3, 78.2 and 84.9% respectively. The results of regression analysis showed that treatment given to patients at non-governmental organizations (NGO's) running HD centers (OR = 0.347, p-value = 0.039) had statistically significant association with prevalence of depression at final visit. CONCLUSIONS Depression was prevalent in the current study participants. Negative association observed between depression and hemodialysis therapy at NGO's running centers signifies patients' satisfaction and better depression management practices at these centers.
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Affiliation(s)
- Amjad Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320 Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
| | - Azreen Syazril Adnan
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
- Management Science University, University Drive, Off Persiaran Olahraga, Section 13, 40100 Shah Alam, Selangor Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Saima Mushtaq
- Health Care Biotechnology Department, Atta ur Rahman School of Applied Biosciences, National University of Science & Technology, Islamabad, 44000 Pakistan
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Pan KC, Hung SY, Chen CI, Lu CY, Shih ML, Huang CY. Social support as a mediator between sleep disturbances, depressive symptoms, and health-related quality of life in patients undergoing hemodialysis. PLoS One 2019; 14:e0216045. [PMID: 31034497 PMCID: PMC6488079 DOI: 10.1371/journal.pone.0216045] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background The hemodialysis regimen is an inevitable and mandatory treatment for patients with end-stage renal disease (ESRD). During the dialysis journey, patients may experience maladaptation in terms of sleep disturbances, depressive symptoms, and reduced health-related quality of life (HRQOL). Psychosocial resources such as social support may have beneficial influences on health outcomes, but studies have rarely analyzed the integrated relationships among risk factors which include pain, sleep disturbances, duration since diagnosis and various health outcomes in Taiwan. This study aimed to bridge this gap by investigating the relationships among related risk factors, social support, sleep disturbances, depressive symptoms, and HRQOL, which is composed of physical quality of life (PQOL) and mental quality of life (MQOL), in ESRD patients. Method A correlational design was used, and 178 patients aged 20 years or older were recruited via convenience sample. The relationships among the risk factors, the mediators, depressive symptoms, PQOL, and MQOL were analyzed using structural equation modeling. Results The findings showed that more than 70% of the participants reported poor sleep quality, and 32% reported depressive symptoms. When participants had greater pain and more sleep disorders, they were more likely to be depressed. When participants had more appraisal support; they had better PQOL and fewer depressive symptoms. Overall, the structural equation model explained 31.8% of the variance in self-reported depressive symptoms, 29.4% of the variance in PQOL, and 5.7% of the variance in MQOL. Moreover, appraisal support enhanced PQOL and reduced depressive symptoms by exerting its two mediating effects on sleep disturbances. Conclusion Our findings indicate that patients with ESRD who have more social support have better PQOL and MQOL and fewer depressive symptoms than those with less social support.
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Affiliation(s)
- Kuei-Ching Pan
- Department of Nursing, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shih-Yuan Hung
- Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chun-I Chen
- Department of Industrial Management, I-Shou University, Kaohsiung, Taiwan
| | - Chu-Yun Lu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Mei-Ling Shih
- Department of Nursing, E-Da Hospital, Kaohsiung, Taiwan
| | - Chiung-Yu Huang
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
- * E-mail:
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Semaan V, Noureddine S, Farhood L. Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis. Appl Nurs Res 2018; 43:80-85. [PMID: 30220369 DOI: 10.1016/j.apnr.2018.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dialysis is a lifelong treatment required by end stage renal disease patients who are not able to undergo renal transplantation. Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients, but their prevalence and correlates vary by sociocultural context. OBJECTIVE The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis at a major tertiary referral medical center in Lebanon that receives patients from all over the country. DESIGN A cross-sectional, descriptive design was used. METHODS Ninety patients receiving hemodialysis were targeted using convenience sampling, with a final sample size of 83 patients. The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale, and asked demographic and clinical questions. RESULTS The majority of participants were married men over 60 years of age; 48% achieved high school education. Depression was prevalent in 40.8% and anxiety in 39.6%, with 20 patients (24.1%) having both conditions. Although 24.1% self-reported anxiety symptoms, only 2.4% were taking anxiolytics. Illiterate patients had significantly higher depression scores than those with higher levels of education (p = 0.021). Patients who were living with their family had higher anxiety scores than those living alone (p = 0.014). CONCLUSION Anxiety and depression are underdiagnosed and undertreated in Lebanese dialysis patients. Screening and appropriate referral to mental health specialists are needed.
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Affiliation(s)
- Victoria Semaan
- American University of Beirut Medical Center, Cairo Street, Beirut 1107 2020, Lebanon.
| | - Samar Noureddine
- American University of Beirut, Hariri School of Nursing, Beirut 1107 2020, Lebanon
| | - Laila Farhood
- American University of Beirut, Hariri School of Nursing, Beirut 1107 2020, Lebanon
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Kim ES. Development and effect of a rational-emotive-behaviour-therapy-based self-management programme for early renal dialysis patients. J Clin Nurs 2018; 27:4179-4191. [PMID: 29968272 DOI: 10.1111/jocn.14608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 05/09/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study attempts to develop and determine the effect a rational-emotive-behaviour-therapy-based self-management programme can have on the self-efficacy, self-care, depression and dyssomnia of patients undergoing early renal dialysis. BACKGROUND When renal dialysis is initiated, changes in everyday life are inevitable, and patients can suffer from both psychological and physical symptoms. Hence, to obtain the best results from renal dialysis, active self-management is required. DESIGN Quasi-experimental and longitudinal. METHODS Forty-eight early-stage renal dialysis patients registered for and undergoing renal dialysis at a hospital located in S city participated in this study. These individuals were divided into an experimental and control group. The former group engaged in a self-management programme consisting of eight weekly sessions of 50 min in duration, while the latter received traditional nursing care. Data were collected from June 2012-May 2014 through the use of a preliminary survey, a postsurvey that was distributed after the eight sessions of the self-management programme had been completed, and a follow-up survey allocated 4 weeks after the postsurvey. Data collection was conducted using the Self-efficacy Scale, Self-care Practice Scale, Beck Depression Inventory, and Korean Sleep Scale, and a repeated-measures ANOVA was used to perform analysis. RESULTS The experimental group significantly differed from the control group in regard to self-efficacy (p = 0.006) and self-care (p = 0.031), but differences in terms of depression (p = 0.492) and dyssomnia (p = 0.141) were nonsignificant. In the experimental group, the depression decreased but then increased again, while the dyssomnia gradually decreased. CONCLUSIONS The provision of a rational-emotive-behaviour-therapy-based self-management programme that involves lectures, discussions, teach-backs, demonstrations and posters explaining diet choices improves the self-efficacy and self-care of patients receiving renal dialysis. RELEVANCE TO CLINICAL PRACTICE Rational-emotive-behaviour-therapy-based self-management programmes can be used in clinical nursing sites to improve the self-efficacy and self-care of early renal dialysis patients.
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Affiliation(s)
- Eun Sook Kim
- Department of Nursing, College of Health Sciences, Cheongju University, Cheongju, Chungbuk, Korea
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Ozen N, Cinar FI, Askin D, Mut D. Uremic pruritus and associated factors in hemodialysis patients: A multi-center study. Kidney Res Clin Pract 2018; 37:138-147. [PMID: 29971209 PMCID: PMC6027816 DOI: 10.23876/j.krcp.2018.37.2.138] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/04/2022] Open
Abstract
Background Uremic pruritus is a common and disturbing problem in hemodialysis patients. Although its pathogenesis is not completely understood, it is thought to be multifactorial. The aim of this study was to identify risk factors of uremic pruritus in hemodialysis patients. Methods A total of 249 patients from four dialysis centers were included in this study. Data were collected using a questionnaire, the visual analogue scale, and the Hospital Anxiety and Depression Scale. We investigated whether socio-demographic and biochemical parameters were correlated to uremic pruritus. Results Pruritus was present in 53.4% of the hemodialysis patients. The mean visual analogue scale severity was 6.47 ± 1.56. Patients with white blood cell (WBC) counts > 6.7 × 103/μL had 1.73 times (95% confidence interval [CI], 1.360-2.888; P = 0.036) more pruritus than did those with WBC counts < 6.7 × 103/μL. Patients with dry skin were 0.2 times (95% CI, 0.070-0.182; P = 0.028) more likely to suffer from very severe pruritus than were those with normal skin. Conclusion Uremic pruritus remains a serious problem in dialysis patients. The WBC level and presence of dry skin are thought to be among its causes. Therefore, data regarding the possible risk factors of uremic pruritus must be followed closely in patients at risk.
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Affiliation(s)
- Nurten Ozen
- Department of Midwifery, Faculty of Health Sciences, Istinye University, Istanbul, Turkey
| | - Fatma Ilknur Cinar
- Department of Internal Disease Nursing, University of Health Sciences, Gulhane School of Nursing, Ankara, Turkey
| | - Dilek Askin
- Deparment of Paediatrics, Haydarpasa Sultan Abdulhamid Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek Mut
- Department of Obstetrics and Gynecology, Dogubayazit Doç. Dr. Yasar Eryilmaz State Hospital, Agri, Turkey
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Depressive symptoms in chronic kidney disease: A comparison between patients on dialysis versus conservative treatment. NEFROLOGÍA LATINOAMERICANA 2017. [DOI: 10.1016/j.nefrol.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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20
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A single question regarding mobility in the World Health Organization quality of life questionnaire predicts 3-year mortality in patients receiving chronic hemodialysis. Sci Rep 2017; 7:11981. [PMID: 28931925 PMCID: PMC5607280 DOI: 10.1038/s41598-017-12276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/07/2017] [Indexed: 12/25/2022] Open
Abstract
Low quality of life, depression and poor quality of sleep are associated with increased mortality in hemodialysis patients. It is not clear which factor has the highest predictive power and what the core element is to explain the predictability. We thus conducted a prospective cohort study that included 151 hemodialysis adults. Three traits of interest were assessed by World Health Organization Quality of Life questionnaire, an abbreviated version (WHOQOL-BREF), Taiwanese Depression Questionnaire, and Athens Insomnia Scale, respectively. They were followed for more than 3 years and the all-cause mortality was 30.5%. The prevalence of quality of life at the lowest tertile, depression and poor quality of sleep was 19.9%, 43.0% and 74.2%, respectively. Discriminant analysis showed the standardized coefficient of each factor as 0.813, −0.289 and 0.066, indicating the highest discriminating power by quality of life to predict mortality. Question 15 “how well are you able to get around?” in the physical health domain of WHOQOL-BREF independently associated a hazard ratio of mortality 0.623 (95% confidence interval 0.423-0.918). Subjective perception of overall quality of life was more related to psycho-social-environmental factors. In conclusion, mobility is an independent and powerful predictor to long term mortality in patients on chronic hemodialysis.
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Shafi ST, Shafi T. A comparison of anxiety and depression between pre-dialysis chronic kidney disease patients and hemodialysis patients using hospital anxiety and depression scale. Pak J Med Sci 2017; 33:876-880. [PMID: 29067057 PMCID: PMC5648956 DOI: 10.12669/pjms.334.12656] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Tocompare frequency of anxiety and depression between pre-dialysis chronic kidney disease (CKD) and hemodialysis patients (ESRD) in Pakistan. Methods: This study was conducted in an out-patient department and hemodialysis unit of Sharif Medical City Hospital. Inclusion criteria included age above 18 years and a diagnosis of CKD including both pre-dialysis CKD and ESRD patients. Patients were screened for anxiety and depression using hospital anxiety and depression scale (HADS). Results: A total of 156 patients were included in the study. Out of these patients, 81 (51.9%) had ESRD and 75 (48.1%) had pre-dialysis CKD. Mean age of all patient was 47.3±18.3 years, 96 (61.5%) were males and 60 (38.5%) were females. Median duration of renal disease was 16 months (IQR 8-36 months). Anxiety and depression were present in 111 (71.2%) and 113 (72.4%) of all patients respectively. Moderate to severe anxiety and depression were present in 54 (34.6%) and 60 (38.5%) patients respectively. In multiple logistic regression model, after adjusting for other variables, ESRD vs. pre-dialysis CKD was significantly associated with moderate to severe depression (AOR 2.26 (1.1-5.1). Conclusion: Both anxiety and depression are common in pre-dialysis CKD and ESRD patients. Patients with ESRD have higher frequency of depression compared to pre-dialysis CKD patients.
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Affiliation(s)
- Salman T Shafi
- Salman T. Shafi, Department of Nephrology, Sharif Medical and Dental College, Sharif Medical City Road Jati Umra, Lahore, Pakistan
| | - Tahir Shafi
- Tahir Shafi, Department of Nephrology, Sharif Medical and Dental College, Sharif Medical City Road Jati Umra, Lahore, Pakistan
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Jong IC, Tsai HB, Lin CH, Ma TL, Guo HR, Hung PH, Hung KY. Close correlation between the ankle-brachial index and symptoms of depression in hemodialysis patients. Int Urol Nephrol 2017; 49:1463-1470. [PMID: 28455662 PMCID: PMC5522508 DOI: 10.1007/s11255-017-1598-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/16/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND As both of peripheral arterial disease (PAD) and depression carried a poor prognosis in patients on maintenance hemodialysis (MHD), we investigated the correlation between the ankle-brachial index (ABI), an indicator of subclinical PAD, and symptoms of depression in patients on MHD. METHODS One hundred and twenty-nine patients on MHD (75 males and 54 females, mean age 64.8 ± 12 years) were enrolled in this cross-sectional study, which aimed at evaluating the relationship between symptoms of depression and ABI. Demographic as well as clinical and laboratory variables including status of diabetes, chronic hepatitis C infection, dialysis duration, Charlson comorbidity index (CCI), plasma levels of albumin, C-peptide, insulin, high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), adiponectin, and lipid profile were obtained. The self-administered beck depression inventory (BDI) was used to determine the presence or absence of symptoms of depression, and depression was defined as a BDI score ≧14. Multivariable-adjusted linear regression models were constructed to confirm the independent association of biologic parameters of symptoms of depression. Significance was defined as P < 0.05. Statistical analyses were performed using SPSS/Windows software (SPSS Science, v. 15.0, Chicago, IL). RESULTS The mode of multivariate analysis showed that diabetes (β = 3.594; P = 0.040), hepatitis C infection (β = 4.057; P = 0.008), levels of serum albumin (β = -5.656; P = 0.024), C-peptide (β = -0.292; P = 0.002), ABI (β = -9.041; P = 0.031), and Ln-transformed hsCRP were significantly associated with BDI. CONCLUSIONS Hepatitis C infection, serum levels of albumin, C-peptide, and ABI levels were found to be correlated with BDI (P < 0.05).
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Affiliation(s)
- Ing-Chin Jong
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Jhongsiao Road, Chia-Yi City, 600, Taiwan
| | - Hung-Bin Tsai
- Department of Tramatology, National Taiwan University Hospital, 7 Chung Shan S. Road, Zhongzheng Dist., Taipei City, 10002, Taiwan
| | - Chien-Hung Lin
- Institute of Clinical Medicine, National Yang-Ming University, 155 Linong Street, Taipei City, 112, Taiwan
- Department of Pediatrics, Zhongxing Branch, Taipei City Hospital, 145 Zhengzhou Road, Datong Dist., Taipei City, 10341, Taiwan
| | - Tsung-Liang Ma
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Jhongsiao Road, Chia-Yi City, 600, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health Medical Colleage, National Cheng Kung University, No. 1 University Road, Tainan City, 70401, Taiwan
| | - Peir-Haur Hung
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Jhongsiao Road, Chia-Yi City, 600, Taiwan.
- Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, 60 Erren Road, Rende Dist., Tainan City, 71710, Taiwan.
| | - Kuan-Yu Hung
- Department of Internal Medicinem, National Taiwan University Hospital, Hsin-Chu Branch, 25 Jingguo Road, Hsin-Chu City, 300, Taiwan
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Firoz MN, Shafipour V, Jafari H, Hosseini SH, Charati JY. Sleep Quality and Depression and Their Association with Other Factors in Hemodialysis Patients. Glob J Health Sci 2016; 8:53485. [PMID: 27045404 PMCID: PMC5016350 DOI: 10.5539/gjhs.v8n8p121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/18/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients. METHOD This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model. RESULTS Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035). CONCLUSION Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders.
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Affiliation(s)
- Masomeh Norozi Firoz
- Student of M.S Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran.
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Najafi A, Keihani S, Bagheri N, Ghanbari Jolfaei A, Mazaheri Meybodi A. Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016; 10:e4962. [PMID: 27803725 PMCID: PMC5087286 DOI: 10.17795/ijpbs-4962] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/25/2015] [Accepted: 02/05/2016] [Indexed: 01/18/2023]
Abstract
Background Depression and anxiety are common among hemodialysis patients and affect their treatment outcomes. Dialysis adequacy also affects the hemodialysis patients’ survival rates. Objectives This study aimed to evaluate the correlation between anxiety and depression with dialysis adequacy. Patients and Methods In this cross-sectional study, 127 hemodialysis patients (73 males, 57.5%) with the mean age of 55.7 ± 17.5 were enrolled. Demographic and recent laboratory data were collected using self-administered questionnaires and by reviewing medical records. Dialysis adequacy measures including the Kt/V and urea reduction rate (URR) were calculated using standard formulas. The Hospital Anxiety and Depression Scale (HADS) was used to diagnose depression and anxiety. Independent sample t-test and Chi-square test were used to compare the values in different groups. Pearson correlations and linear regression were used to analyze the data using SPSS version 21. Results The prevalence rates of depression and anxiety (HADS score ≥ 8) were 31.5% and 41.7%, respectively. The prevalence of both conditions was significantly higher in women than in men (P < 0.05). The mean values of Kt/V and URR were not different in patients with and without depression or anxiety. The anxiety scores were correlated with age (P = 0.007, r = -0.24) and parathyroid hormone (P = 0.04, r = -0.19). Younger age and lower parathyroid hormone were the only factors that predicted higher scores of anxiety in linear regression. The Kt/V or URR were not significantly correlated with depression and anxiety scores. Conclusions Depression and anxiety are common among hemodialysis patients. There are no statistically significant correlation between depression and anxiety and dialysis adequacy.
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Affiliation(s)
- Afshan Najafi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Sorena Keihani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Nazila Bagheri
- Department of Nephrology, Taleghani Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Azadeh Mazaheri Meybodi
- Department of Psychiatry, Taleghani Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Physical activity reduces the risk for hospitalizations in patients with type 2 diabetes. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
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.
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Affiliation(s)
- Shigeki Inui
- Department of Regenerative Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
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Grigoriou SS, Karatzaferi C, Sakkas GK. Pharmacological and Non-pharmacological Treatment Options for Depression and Depressive Symptoms in Hemodialysis Patients. Health Psychol Res 2015; 3:1811. [PMID: 26973957 PMCID: PMC4768541 DOI: 10.4081/hpr.2015.1811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 12/04/2022] Open
Abstract
Depression is a mental disorder with a high prevalence among patients with end stage renal disease (ESRD). It is reported that depression afflicts approximately 20-30% of this patient population, being associated, amongst other, with high mortality rate, low adherence to medication and low perceived quality of life. There is a variety of medications known to be effective for the treatment of depression but due to poor adherence to treatment as well as due to the high need for medications addressing other ESRD comorbidities, depression often remains untreated. According to the literature, depression is under-diagnosed and undertreated in the majority of the patients with chronic kidney disease. In the current review the main pharmacological and non-pharmacological approaches and research outcomes for the management of depressive symptoms in hemodialysis patients are discussed.
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Affiliation(s)
- Stefania S Grigoriou
- Department of Physical Education and Sport Science, University of Thessaly, Trikala; Institute of Research and Technology Thessaly, Centre for Research and Technology-Hellas , Trikala, Greece
| | - Christina Karatzaferi
- Department of Physical Education and Sport Science, University of Thessaly, Trikala; Institute of Research and Technology Thessaly, Centre for Research and Technology-Hellas , Trikala, Greece
| | - Giorgos K Sakkas
- Department of Physical Education and Sport Science, University of Thessaly, Trikala; Institute of Research and Technology Thessaly, Centre for Research and Technology-Hellas , Trikala, Greece
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Sheayria F, Karkar AM, Almenawi LA, Alreemawi R, Awn N, Alzenim MM, Hejaili FF, Shaheen FA, Al Sayyari AA. Stroke-free status and depression scores among Saudi dialysis patients. Ren Fail 2015; 37:392-7. [PMID: 25578814 DOI: 10.3109/0886022x.2014.996088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To assess the prevalence of stroke symptoms and depression among Saudi dialysis patients and related factors. METHODS This is a cross-sectional multicentre study of Saudi dialysis patients. Demographics, clinical and laboratory's data were collected. Freedom from stroke symptoms was assessed using the Questionnaire for Verifying Stroke-Free Status and depression using the Geriatric Depression Scale. RESULTS Five-hundred and forty-nine patients (77.3% response rate); 94.6% were receiving hemodialysis and 5.4% peritoneal dialysis were included in the study. Freedom from stroke was reported in 76.6% of patients, was higher in females (p = 0.07), and was not affected by the presence of diabetes mellitus coronary artery disease or peripheral vascular disease. However, it was significantly lower in hypertensive patients (p = 0.035) and was not affected by age, dialysis duration, Kt/V, albumin or hemoglobin levels. It was, however, more prevalent in the non-depressed patients compared to depressed patients (p = 0.036). Mild and major depression scores were noted in 45.2% and 6.1%, respectively; the depression score being significantly higher in HD than in PD patients (6.3 ± 3.4 vs. 5.0 ± 3.2 p = 0.049) but was not related to sex, employment, vascular access type, age, dialysis duration, Kt/V or serum albumin or hemoglobin levels. CONCLUSION A quarter of the patients were not stroke symptom-free and these were more likely the depressed patients, in females, but significantly less in hypertensive patients. Almost half of the patients were depressed with 6.1% having major depression. The depression score was significantly higher in HD than in PD patients.
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Affiliation(s)
- Fouad Sheayria
- Jeddah Kidney Center, King Fahd Hospital , Jeddah , Saudi Arabia
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Russcher M, Nagtegaal JE, Nurmohamed SA, Koch BCP, van der Westerlaken MML, van Someren EJW, Bakker SJL, Ter Wee PM, Gaillard CAJM. The effects of kidney transplantation on sleep, melatonin, circadian rhythm and quality of life in kidney transplant recipients and living donors. Nephron Clin Pract 2014; 129:6-15. [PMID: 25531829 DOI: 10.1159/000369308] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sleep disturbance is an important medical problem in patients with end-stage renal disease. It might be related to the disruption of the body's circadian clock since nocturnal levels of its key biomarker melatonin are markedly reduced. We aimed at investigating whether a change in renal function due to kidney transplantation or donation would modify sleep, melatonin levels, circadian rhythmicity, and quality of life in kidney transplant recipients (KTR) and living donors (LD). METHODS In KTR, we assessed saliva melatonin concentrations, sleep quality and daytime sleepiness prior to and at 2 weeks and 3 months after transplantation. In LD, we assessed these parameters prior to and at 3 months after donation. We additionally assessed 24-hour core body temperature (cBT), 24-hour blood pressure profile, and quality of life (QoL) prior to and 3 months after transplantation. RESULTS Twenty-three KTR and 23 LD completed the study. Regarding sleep, the amount of nighttime awake minutes tended to be reduced in recipients after transplantation (p = 0.05). Nocturnal melatonin concentrations did not change with transplantation or donation. Blood pressure dipping profile and the two circadian markers dim-light melatonin onset and time of core body temperature minimum did not change. Nevertheless, KTR reported that daytime sleepiness and QoL had improved. CONCLUSION Objectively nocturnal sleep quality marginally improved after transplantation. Subjectively patients reported improved QoL and daytime sleepiness scores. Changes in renal function were not associated with modified melatonin secretion or circadian rhythmicity.
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Depression in patients with chronic kidney disease on dialysis in Saudi Arabia. Int Urol Nephrol 2014; 46:2393-402. [PMID: 25164589 DOI: 10.1007/s11255-014-0802-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients with chronic kidney disease on hemodialysis experience considerable psychological stress due to physical and social changes brought on by illness, increasing the risk of depressive disorder (DD). We examined the prevalence of DD and depressive symptoms, identified treatments for depression, and determined baseline demographic, social/behavioral, physical, and psychological correlates. METHODS A convenience sample of 310 dialysis patients in Jeddah, Saudi Arabia, was screened for DD using the Structured Clinical Interview for Depression and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Established measures of psychosocial and physical health characteristics were administered, along with questions about current and past treatments. Bivariate and multivariate analyses identified independent correlates of DD and symptoms. RESULTS The prevalence of DD was 6.8 % (major depression 3.2 %, minor depression 3.6 %), and significant depressive symptoms were present in 24.2 % (HDRS 8 or higher). No patients with DD were being treated with antidepressant medication, whereas 28.6 % (6 of 21) were receiving counseling. Being a Saudi national, married, in counseling, or having a history of antidepressant were associated with DD in bivariate analyses. Correlates of depressive symptoms HDRS in multivariate analyses were Saudi nationality, marital status, stressful life events, poor physical functioning, cognitive impairment, overall severity of medical illness, and history of family psychiatric problems. CONCLUSIONS The prevalence of DD and depressive symptoms is lower in Saudi dialysis patients than in the rest of the world, largely untreated, and is associated with a distinct set of demographic, psychosocial, and physical health characteristics.
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Russcher M, Koch BCP, Nagtegaal JE, van Ittersum FJ, Pasker-de Jong PCM, Hagen EC, van Dorp WT, Gabreëls B, Wildbergh TX, van der Westerlaken MML, Gaillard CAJM, Ter Wee PM. Long-term effects of melatonin on quality of life and sleep in haemodialysis patients (Melody study): a randomized controlled trial. Br J Clin Pharmacol 2014; 76:668-79. [PMID: 23432361 DOI: 10.1111/bcp.12093] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/06/2013] [Indexed: 12/27/2022] Open
Abstract
AIM The disturbed circadian rhythm in haemodialysis patients results in perturbed sleep. Short term melatonin supplementation has alleviated these sleep problems. Our aim was to investigate the effects of long-term melatonin supplementation on quality of life and sleep. METHODS In this randomized double-blind placebo-controlled trial haemodialysis patients suffering from subjective sleep problems received melatonin 3 mg day(-1) vs. placebo during 12 months. The primary endpoint quality of life parameter 'vitality' was measured with Medical Outcomes Study Short Form-36. Secondary outcomes were improvement of three sleep parameters measured by actigraphy and nighttime salivary melatonin concentrations. RESULTS Sixty-seven patients were randomized. Forty-two patients completed the trial. With melatonin, no beneficial effect on vitality was seen. Other quality of life parameters showed both advantageous and disadvantageous effects of melatonin. Considering sleep, at 3 months sleep efficiency and actual sleep time had improved with melatonin compared with placebo on haemodialysis days (difference 7.6%, 95% CI 0.77, 14.4 and 49 min, 95% CI 2.1, 95.9, respectively). At 12 months none of the sleep parameters differed significantly from placebo. Melatonin salivary concentrations at 6 months had significantly increased in the melatonin group compared with the placebo group. CONCLUSIONS The high drop-out rate limits the strength of our conclusions. However, although a previous study reported beneficial short term effects of melatonin on sleep in haemodialysis patients, in this long-term study the positive effects disappeared during follow up (6-12 months). Also the quality of life parameter, vitality, did not improve. Efforts should be made to elucidate the mechanism responsible for the loss of effect with chronic use.
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Affiliation(s)
- Marije Russcher
- Department of Hospital Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands
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Hod T, Goldfarb-Rumyantzev AS. The role of disparities and socioeconomic factors in access to kidney transplantation and its outcome. Ren Fail 2014; 36:1193-9. [PMID: 24988495 DOI: 10.3109/0886022x.2014.934179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research focused on identifying vulnerable populations and revealing specific risk factors for barriers along the pathway from ESRD to kidney transplantation has been mostly descriptive and the causes of existing disparities remain unclear. However, several socio-economic factors that are associated with the access to and the outcome of the kidney transplantation have been identified. SUMMARY While the presence of racial, gender, and geographic disparities is noted, we were interested mostly to describe potential socio-economic factors associated with and possibly responsible for the presence of such disparities. In this review we focused on five factors: education level, employment status, income, presence of substance addiction or abuse, and marital status. We describe the new method to quantify patients' socio-economic status and identify the group of high risk in terms of the transplant outcome, easily calculated social adaptability index, previously associated with clinical outcome in several patient populations including those with kidney transplant. At the end, based on literature analyzed we offer potential interventions that potentially can be used in order to reduce the degree of disparities. CONCLUSION Based on review of literature socio-economic factors are associated with and possibly responsible for healthcare disparities. Social adaptability index allows quantifying the degree of socio-economic status and identifying the group of high risk for inferior transplant outcome.
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Affiliation(s)
- Tammy Hod
- Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston , MA
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Teles F, Azevedo VFDD, Miranda CTD, Miranda MPDM, Teixeira MDC, Elias RM. Depression in hemodialysis patients: the role of dialysis shift. Clinics (Sao Paulo) 2014; 69:198-202. [PMID: 24626947 PMCID: PMC3935125 DOI: 10.6061/clinics/2014(03)10] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/23/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008). CONCLUSION These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.
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Affiliation(s)
- Flavio Teles
- School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil
| | - Vega Figueiredo Dourado de Azevedo
- School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil
| | - Claudio Torres de Miranda
- Federal University of Alagoas, School of Medicine, MaceióAL, Brazil, Federal University of Alagoas School of Medicine, Maceió/AL, Brazil
| | - Milma Pires de Melo Miranda
- Federal University of Alagoas, School of Medicine, MaceióAL, Brazil, Federal University of Alagoas School of Medicine, Maceió/AL, Brazil
| | - Maria do Carmo Teixeira
- School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil
| | - Rosilene M Elias
- School of Medicine, University of Sao Paulo, Renal Division, São PauloSP, Brazil, University of Sao Paulo School of Medicine, Renal Division, São Paulo/SP, Brazil
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Daniele TMDC, Bruin VMS, Oliveira DS, Pompeu CM, Forti AC. Improving patient's independence and treating depressive symptoms can promote physical activity in diabetic patients. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2013; 57:665-666. [PMID: 24343639 DOI: 10.1590/s0004-27302013000800015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Silva Junior GB, Daher EF, Buosi APA, Lima RS, Lima MM, Silva EC, Sampaio AM, Santana JML, Monteiro FEC, Araújo SM. Depression among patients with end-stage renal disease in hemodialysis. PSYCHOL HEALTH MED 2013; 19:547-51. [DOI: 10.1080/13548506.2013.845303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Geraldo B. Silva Junior
- School of Medicine, University of Fortaleza, Fortaleza, Brazil
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Centro de Nefrologia de Caucaia, Caucaia, Brazil
| | - Elizabeth F. Daher
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | | | | | | | - Aline M. Sampaio
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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[Prevalence and correlates of anxiety and depression in patients with end-stage renal disease (ESRD)]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2013; 59:170-88. [PMID: 23775555 DOI: 10.13109/zptm.2013.59.2.170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Depressive symptoms are common among patients with end-stage renal disease (ESRD). They are associated with both high morbidity and high mortality. In this explorative study we investigated the frequency of Major Depression and Generalized Anxiety Disorder in a German dialysis center. We further investigated the correlation between expert-rating and self-report questionnaires as well as the extent to which somatic, dialysis-specific and sociodemographic parameters are associated with depressive and anxious symptoms. METHOD During dialysis treatment 52 patients (21 women and 31 men) aged 29 to 85 years with end-stage renal disease (ESRD) completed the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS-D). A physician administered the Structured Clinical Interview for DSM-IV (SCID) for the expert diagnosis of Major Depression and Generalized Anxiety Disorder. RESULTS Nine patients met DSM-IV criteria for Major Depression (17 %). The self-report scales showed depressive symptoms in 17 patients (33 %) and 8 patients (15 %), respectively. Generalized Anxiety Disorder according to SCID was diagnosed in 9 patients (17 %), while 12 patients (23 %) scored higher than seven points on the HADS Anxiety subscale. Depressive and anxious symptoms were associated with gender, employment status, and physical activity; anxious symptoms were also associated with the body-mass-index (BMI). CONCLUSIONS The higher agreement between the HADS depression subscale and the SCID diagnosis of Major Depression suggests that the HADS-D depression subscale is more useful than the BDI when screening for depression in patients with ESRD. Physical activity seems to be a protective factor for patients with ESRD and should be further investigated.
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Mitrou GI, Grigoriou SS, Konstantopoulou E, Theofilou P, Giannaki CD, Stefanidis I, Karatzaferi C, Sakkas GK. Exercise Training and Depression in ESRD: A Review. Semin Dial 2013; 26:604-13. [DOI: 10.1111/sdi.12112] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Georgia I. Mitrou
- Department of PE and Sport Science; University of Thessaly; Trikala Greece
| | - Stefania S. Grigoriou
- Department of PE and Sport Science; University of Thessaly; Trikala Greece
- Department of Kinesiology; Centre for Research and Technology Hellas; Greece
| | | | - Paraskevi Theofilou
- Department of Kinesiology; Centre for Research and Technology Hellas; Greece
- Department of Psychology; Panteion University; Athens Greece
| | | | - Ioannis Stefanidis
- School of Health Science; Department of Medicine; University of Thessaly; Larissa Greece
| | - Christina Karatzaferi
- Department of PE and Sport Science; University of Thessaly; Trikala Greece
- Department of Kinesiology; Centre for Research and Technology Hellas; Greece
| | - Giorgos K. Sakkas
- Department of PE and Sport Science; University of Thessaly; Trikala Greece
- Department of Kinesiology; Centre for Research and Technology Hellas; Greece
- School of Health Science; Department of Medicine; University of Thessaly; Larissa Greece
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Santos PR, Capote JRFG, Cavalcanti JU, Vieira CB, Rocha ARM, Apolônio NAM, de Oliveira EB. Sexual dysfunction predicts depression among women on hemodialysis. Int Urol Nephrol 2013; 45:1741-6. [DOI: 10.1007/s11255-013-0470-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/08/2013] [Indexed: 11/28/2022]
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Turkmen K, Erdur FM, Guney I, Gaipov A, Turgut F, Altintepe L, Saglam M, Tonbul HZ, Abdel-Rahman EM. Sleep quality, depression, and quality of life in elderly hemodialysis patients. Int J Nephrol Renovasc Dis 2012; 5:135-42. [PMID: 23091392 PMCID: PMC3474160 DOI: 10.2147/ijnrd.s36493] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Both the incidence and the prevalence of end-stage renal disease (ESRD) in elderly patients are increasing worldwide. Elderly ESRD patients have been found to be more prone to depression than the general population. There are many studies that have addressed the relationship between sleep quality (SQ), depression, and health related quality of life (HRQoL) in ESRD patients, but previous studies have not confirmed the association in elderly hemodialysis (HD) patients. Therefore, the aim of the present study was to demonstrate this relationship in elderly HD patients. PATIENTS AND METHODS Sixty-three elderly HD patients (32 females and 31 males aged between 65 and 89 years) were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI), the Medical Outcomes Study 36-item short form health survey, and the Beck Depression Inventory (BDI) were applied. RESULTS The prevalence of poor sleepers (those with a PSI total sleep score [PSI-4 score] of 4 or higher) was 71% (45/63), and the prevalence of depression was 25% (16/63). Of the 45 poor sleepers, 15 had depression, defined as a BDI score of 17 or higher. Poor sleepers had a significantly higher rate of diabetes mellitus (P = 0.03), significantly higher total BDI scores, and lower Physical Component Scale scores (ie, lower HRQoL) than good sleepers. The PSI-4 score correlated negatively with Physical Component Scale (r = -0.500, P < 0.001) and Mental Component Scale scores (r = -0.527, P < 0.001) and it correlated positively with the BDI score (r = 0.606, P < 0.001). In multivariate analysis, independent variables of PSI-4 score were BDI score (beta value [β] = 0.350, P < 0.001), Mental Component Scale score (β = -0.291, P < 0.001), and age (β = 0.114, P = 0.035). CONCLUSION Poor SQ is a very common issue and is associated with both depression and lower HRQoL in elderly HD patients.
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Affiliation(s)
- Kultigin Turkmen
- Division of Nephrology, Meram School of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
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Nowak Ł, Adamczak M, Więcek A. Is inflammation a new risk factor of depression in haemodialysis patients? Int Urol Nephrol 2012; 45:1121-8. [PMID: 22972567 PMCID: PMC3732758 DOI: 10.1007/s11255-012-0269-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/08/2012] [Indexed: 11/29/2022]
Abstract
Purpose Prevalence of depression is high in patients with chronic kidney disease. Depression is associated with increased mortality and the higher rate of suicides in these patients. The aim of the study was to estimate the prevalence of depressive symptoms in haemodialyzed patients in Upper Silesia region of Poland and the possible role of inflammation in depression development. Methods Six hundred and ninety-seven haemodialyzed patients from 22 dialysis centres in Upper Silesia region of Poland were enrolled into the study. Mean age was 59.1 ± 0.5 years, and mean time of dialysis treatment was 3.6 ± 0.2 years. Each patient received 21-item Beck Depression Inventory (BDI) questionnaire for depression screening. Additional questions considering length of dialysis treatment, concomitant diseases and number of days spent in hospitals during the last year were also asked. Results Depressive symptoms were found in 268 (38.6 %) patients. Patients with depressive symptoms when compared with the patients without them tended to have higher C-reactive protein plasma concentration (14.3 ± 1.3 vs. 11.1 ± 0.9 mg/l; p = 0.067) and were more often dialyzed with central catheter (27.6 vs. 18.2 %; p = 0.0042). During the last year, patients with depressive symptoms spent in hospitals more days than patients without depressive symptoms (24.3 vs. 15.3 days, respectively; p < 0.0001). Significant positive correlation between BDI score and C-reactive protein level (r = 0.1625; p = 0.001) was found both in univariate and multivariate analysis. Conclusions (1) Depressive symptoms are frequently found (38.6 %) in haemodialyzed patients in Upper Silesia part of Poland. (2) Catheter placement and inflammation seem to play an important role in the pathogenesis of depression in haemodialysis patients.
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Affiliation(s)
- Łukasz Nowak
- Department of Nephrology, Endocrinology and Metabolic Disorders, Medical University of Silesia, Francuska 20-24, 40-027, Katowice, Poland.
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Inui S, Shirakawa Y, Itami S. Effect of nalfurafine hydrochloride on pruritus and anxiety level in hemodialysis patients. J Dermatol 2011; 39:886-7. [PMID: 22142516 DOI: 10.1111/j.1346-8138.2011.01442.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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