Impact of anxiety and depression on the quality of life of haemodialysis patients

Physical activity in patients receiving peritoneal dialysis: a systematic evaluation and meta-analysis

BACKGROUND

Exercise has been proven to be beneficial for both the general population and individuals with chronic diseases. However, the specific effects of physical activity on patients undergoing peritoneal dialysis (PD) remain unclear.

AIM

This systematic review and meta-analysis aims to evaluate the effects of physical exercise on quality of life, physical function, pain, energy, sleep, and malnutrition-inflammation-atherosclerosis (MIA) syndrome in PD patients.

METHODS

We conducted a systematic search of PubMed, EMBASE, Web of science and the Cochrane Library for randomized controlled trials (RCTs) that compared routine care with physical activity interventions in patients with chronic kidney disease (CKD) undergoing PD. The search covered studies from database inception to December 2023. Outcomes were reported as mean differences (MD) with standard deviations (SD) and 95% confidence intervals (CI). All statistical analyses were performed using RevMan version 5.3.

RESULTS

We included nine RCTs involving 398 patients, with 199 (50%) randomized to the physical activity group. Follow-up ranged from 12 weeks to 6 months. Compared to routine care, the exercise group showed significant improvements in BKD (MD 9.98; 95% CI 2.14-17.82; p = 0.01), EKD (MD 7.15; 95% CI - 0.13-14.43; p = 0.05), social support (MD 9.51; 95% CI 0.27-18.75; p = 0.04), social interaction (MD 6.91; 95% CI 0.82-13.00; p = 0.03), and physical pain (MD 14.35; 95% CI 3.60-25.10; p = 0.009). Qualitative analysis revealed a significant decrease in homeostatic model assessment of insulin resistance (HOMA-IR), a significant increase in C-reactive protein (CRP), and improvements in sitting and standing tests (CS-30, FTTST, SS5) in the exercise group (p < 0.05).

CONCLUSIONS

This study represents the first meta-analysis comparing usual care with exercise interventions in PD patients. The findings indicate that exercise is a viable therapeutic option. Future research should prioritize the development of tailored exercise programs to optimize PD management.

A period prevalence study of palliative care need and provision in adult patients attending hospital-based dialysis units

BACKGROUND

Advanced chronic kidney disease is a life-limiting disease that is known to benefit from palliative care. Unmet palliative care need in patients with kidney failure is commonly reported but the level of need among patients receiving haemodialysis is unknown.

METHODS

A period prevalence study of adult patients attending two hospital-based dialysis units was conducted. Patient medical records were reviewed using the Gold Standards Framework Proactive Indication Guidance to assess for potential palliative care need.

RESULTS

A total of 128 patient medical records were reviewed, 45% (n = 58) of patients could have potentially benefitted from palliative care. Of the patients with indicators for palliative care, 72% (n = 42) had no evidence of receiving or awaiting any form of palliative care. High levels of palliative care need were found in patients who identified as Aboriginal or Torres Strait Islander and non-Indigenous patients.

CONCLUSIONS

This study found high levels of palliative care need among adult patients attending hospital-based dialysis units. The majority of patients with indicators were not receiving any form of palliative care.

Treatment of depression and poor quality of life through breathing training in hemodialysis patients

BACKGROUND

The management of depression in patients undergoing hemodialysis remains challenging and affects quality of life; however, there is a possibility that breathing exercises may be effective in this context. Thus, the purpose of this study was to evaluate the effectiveness of a breathing training program on quality of life and depression among patients on hemodialysis.

METHODS

A one-group pretest-posttest quasi-experimental design was used. Data were collected from hemodialysis patients at three dialysis centers. Initial baseline data were collected, and a breathing training program was implemented. The program included three types of breathing exercises. A total of 41 participants completed the study. The participants were asked to perform the breathing training program three times a day for 30 days. The impact of the intervention on patients' quality of life and depression was measured using both the Kidney Disease Quality of Life Short Version and the Beck Depression Inventory-Second Edition.

RESULTS

A significant decrease in the overall depression score was observed after implementing the breathing training program (BDI-II mean difference =-3.9, 95% CI:0.35-7.45, p = 0.03). The intervention has also had significant improvements on overall quality of life (KDQOL mean difference = 6.09, 95% CI: 0.48-11.70, p = 0.03) and a reduction in the symptoms and problems domain (domain mean difference = 6.71, 95% CI: 0.01-13.40, p = 0.05). There were some improvements on other quality of life domains but did not reach the statistical differences after program implementation.

CONCLUSIONS

Breathing exercises are associated with improved quality of life and reduced depression among HD patients, providing a simple and cost-effective intervention.

The prevalence of anxiety in respiratory and sleep diseases: A systematic review and meta-analysis

BACKGROUND

Anxiety is common in those with chronic physical health conditions and can have significant impacts on both quality of life and physical health outcomes. Despite this, there are limited studies comprehensively investigating the prevalence of anxiety in respiratory and sleep medicine settings. This systematic review and meta-analysis aims to provide insight into the global prevalence of anxiety symptoms/disorders in respiratory and sleep medicine outpatients.

METHODS

PubMed, Embase, Cochrane, PsycINFO and Google Scholar databases were searched from database inception to January 23, 2023 for studies assessing the prevalence of anxiety in adult (≥16 years) respiratory and sleep medicine outpatients. Data was screened and extracted independently by two investigators. Anxiety was measured using various self-report questionnaires, structured interviews, and/or patient records. Using CMA software for the meta-analysis, a random-effects model was used for pooled estimates, and subgroup analysis was conducted on relevant models using a mixed-effects model.

RESULTS

116 studies were included, featuring 36,340 participants across 40 countries. The pooled prevalence of anxiety was 30.3 % (95%CI 27.9-32.9 %, 10,679/36,340). Subgroup analysis found a significant difference across type of condition, with pulmonary tuberculosis the highest at 43.1 % and COVID-19 outpatients the lowest at 23.4 %. No significant difference was found across anxiety types, country or age. Female sex and the use of self-report measures was associated with significantly higher anxiety estimates.

CONCLUSIONS

Anxiety is a common experience amongst patients in respiratory and sleep medicine outpatient settings. Thus, it is crucial that anxiety identification and management is considered by physicians in the field.

REGISTRATION

The protocol is registered in PROSPERO (CRD42021282416).

The effect of conscious mindfulness-based informative approaches on managing symptoms in hemodialysis patients

Introduction

The research was conducted to determine the effect of conscious mindfulness based informative approaches applied in hemodialysis patients on reducing stress and managing symptoms.

Methods

This research was conducted as a real experimental model with a control group. Research population consisted of 160 hemodialysis patients. The sample of the study was determined as 120 hemodialysis patients in total, 60 in the experimental and 60 in the control group, as a result of the power analysis. After the pre-test application, a mindfulness-based stress reduction program was applied to the experimental group. In the analysis of the data collected in the research, percentage, frequency, chi-square analysis, t-test for independent groups, t-test for dependent groups were used by means of SPSS for Windows 22.00 statistical software package.

Results

The t-test analyses of the differences between pre-test and post-test scores of hemodialysis patients in the experimental group were found to be significant in favor of the post-tests.

Discussion

It was found out that the conscious mindfulness-based informative approaches decreased the perceived stress and anxiety of the patients in the experimental group, whereas increased their levels of conscious mindfulness and symptom management.

Mediating role of social support in dysphoria, despondency, and quality of life in patients undergoing maintenance hemodialysis

BACKGROUND

Dysphoria and despondency are prevalent psychological issues in patients undergoing Maintenance Hemodialysis (MHD) that significantly affect their quality of life (QOL). High levels of social support can significantly improve the physical and mental well-being of patients undergoing MHD. Currently, there is limited research on how social support mediates the relationship between dysphoria, despondency, and overall QOL in patients undergoing MHD. It is imperative to investigate this mediating effect to mitigate dysphoria and despondency in patients undergoing MHD, ultimately enhancing their overall QOL.

AIM

To investigate the mediating role of social support in relationships between dysphoria, despondency, and QOL among patients undergoing MHD.

METHODS

Participants comprised 289 patients undergoing MHD, who were selected using a random sampling approach. The Social Support Rating Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and QOL Scale were administered. Correlation analysis was performed to examine the associations between social support, dysphoria, despondency, and QOL in patients undergoing MHD. To assess the mediating impact of social support on dysphoria, despondency, and QOL in patients undergoing MHD, a bootstrap method was applied.

RESULTS

Significant correlations among social support, dysphoria, despondency, and quality in patients undergoing MHD were observed (all P < 0.01). Dysphoria and despondency negatively correlated with social support and QOL (P < 0.01). Dysphoria and despondency had negative predictive impacts on the QOL of patients undergoing MHD (P < 0.05). The direct effect of dysphoria on QOL was statistically significant (P < 0.05). Social support mediated the relationship between dysphoria and QOL, and this mediating effect was significant (P < 0.05). Similarly, the direct effect of despondency on QOL was significant (P < 0.05). Moreover, social support played a mediating role between despondency and QOL, with a significant mediating effect (P < 0.05).

CONCLUSION

These findings suggest that social support plays a significant mediating role in the relationship between dysphoria, despondency, and QOL in patients undergoing MHD.

Effects of a temporal self-regulation theory-based intervention on self-management in hemodialysis patients: A randomized controlled trial

OBJECTIVE

To investigate the effects of a temporal self-regulation theory-based intervention on self-management in hemodialysis patients.

METHODS

A randomized controlled trial was carried out in Lanzhou, China. Participants were randomly allocated to either the intervention group (n = 42) or control group (n = 42). The outcomes of self-management level, interdialytic weight gain, serum potassium and serum phosphorus were collected at baseline (T0), 1 month after intervention (T1), and 2 months after follow-up (T2).

RESULTS

After intervention and follow-up, the self-management score of the intervention group was significantly higher than that of the control group, while the interdialytic weight gain, serum potassium, and serum phosphorus were significantly lower. The group and time interaction effects revealed that participants in the intervention group exhibited significantly greater improvement in self-management at T1 and T2. Interdialytic weight gain decreased significantly at T2. Serum potassium levels did not differ significantly at T1 or T2. The changes in serum phosphorus were both significant at T1 and T2.

CONCLUSION

This study demonstrated that the temporal self-regulation theory-based intervention was effective in improving hemodialysis patients' self-management.

PRACTICE IMPLICATIONS

The findings suggest popularizing and applying this intervention in the clinic to maintain the long-term effectiveness of the intervention effect.

Exploring the Needs of Patients Undergoing Hemodialysis: A Qualitative Study

BACKGROUND

 Many studies have focused on patients' experiences living with hemodialysis therapy; however, there is little research exploring their needs. Therefore, the purpose of this study was to explore hemodialysis patients' needs in Saudi Arabia.

METHODS

A qualitative research design with semi-structured interviews was used. Data were collected from Aghrass Medical Center, Jeddah, Saudi Arabia. Data were analyzed using thematic analysis.

RESULTS

A total of 16 hemodialysis patients underwent in-depth interviews. The mean age of the participants was 49 ± 14.93 years of age. More than half of the participants were male (56.25%), and most of them were married (75%). Regarding the clinical characteristics, all patients had three sessions in a week, and the average duration was four hours per session. The mean number of years on dialysis therapy was 3.80 ± 2.8. Using thematic analysis, four themes emerged. These were the impact of fatigue and need for fatigue self-management, need for family and social support, psychological and emotional support from healthcare professionals, and changes in the patients' role performance and their need for adaptation.  Conclusions: This study highlights the aspects of needs among hemodialysis patients from their own perspective. Four themes of needs emerged from this study. Consequently, healthcare professionals should assess patients' needs frequently to ensure high-quality care.

The impact of anxiety and depression on the quality of life of hemodialysis patients in a sample from Somalia

OBJECTIVE

The main objective of the present study was to determine the quality of life (QoL), depression, and anxiety levels in kidney failure patients undergoing hemodialysis (HD) treatment and examine the impact of depression and anxiety on the QoL of these patients in a sample from Somalia.

METHODS

A sample of 200 patients with kidney failure who were undergoing HD treatment approximately two to three times a week was included. All participants were administered a sociodemographic data form, the Patient Health Questionnaire-9 (PHQ-9), the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life (WHO-QOL-BREF). Subjects on HD for less than 3 months prior to the study date were excluded.

RESULTS

Of the kidney failure patients, 200 patients, aged 18-86 years (median: 50.0; IQR: 25.0), consented and participated in the study. 58.5% of the participants were men; 64% had a kidney failure duration of 1-5 years, and 52.6% had a HD duration of 1-5 years. Mild symptoms of depression were found in 48%, while moderate-to-severe depressive symptoms were found in 13.5% of HD patients. Depression and anxiety were found to be significantly correlated with overall QoL, physical health, psychological health, social relationships, and environmental well-being. There were similar predictors of overall QoL, physical health, psychological well-being, social relationships, and environmental well-being relating to socio-demographic factors such as age, gender, family income, anxiety, and depression.

CONCLUSIONS

This study emphasizes the important role that anxiety, depression, and family income have in HD patients' QoL in Somalia. It highlights the significance of regular emotional assessment and efficient management in order to increase patient satisfaction. Future studies with larger samples are necessary for more accurate statistical analysis. To optimize patient care, a multidisciplinary healthcare team is recommended.

Global Prevalence of Anxiety in Adult Cardiology Outpatients: A Systematic Review and Meta-analysis

Anxiety and anxiety disorders are associated with adverse cardiovascular outcomes, and reduced quality of life. Despite this, no comprehensive study on the global prevalence of anxiety symptoms and disorders among adult cardiology outpatients exists. This systematic review and meta-analysis aims to provide cardiologists with a precise estimate of the prevalence of anxiety in their outpatient clinics. PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched from database inception to January 23, 2023. Data characteristics were extracted independently by 2 investigators. Ninety-three studies, n = 36,687 participants across 31 countries, were included. Global prevalence of anxiety symptoms/disorders was 28.9% (95%CI 25.7-32.4; 8927/36, 687; I2 = 97.33; n = 93). The highest rates were found in patients presenting with hypertension, 43.6%. Subgroup analyses revealed higher prevalence estimates when using self-report screening compared to gold-standard diagnostic interview. When using diagnostic interview, the highest rates were reported in outpatients with undifferentiated chest pain/palpitations, 19·0%. Panic disorder was the most frequent diagnosis 15.3%, and rates were significantly higher in patients with undifferentiated chest pain/palpitations compared to ischemic heart disease. Higher rates of anxiety were found in studies of outpatients from developing countries, and female outpatients tended to have higher rates compared to males. Anxiety occurred frequently among cardiology outpatients and at a higher rate than estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective identification and management strategies be developed to support cardiologists in identifying and treating these conditions in their clinics.