Mediating effects of fatigue on the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis

The relationship between fatigue, pruritus, and thirst distress with quality of life among patients receiving hemodialysis: a mediator model to test concept of treatment adherence

Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.

Relationship between fatigue and quality of life and related factors in family caregivers of patients on hemodialysis

BACKGROUND

The incessant and stressful nature of providing care to patients with chronic diseases can cause fatigue in caregivers. Caregivers' fatigue and reduced quality of life can reduce the patient's quality of care. Since it is important to pay attention to the mental health of family caregivers, this study investigated the relationship between fatigue and quality of life and their related factors in family caregivers of patients on hemodialysis.

METHODS

This cross-sectional descriptive-analytical study was performed in 2020-2021. One hundred seventy family caregivers were recruited by convenience sampling from two hemodialysis referral centers in the east of Mazandaran province, Iran. The data collection tools were the Family Caregiver Quality of Life questionnaire and Krupp's fatigue severity scale.

RESULTS

The majority (88%) of caregivers had moderate to severe fatigue. Caregivers' fatigue was a major factor influencing their quality of life. There was a significant fatigue difference between some categories of kinship and the caregiver's income level (P < 0.05). Caregivers with lower income and education levels, those who were the patient's spouse, and those who could not leave the patient alone had significantly worse quality of life than other caregivers (P < 0.05). Also, caregivers living with the patient in the same house had a worse quality of life than those living separately (P = 0.05).

CONCLUSION

Considering the high prevalence of fatigue among family caregivers of patients on hemodialysis and its adverse effect on their quality of life, it is recommended to perform routine screenings and implement fatigue alleviation interventions for these caregivers.

The effect of an educational app on hemodialysis patients' self-efficacy and self-care: A quasi-experimental longitudinal study

OBJECTIVE

Adequate self-care and exploring ways to improve it is imperative for patients with hemodialysis in order to meet the challenges arising from hemodialysis. This study aimed to determine the effect of an educational app on patients with hemodialysis' self-efficacy and self-care.

METHODS

The present study is a quasi-experimental longitudinal single-group study, carried out from October 2020 to March 2021 with the participation of 60 Patients with hemodialysis. Simple random sampling was used to sample patients. The intervention included an educational application, and participants completed questionnaires on self-efficacy and self-care performance at four points including baseline and at one, three, and six-month intervals post- intervention. Two-way ANOVA with repeated measures was used to examine the impact of the intervention. Bonferroni's posthoc test was also used for in-class calculation and comparison of changes over various periods.

RESULTS

The results of this study showed that the self-care performance of patients at different times was statistically significant (P <0.001). Also, the results showed that the mean total score of self-efficacy in the second period compared to the first was significantly improved (P <0.001). But the trend of changes in the third period compared to the second and the fourth to the third was not significant (p = 0.1 and p = .82). Also, a significant change was observed in the fourth period compared to the first (p = .029).

CONCLUSIONS

The study showed that education through a mobile app can result in significant improvements in these patients' self-care behaviors and self-efficacy over time. The educational intervention should be provided to patients with hemodialysis over a several-month period to allow for proper integration of the learning.

Prevalence and predisposing factors for fatigue in patients with chronic renal disease undergoing hemodialysis: a cross-sectional study

BACKGROUND

Patients with chronic renal disease and undergoing hemodialysis are at a high risk for developing several complications. Fatigue is a common, troubling symptom that affects such patients and can contribute to unfavorable outcomes and high mortality.

OBJECTIVE

This cross-sectional study aimed to evaluate the prevalence of fatigue in Brazilian patients with chronic kidney disease undergoing hemodialysis and determine the predisposing factors for fatigue.

DESIGN AND SETTING

An observational, cross-sectional, descriptive study was conducted in two renal replacement therapy centers in the Greater ABC region of São Paulo.

METHODS

This study included 95 patients undergoing dialysis who were consecutively treated at two Brazilian renal replacement therapy centers between September 2019 and February 2020. The Chalder questionnaire was used to evaluate fatigue. Clinical, sociodemographic, and laboratory data of the patients were recorded, and the Short Form 36 Health Survey, Pittsburgh Sleep Quality Index, and Beck Depression Inventory were administered.

RESULTS

The prevalence of fatigue in patients undergoing hemodialysis was 51.6%. Fatigue was independently associated with lower quality of life in terms of physical and general health. Patients with fatigue had a higher incidence of depression (65.9% vs. 34.1%, P = 0.001) and worse sleep quality (59.1% vs. 49.9%; P = 0.027) than those without fatigue.

CONCLUSION

Prevalence of fatigue is high in patients undergoing hemodialysis and is directly related to physical and general health.

A Cross-sectional Study of Depression among Non-dialysis Stage 3-5 Chronic Kidney Disease Patients

Depression is common among patients undergoing dialysis. However, there is a dearth of data on depression and its predictors among patients at different stages of chronic kidney disease (CKD). This study assessed the prevalence of depression and the relationships between depression and sociodemographic and clinical factors among non-dialysis CKD patients. A convenience sample of 88 CKD patients was recruited using a cross-sectional study design. The Beck Depression Inventory-II (BDI-II) was used to assess the levels of depression among CKD patients, with a cutoff score of ≥11. Data on the sociodemographic factors and clinical factors were also collected. Inferential statistics were used to determine the characteristics of the sample and assess the prevalence and severity of depression. Multiple regression analysis was used to assess the associations between the characteristics of the sample and depression. The overall mean BDI-II score was 6.23 ± 6.13. With a cutoff score of ≥11, patients with major depressive episodes constituted 18.2% of the sample. Stages of the disease, comorbidities, and sex were independently associated with a high depression score. The model explained 39% of the variation in the depression score. Depression is common among non-dialysis CKD patients. Screening for depression with brief validated tools should be integrated into routine clinical practice at renal clinics because patients in the advanced stages of CKD and those with multiple comorbidities require close attention. Furthermore, large studies assessing the prevalence and predictors of depression among different stages of CKD are required.

Examining social support, psychological status and health-related quality of life in people receiving haemodialysis

BACKGROUND

Being on haemodialysis can lead to many burdens on patients' lives. Social support for patients is crucial; however, whether social support affects health outcomes including both depression, anxiety and health-related quality of life is not well understood.

OBJECTIVES

To explore the relationship between social support, psychological status and health-related quality of life of people undergoing haemodialysis.

DESIGN

A cross-sectional study.

PARTICIPANTS

Convenience sampling recruited 388 patients from one dialysis centre.

MEASUREMENTS

Survey data collected included demographic and clinical data, the Medical Outcomes Social Support Survey, Depression Anxiety Stress Scales and Short-Form Health Survey 36. Multiple linear regression was used to determine the direct and mediation effects of social support on health outcomes.

RESULTS

Participants' ages ranged from 19 to 84 years and most had undergone haemodialysis for more than 5 years (53.2%). Overall, there was a moderate level of social support, and although tangible support was high, emotional-oriented support functions were missing. Participants reported a high level of anxiety, moderate levels of depression, mild levels of stress and impaired physical and mental health. Greater social support independently and positively affected mental health, and also reduced the negative influences of depression on the mental health component but not the physical health component. Social support, depression, anxiety and participation in social groups explained 48% of the variance in mental health.

CONCLUSIONS

People undergoing haemodialysis require both tangible and emotional social support. When there is enough social support, there are positive effects on reducing depression and improving mental, but not physical health.