The role of mind-body interventions in pre-dialysis chronic kidney disease and dialysis patients - A systematic review of literature

The impact of mindfulness meditation on pro-inflammatory biomarkers in patients with end-stage renal disease: A randomized trial

Background and aim

Mindfulness meditation has been inadequately used in patients with end-stage renal disease although it has been effective in reducing pro-inflammatory biomarkers in patients with chronic illnesses. Thus, this study examined mindfulness meditation effect on pro-inflammatory biomarkers and C-reactive protein in patients with end-stage renal disease.

Materials and methods

Repeated measures, randomized, control experimental design was used. A convenience sampling technique was used to select the sample from a hospital located in northern Jordan. The participants were randomly distributed into experimental (n = 31) and control (n = 31) groups. During hemodialysis sessions, the group of experiment participants practiced 30 min of the Attentional behavioral cognitive theory version of mindfulness meditation; 3 times a week for 8 weeks). The inflammatory biomarkers including C-reactive protein, tumor necrosis factor-alpha, and interleukine-6 were measured by collecting peripheral blood through venipuncture. These biomarkers were analyzed using the enzyme-linked immunosorbent assay (ELISA) protocol after 5 weeks of the intervention, and at its end (8 weeks). An Excel sheet was used to collect data for participants.

Results

Compared to the control condition, mindfulness meditation led to statistically significant reductions in C-reactive protein and tumor necrosis factor over time but a nonsignificant effect on interleukine-6.

Conclusion

Study's results support the evidence-based practice recommendation of adding mindfulness meditation as a complementary treatment to the nurse's care plans for patients with end-stage renal disease.

Trial registration

Clinical trial.gov; ID: NCT06064708; Date: 09/26/2023.

Music therapy in hemodialysis patients: Systematic review and meta-analysis

BACKGROUND

Patients undergoing hemodialysis (HD) face significant challenges; however, non-pharmaceutical interventions hold potential for enhancing their quality of life. This paper evaluates the effects of music therapy on various mental and physiological outcomes in patients undergoing HD.

METHODS

This systematic review and meta-analysis followed the PRISMA 2020 guidelines. A comprehensive database search conducted up to May 21, 2024, identified studies for inclusion based on PICOS criteria. The methodological quality of these studies was assessed using the Cochrane risk-of-bias tool and Review Manager 5.4. For the meta-analysis, R and Stata/SE 15.1 were used, applying a random-effects model in cases of significant heterogeneity, and a fixed-effects model when heterogeneity was minimal.

RESULTS

Twenty-four studies involving 1703 participants were analyzed. Music therapy significantly decreased anxiety (SMD: -0.72, 95 % CI: -0.97 to -0.46, I²: 83 %), pain (SMD: -1.22, 95 % CI: -1.68 to -0.75, I²: 93 %), depression (SMD: -0.85, 95 % CI: -1.31 to -0.39, I²: 77 %), stress (SMD: -0.93, 95 % CI: -1.17 to -0.68, I²: 41 %), and adverse reactions associated with HD (SMD: -0.67, 95 % CI: -0.88 to -0.46, I²: 0 %), all showing strong effect sizes (p < 0.001 for all). However, no significant changes were observed in sleep quality, fatigue, satisfaction with HD, systolic or diastolic blood pressure, heart rate, or finger temperature. A slight reduction in respiration rate (p = 0.0072) and an increase in oxygen saturation (p = 0.0056) were noted. While music therapy showed promising results, the notable heterogeneity in pain and anxiety outcomes suggests careful interpretation, although no significant publication bias was detected.

CONCLUSION

Music therapy has demonstrated encouraging outcomes in improving the well-being of patients undergoing HD, particularly in reducing anxiety, pain, and stress. However, due to notable heterogeneity and methodological issues such as small sample sizes and inconsistent blinding, further high-quality research is needed to confirm these findings and establish more robust evidence.

Effectiveness of Yoga and Meditation on Quality of Life Among Patients Undergoing Hemodialysis

The rising prevalence of chronic kidney disease poses a future challenge for healthcare and the economy. For patients diagnosed with kidney failure, hemodialysis is the sole recourse until a suitable renal donor is acquired, exerting a discernible impact on the overall quality of life. Yoga and meditation emerge as pivotal elements in enhancing quality of life (QoL), significantly influencing diverse aspects of well-being. The study aimed to identify the effectiveness of yoga and meditation on QoL among hemodialysis patients. An experimental research design with one group pretest - post-test on 100 participants was conducted in Muljibhai Patel Urology Hospital, Nadiad. Pre-tests were conducted on day 1, followed by a 12-week yoga and meditation program with a post-test. Data analysis utilised SPSS-20 software, employing descriptive and inferential statistics. Yoga and meditation effectively demonstrated improvement in QoL in each domain (p < 0.001.) post-intervention. These results emphasize QoL enhancement after incorporating these practices into hemodialysis care.

The effects of mandala coloring on fatigue, psychological well-being, and coping with stress in patients receiving hemodialysis treatment

BACKGROUND

Hemodialysis is an important health problem that negatively affects psychosocial status and support systems. Through practices such as mandala coloring, individuals transfer the unknowns they experience to the outside and make them visible. This study was conducted to examine the effects of mandala coloring on fatigue, psychological well-being, and factors associate with coping with stress in patients receiving hemodialysis treatment.

METHODS

The design was a prospective, parallel-group controlled trial. The study was conducted in the dialysis unit of a university hospital in eastern Turkey between April 4 and October 31, 2022, with a total of 60 patients, 30 in the intervention group, and 30 in the control group. The patients in the intervention group colored mandala once a week for 2 h, for a total of 8 weeks. The data were collected face-to-face using a patient information form, a Fatigue Severity Scale, a Psychological Well-Being Scale, and a Ways of Coping Questionnaire.

RESULTS

There were improvements in fatigue severity and psychological well-being over the 8-week study period in both the intervention and control groups. Scores were similar at baseline in the control and intervention groups, but better in the intervention groups compared to controls at 4 and 8 weeks for both metrics (p < 0001). Five factors from the Ways of Coping Questionnaire (self-confident approach, optimistic approach, seeking social support, helpless approach, and submissive approach) each improved during the 8-week period in the intervention group (p < 0.001). Three of these five factors improved in the control group as well. Scores for each of the five coping factors were better in the intervention group compared to controls at 4 and 8 weeks (p < 0.001).

CONCLUSION

Mandala coloring improved fatigue and psychological well-being and was associated with improved patient coping strategies.

Live music during haemodialysis: A multiple methods randomised controlled pilot study

BACKGROUND

Fatigue is an immense problem among patients undergoing haemodialysis and is associated with anxiety and depression. Live music used in different hospital settings has shown promising effects, but the feasibility and potential effectiveness of live music during haemodialysis are unknown.

OBJECTIVES

To evaluate the feasibility, the participants' musical experience and potential effectiveness of live music on patients' levels of fatigue, relaxation, anxiety, depression, treatment satisfaction and work engagement among nurses.

DESIGN

A pilot randomised controlled trial evaluated with a multiple methods design.

PARTICIPANTS

Two clusters of 12 patients were each randomised to receive either 30 min of live music once a week during haemodialysis or usual care over a period of 6 weeks.

MEASUREMENTS

The primary outcome was patients' immediate fatigue. Other outcomes were patients' long-term and post-dialysis fatigue, relaxation, anxiety, depression, treatment satisfaction and work engagement among nurses. Observations and semi-structured interviews with patients, nurses and musicians were conducted to gain an in-depth understanding of the musical experience as well as feasibility.

RESULTS

The study was feasible and detected significant differences on immediate fatigue (p < 0.001) and anxiety (p < 0.012) in the intervention group compared to controls. Among 17 nurses, a significant difference was found in Dedication (p < 0.024). Furthermore, live music gave patients an uplifting experience, bringing joy and relaxation and the nurses experienced a sense of quietness in a stressful day.

CONCLUSIONS

Providing live music performed by professional musicians in a haemodialysis setting is feasible and showed a significant effect on immediate fatigue and anxiety compared to controls.

Prevalence and varieties of complementary and alternative medicine usage among individuals with pre-dialysis chronic kidney disease in Taiwan: an investigative cross-sectional analysis

BACKGROUND

Complementary and alternative medicine (CAM) is frequently used in the general population, yet only limited data are available regarding the prevalence of these medications in patients with chronic kidney disease (CKD). Hence, our study aimed to explore the prevalence and types of CAM in Taiwanese patients with CKD.

METHODS

A cross-sectional questionnaire survey was conducted by face-to-face interview of 275 pre-dialysis patients without dialysis treatment or kidney transplant at an outpatient nephrology clinic in Taiwan from March 2021 to June 2023. The study outcomes were the prevalence of CAM, CAM types, reasons for using CAM, and sources of information about CAM.

RESULTS

Overall, 128 patients (46.5%) were using CAM, but no significant differences from non-CAM users in the various CKD stages (p = 0.156) were found. CAM usage was high in the age range of 20-60 years and duration of CKD ≤ 5 years (p < 0.05). The most commonly used type of CAM was nutritional approaches (79.7%), followed by other complementary health approaches (26.6%). The most commonly utilized modalities of CAM were vitamins and minerals (38.3%), and only 27.1% of patients disclosed their CAM use to their physicians. The most common sources of information about CAM were family and friends, cited by 66% of the participants. Health promotion and a proactive attitude were reported by 40% of users as the reasons for using CAM.

CONCLUSIONS

The present study provides data on the CAM usage among CKD patients and adds to the increasing evidence on CAM use. Because some of these practices have safety concerns, better education from healthcare providers on the risks and benefits of CAM therapy is needed by CKD patients.

Banging the drum: evolutionary and cultural origins of music and its implications for psychiatry

SUMMARY

There is growing interest in music-based therapies for mental/behavioural disorders. We begin by reviewing the evolutionary and cultural origins of music, proceeding then to discuss the principles of evolutionary psychiatry, itself a growing a field, and how it may apply to music. Finally we offer some implications for the role of music and music-based therapies in clinical practice.

Factors Affecting Pain in Hemodialysis and Non-pharmacological Management

Pain is a frequent problem among hemodialysis patients, mostly caused by painful procedures, acute complications of hemodialysis, and painful syndromes, such as musculoskeletal and neuropathic syndromes. Pain can frequently lead to sleep disturbances, reduced adherence to hemodialysis treatment, frequent hospital admissions, decreased quality of life, and high mortality rates. Non-pharmacological management of pain in the hemodialysis population includes aerobic and resistance exercises, music therapy, and cognitive behavioral therapy. The present review focuses on the factors affecting pain in hemodialysis and its non-pharmacological management, offering important information to renal professionals.

Role of Alternative Medical Systems in Adult Chronic Kidney Disease Patients: A Systematic Review of Literature

There is a growing interest in the use of alternative medical systems (AMS), such as traditional Chinese medicine (TCM), ayurveda, homeopathy, and naturopathy, among chronic kidney disease patients. This review summarizes the efficacy and safety of AMS interventions in chronic kidney disease (CKD) patients. A systematic review was conducted in MEDLINE, Embase, Scopus, CINAHL, CENTRAL, and PsycINFO in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines. Randomized controlled trials (RCTs) which evaluated the use of AMS among adult CKD patients were included. The efficacy of each AMS was assessed based on improvement in biochemical markers or reduction in symptom severity scores. All adverse reactions were recorded. Of the 14,583 articles retrieved, 33 RCTs were included. TCM (n=20) and ayurveda (n=6) were the most well-studied. Majority of studies (66.7%) had a sample size <100. Common indications evaluated included improvement in renal function (n=12), proteinuria (n=5), and uremic pruritus (n=5). Among TCM, acupuncture and syndromes-based TCM granules formulation were shown to improve estimated glomerular filtration rate (eGFR) by 5.1-15.5% and 7.07-8.12% respectively. Acupuncture reduced uremic pruritus symptoms by 54.7-60.2% while Huangkui, Shenqi granules, and Tripterygium wilfordii Hook F reduced proteinuria by 18.6-50.7%, 61.8%, and 32.1% respectively. For Ayurveda, camel milk and Nigella sativa oil improved eGFR by 16.9% and 86.8%, respectively, while capsaicin reduced pruritus scores by 84.3%. Homeopathic verum medication reduced pruritus scores by 29.2-41.5%. Nausea was the most common adverse effect reported with alpha-keto amino acids (0.07%), Nigella sativa oil (7.04%), and silymarin (10%). TCM and ayurveda were more well-studied AMS therapies that demonstrated efficacy in CKD patients. RCTs with larger sample sizes are needed to ascertain the efficacy and safety of promising AMS.

Frailty as an Independent Risk Factor for Depression in Patients With End-Stage Renal Disease: A Cross-Sectional Study

Background

Depression confers substantial disease burden globally, especially among those with chronic kidney disease (CKD). The presence of depression significantly impairs one's quality of life. Risk factors for depression in patients with CKD remain under-appreciated, and whether frailty, a geriatric phenotype, constitutes a risk factor for depression in this population is unknown.

Methods

We prospectively enrolled patients with end-stage renal disease (ESRD) undergoing hemodialysis for >3 months from National Taiwan University Hospital Yunlin Branch between 2019 and 2021. Clinical, physical, functional, and performance parameters were recorded, followed by frailty/sarcopenia assessment. Depression was screened for using the Geriatric Depression Scale. We analyzed the independent relationship between frailty and depression in these patients, using multiple regression analyses.

Results

Totally 151 patients with ESRD were enrolled (mean 61.1 years, 66.9% male), among whom 16.6% had screening-identified depression. ESRD participants with depression did not differ from those without regarding most parameters except serum creatinine, functional indices, and sarcopenia/frailty status. We found that having greater frail severities was independently associated with a higher probability of depression; having FRAIL- (odds ratio [OR] 5.418) and SOF-based (OR 2.858) frailty independently correlated with a higher depression probability. A linear relation exists between a greater frail severity and the probability of depression. Using a more relaxed criterion for detecting depression, higher SOF scores remained significantly associated with an increased depression risk.

Conclusions

In patients with CKD, frailty independently correlated with a higher probability of having depression. Strategies aiming to attenuate frailty may be able to benefit those with depression simultaneously in this population.

Prevalence and risk factors for elevated anxiety symptoms and anxiety disorders in chronic kidney disease: A systematic review and meta-analysis

BACKGROUND

Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients.

METHODS

Articles evaluating the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients, as diagnosed via DSM 4th or 5th edition criteria, clinical interviews or validated questionnaires, were searched in Medline®, Embase®, PsychINFO® and CINAHL®. Using random-effects meta-analyses, the prevalence of elevated anxiety symptoms and disorders were estimated. A narrative review on the risk factors associated with elevated anxiety symptoms and disorders was presented.

RESULTS

From 4941 articles, 61 studies were included. The pooled prevalence of anxiety disorders (9 studies, n = 1071) among CKD patients across studies was 19% while that of elevated anxiety symptoms (52 studies, n = 10,739) was 43%. Across continents, prevalence of elevated anxiety symptoms was highest in Europe and Asia. Between pre-dialysis and dialysis patients, the prevalence of elevated anxiety symptoms was not statistically different at 31% and 42% respectively. Common risk factors associated with elevated anxiety symptoms included concomitant depression, lower parathyroid hormone levels, increased comorbidities, increased duration of hospitalization, reduced perceived quality of life, and decreased vitality levels.

CONCLUSION

Given the high prevalence of anxiety disorders and elevated anxiety symptoms, more studies are required to assess the role and outcomes of anxiety screening among CKD patients. This could facilitate early identification of at-risk patients and potentially improve their clinical outcomes.