Quality of life of individuals with chronic kidney disease on dialysis

Pain Assessment in Patients during Hemodialysis Treatment: Quality Improvement Project

Pain is a prevalent symptom in patients with chronic kidney disease, related to disease progression, comorbidities, and required immobility during dialysis treatment. Nurses must perform detailed pain assessments to manage pain effectively during hemodialysis treatment. This quality improvement project, reported using SQUIRE 2.0, aims to describe pain characteristics in chronic kidney disease patients in a hemodialysis unit clinic in Portugal, implement strategies to improve the pain assessment process in patients with chronic kidney disease during hemodialysis treatment, and assess nurses' satisfaction with the implemented strategies. The study was conducted in a Portuguese hemodialysis clinic, with patients and nurses, in three phases: diagnostic study, protocol implementation, and a descriptive study to assess nurse satisfaction. Seventy-five patients (mean age 71 ± 12.6 years) participated, with 64% reporting moderate chronic pain daily and 48% during hemodialysis treatment. Thirteen nurses considered the pain assessment protocol important, rating their satisfaction at 7.92 ± 1.32 (0-10). Standardizing practices through protocol implementation is likely to improve care and increase nurse satisfaction.

Effects of intradialytic exercise on functional capacity in patients with end-stage chronic kidney disease: a systematic review and meta-analysis

The study aimed to investigate the effect of intradialytic exercise training programmes on the submaximal functional capacity of patients with kidney failure. We searched for randomized clinical trials that assessed submaximal functional capacity using the 6-min walk test (6 MWT) in adult patients on maintenance haemodialysis submitted to intradialytic physical training. The search was performed on 15 October 2021, in different databases. Random-effect, multivariate meta-regression adjusted for multiplicity were performed to examine the relationship between exercise effect and covariates. Intradialytic physical exercise induced greater changes in 6MWT distance (k = 18; n = 1,458; WMD: 37.0; 95% CI 29.3; 50.6 metres) than control groups, with substantial heterogeneity (I2 = 78.3%). Aerobic, strength, and combined exercise promoted an average increase of 48.7 (95%CI 30.9; 66.4 metres), 16.9 (95%CI 7.6; 26.3 metres), and 75.8 (95%CI 55.1; 96.6 metres) metres, respectively. Strength training resulted in inferior gains in 6MWT distance compared to aerobic training (WMD: -25.0; 95%CI: -49.1; -0.9). Intervention length shorter than 11 weeks (WMD: 37.0; 95%CI: -5.4; 79.3 metres) did not induce greater changes in 6MWT compared to control groups. There was a positive response in submaximal functional capacity to intradialytic training in kidney failure patients on maintenance haemodialysis.

Assessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis

OBJECTIVES

to evaluate the prevalence of sarcopenia in individuals aged 50 years or older on hemodialysis; to verify the association between sarcopenia and sociodemographic, clinical, anthropometric factors, components of sarcopenia and quality of life (QoL); and to correlate the components of sarcopenia with QoL.

METHODS

Participated 83 individuals on hemodialysis. Sarcopenia was established according to the current European consensus. Dynamometry to determine strength, calf circumference (CC) and appendicular skeletal muscle mass index (ASMMI) to obtain muscle mass and gait speed (GS) for physical performance. For QoL used the WHOQOL-bref.

RESULTS

the prevalence of sarcopenia was 32.6% (CC) and 18.1% (ASMMI). There was no association between sarcopenia and QoL. Both handgrip strength (r=0.25) and GS (r=0.36) showed a correlation with physical domain.

CONCLUSIONS

sarcopenia was expressive, and the aspects of functionality determine the physical impairment in this population.

Visual Impairment in Hemodialyzed Patients-An IVIS Study

Background and Objectives: The growing and aging population of hemodialysis patients has become increasingly disabled, with more complex comorbidities, and are older upon initiating dialysis. Visual impairment can adversely affect their quality of life and life satisfaction. Treatment evaluation should not only consider remission of the disease, but also the improvement of quality of life and life satisfaction. This is a single-center cross-sectional study. It was designed to evaluate visual impairment in hemodialyzed patients, its correlation with quality of life and life satisfaction, and its relationship to clinical outcomes in hemodialyzed patients. Materials and Methods: Seventy patients with chronic kidney disease undergoing hemodialysis and aged 18 years or older were recruited from a single Dialysis Unit. The Impact of Visual Impairment Scale (IVIS), WHOQOL-BREF, and Cantril Ladder questionnaires were utilized to assess both sociodemographic and clinical variables. Results: It was found that, among all assessed variables (i.e., sex, marital status, level of education, months on hemodialysis, history of kidney transplantation, Kt/V, URR, and UF), only age and central venous catheter placement were positively correlated with IVIS scores, while arteriovenous fistula and willingness to become a kidney transplant recipient were negatively correlated. Furthermore, a comparison between patients with moderate and severe visual impairment yielded supplemental data indicating that individuals whose dialysis access was through a dialysis catheter and those ineligible or unwilling to undergo transplantation suffered more often from severe visual impairment. This finding may be attributed to age. Conclusions: Older patients were predominantly observed to experience visual impairment. Patients intending to receive a kidney transplant and whose dialysis access was through an arteriovenous fistula were less prone to visual impairment, compared to those who may be ineligible or unwilling to receive transplantation and those with hemodialysis catheters. This phenomenon can be attributed to age-related distinctions in patients' suitability for specific dialysis access and transplantation. Those reporting visual impairment gave lower ratings in all four domains of their quality of life (comprising physical health, psychological health, social relationships, and environment) and in both present and anticipated five-year life satisfaction. More severe visual impairment was related to an additional reduction in physical health, social relationship, and environment domains, and in life satisfaction.

Role of breathing training programs on quality of life in chronic kidney disease patients

Background

Due to its chronic and progressive nature, chronic kidney disease (CKD) affects patients in many spheres including their perception of quality of life (QOL). Breathing training techniques have shown positive effects on health and QOL for different conditions.

Objective

The aim of this study was to perform a scoping review to examine the characteristics related to the application of breathing training on patients with CKD, and to identify the relevant outcomes and target group for the application of breathing training.

Methods

This scoping review was performed in accordance with PRISMA-SRc guidelines. We systematically searched three electronic databases for articles published before March 2022. The studies included patients with chronic kidney disease that received breathing training programs. The breathing training programs were compared to usual care or no treatment.

Results

A total of four studies were included in this scoping review. The four studies had heterogeneous disease stages and breathing training programs. All the studies included reported positive effects of breathing training programs on QOL of CKD patients.

Conclusion

The breathing training programs were able to improve the quality of life of patients with CKD undergoing hemodialysis treatment.

Mesenchymal Stromal Cell Therapy Reverses Detrusor Hypoactivity in a Chronic Kidney Patient

Detrusor hypoactivity (DH) is characterized by low detrusor pressure or a short contraction associated with low urinary flow. This condition can progress to chronic renal failure (CRF) and result in the need for dialysis. The present case report demonstrates that a patient diagnosed with DH and CRF who received two transplants with 2 × 10⁶ autologous mesenchymal stromal cells at an interval of 30 days recovered the contractile strength of the bladder and normalized his renal function. The patient had a score of 19 on the ICIQ-SF before cell therapy, and that score was reduced to 1 after transplantation. These results demonstrate that there was an improvement in his voiding function, urinary stream and urine volume as evaluated by urofluxometry. In addition, a urodynamic study carried out after treatment showed an increase in the maximum flow from 2 mL/s to 23 mL/s, the detrusor pressure in the maximum flow from 21 cm H₂O to 46 cm H₂O and a BCI that went from 31 to 161, characterizing good detrusor contraction. Thus, in the present case, the transplantation of autologous mesenchymal stromal cells proved to be a viable therapeutic option to allow the patient to recover the contractile strength of the bladder, and reversed the CRF.

Quality of Life of Hemodialysis Patients in Greece: Associations with Socio-Economic, Anthropometric and Nutritional Factors

Chronic kidney disease (CKD) is a serious public health problem that, in recent decades, has taken on significant dimensions with serious effects on the quality of life (QoL) of patients. The purpose of this cross-sectional study is to evaluate the QoL of a sample of hemodialysis patients in Greece and the possible correlations with socio-economic and anthropometric factors, as well as with adherence to the Mediterranean Diet (MD). During September-November 2019, one-hundred and five (n = 105) patients with end-stage CKD (63.4 ± 13.09 years of age) who were regularly monitored in five public and private hemodialysis units in the region of Attica, completed a demographic questionnaire, the MedDietScore questionnaire, and the KDQOL-SF questionnaire. Females presented worse QoL than males (p < 0.05), and older patients presented worse QoL than younger patients (p < 0.01). Patients of higher educational status presented better QoL scores than those of lower educational status (p < 0.01), while those with low financial status presented lower QoL scores than patients of middle and high financial status (p < 0.01). Obese patients had lower QoL scores than overweight patients (p < 0.05), and overweight males scored higher than normal weight males (p < 0.05). Age was negatively correlated to the total and most of the scales of QoL (p < 0.01). A majority of the patients (90.5%) showed a moderate adherence to MD, although "work status" was the only QoL scale that was correlated to MD. Age, educational status and financial status accounted for 28.1% of the variance in the KDQOL-SF total score. Hemodialysis patients need support in various levels, such as social, financial and educational, as well as nutritional counseling to adopt a balanced diet and maintain a healthy weight, in order to achieve a better quality of life.

Effect of Uncertainty in Illness and Fatigue on Health-Related Quality of Life of Patients on Dialysis: A Cross-Sectional Correlation Study

This study aimed to determine the effect of uncertainty in illness and fatigue on the health-related quality of life of patients on dialysis. A community-based cross-sectional study was conducted among patients on hemodialysis (n = 80) and peritoneal dialysis (n = 81) in Korea. Data were collated using self-reported structured questionnaires. Multiple regression analysis was used to identify those factors affecting the physical and mental health-related quality of life of patients. Patients on peritoneal dialysis reported higher levels of fatigue (p < 0.001). Factors affecting the physical health-related quality of life of patients on dialysis were fatigue (p < 0.001), employment (p = 0.001), and exercise (p = 0.016), thus explaining the observed variance of 37%. Factors affecting mental health-related quality of life were fatigue (p < 0.001), uncertainty (p = 0.004), educational level (p = 0.005), and smoking (p = 0.035). To improve the health-related quality of life of patients on dialysis, clinicians should assess their fatigue levels and plan multidisciplinary interventions to manage it. In addition, education level and employment status should be considered, and tailored interventions should be provided to acquire positive coping strategies and health promotion behaviors to counter disease uncertainty.

Quality of Life, Depression, and Anxiety in Patients Undergoing Renal Replacement Therapies in Saudi Arabia

Despite improvements in renal replacement therapy (RRT) for end-stage renal disease (ESRD), it continues to have serious negative impacts on quality of life (QOL) and emotional status. This study determines the association between demographic characteristics and the negative emotional states of depression, anxiety, and stress in Saudi Arabia. A comparative cross-sectional study was conducted in the Eastern Region of Saudi Arabia. Convenience sampling was used to recruit participants comprising hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (Tx) patients. They completed the Short Form-36 Survey and the Depression, Anxiety, Stress Scale (DASS). The physical component summary (PCS) score was similar for HD (41.7) and PD (41.5), but higher among Tx (45.2). The mental component summary (MCS) score was similar between HD (48.0) and Tx (48.8), but lower in PD (42.3). The majority of patients in all groups had normal levels of depression, anxiety, and stress. Overall, the study found that PCS was higher among Tx patients compared to HD and PD, while MCS was higher among HD and Tx patients than PD patients. Most patients' levels of depression, anxiety, and stress were within the normal range. Those findings will provide policymakers and health managers with the significant factors which can affect the QOL of dialysis and Tx patients.

A qualitative content analysis of an online forum for people with kidney disease: Exploring the role of companion and non-companion animals

BACKGROUND

Companion and other animals have been known to promote wellbeing of people living with chronic disease by assisting in emotional regulation, social interaction and enhancing self-identity. However, little is known about the impact of animals on people with kidney disease, who often live with treatment burden, as well as compromised immune systems making them vulnerable to zoonotic diseases.

OBJECTIVES

To explore the impact companion and non-companion animals have on the lives of people living with kidney disease.

DESIGN

Qualitative Content Analysis of 518 posts from an online forum.

PARTICIPANTS

One hundred seventy-two people (109 female, 41 male and 22 unknown) posting to an online forum for people undergoing kidney dialysis.

RESULTS

Benefits of bonds with animals included reciprocal love and affection, emotional support, stress reduction, aiding relaxation, assisting social interaction, animals' intuitive comfort when unwell, feelings of loyalty, and motivation to live, concerns relating to zoonotic disease risk, and patients' impressions of health professionals' opinions on animals.

CONCLUSIONS

This study reinforces the existence of strong bonds between humans and animals, as well as demonstrating the importance of and concerns regarding interacting with non-companion animals for people with chronic kidney disease (CKD). There is a mismatch between patients' perception of infection risk and the advice and opinions of some healthcare professionals. Recognition and support for the role of animals as social supports are warranted in history taking, patient education of risk, and the biopsychosocial benefits of animals.

Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis

OBJECTIVE

To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument.

SOURCES OF DATA

A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out.

SUMMARY OF THE FINDINGS

17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3-5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the physical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points.

CONCLUSION

The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the "school" dimension being the most affected and the "emotional" one the least. In this sense, we suggest monitoring the health-related quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease.

Religious coping and hope in chronic kidney disease: a randomized controlled trial

OBJECTIVE

To evaluate the effect of prayer on religious/spiritual coping and on the hope of patients with chronic kidney disease undergoing hemodialysis.

METHOD

Randomized, controlled and blinded clinical trial, carried out in a dialysis unit, with a total of 62 patients undergoing hemodialysis - 31 participants in intervention group and 31 in the control group. Intercession prayer was applied three times, in alternate weeks, during hemodialysis sessions. Differences between groups in the outcome of the effect of prayer on religious/spiritual coping and hope were analyzed.

RESULTS

Participants used positive coping at high mean scores in both groups (control - 3.62 and intervention - 3.26) and negative coping had little use (control - 1.66 and intervention - 1.47). The use of total coping was between 2.35 and 2.48 in the intervention group (p = 0.015). Hope variables were better in the intervention group: optimism (p = 0.001), short- and long-term plans (p = 0.004), remembering happy moments (p = 0.039) and valuing life (p = 0.050).

CONCLUSION

The use of prayer promotes an increase in religious/spiritual coping and hope. Brazilian Registry of Clinical Trials: RBR-4pphkf.

Effect of continuous nursing on quality of life of hemodialysis patients: A protocol for systematic review and meta-analysis

BACKGROUND

Hemodialysis is a common treatment for patients with end-stage renal failure. Long-term hemodialysis will lead to a series of complications and reduce the quality of life of patients. At present, routine nursing is only limited to in-hospital patients, whereas continuous nursing is an extension of hospital nursing work, which can solve the follow-up health problems of some patients and meet the health needs of patients in their daily life. A number of clinical studies have shown that continuous nursing can improve the quality of life of hemodialysis patients, but there is a lack of evidence-based medicine. Therefore, the purpose of this study is to explore the effect of continuous nursing on the quality of life of hemodialysis patients through systematic evaluation.

METHOD

The Cochrance Library, PubMed, Embase, Web of Science, CNKI, VP Information Chinese Journal Service Platform (VIP), and Wanfang will be searched by computer. In addition, Baidu academic and Google academic are searched manually, and all randomized controlled trials on the effects of continuous nursing on the quality of life of hemodialysis patients are collected. The retrieval time is of the establishment of the database to January 31, 2021. Two evaluators screens, extract and evaluate the literature, and the data are analyzed by RevMan5.3 software.

RESULT

The purpose of this study is to evaluate the effect of continuous nursing on the quality of life of hemodialysis patients by the MOS item short from health survey, exercise of self-care agency, and the incidence of complications.

CONCLUSION

This study will provide reliable evidence for the application of continuous nursing in hemodialysis patients.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/HZKUA.

Exercise interventions improve depression and anxiety in chronic kidney disease patients: a systematic review and meta-analysis

PURPOSE

This systematic review examined the effects of exercise interventions on depression and anxiety in chronic kidney disease patients.

METHODS

Electronic searches were conducted between August 2019 and February 2020 at PubMed, MEDLINE, Web of Science, EBSCO, Scopus, LILACS, EMBASE, Physiotherapy Evidence Database, and Cochrane Library databases. Original clinical trial studies that examined the effects of exercise on depression and anxiety in chronic kidney disease patients, stages 3-5, were included. A total of eight studies were included in the systematic review after applying the eligibility criteria, and six studies used for the meta-analysis procedures.

RESULTS

The meta-analysis demonstrated statistical difference on depression in favour to exercise when compared to active control (SMD = - 0.66 [- 1.00, - 0.33], p < 0.0001) and passive control (MD = - 6.95 [- 8.76, - 5.14], p < 0.00001). Same results on anxiety demonstrated statistical difference between exercise and active control (SMD = - 0.78 [- 1.21, - 0.34], p = 0.0004).

CONCLUSION

From the current limited number and quality of published studies, exercise seems to be more effective than sedentary control and other active control groups for improving depression and anxiety symptoms in chronic kidney disease patients.

Health related quality of life and healthcare utilization among adults with diabetes and kidney and eye complications in the United States

BACKGROUND

One-third of adults with diabetes in the United States have chronic kidney disease (CKD), and 19% of them have eye complications (ECs). However, little is known about the Health-related Quality of Life (HRQoL) of adults with both of these diabetes-related complications. Therefore, the purpose of this study is to examine differences in the HRQoL, mental health, and healthcare utilization of adults with diabetes who have CKD, ECs, both or neither.

METHODS

A cross-sectional study design was implemented using data from multiple panels (2009-2015) of the Medical Expenditure Panel Survey. HRQoL was measured using the SF-12 Physical and Mental Component Summary (PCS & MCS) scores. The HRQoL, mental health, and healthcare utilization of four mutually exclusive groups: 1) diabetes with both CKD and ECs; 2) diabetes with CKD only; 3) diabetes with ECs only, and 4) diabetes with neither CKD nor ECs were compared. In all analyses, adults with neither CKD nor ECs were the reference group.

RESULTS

There were 8415 adults with diabetes who met the inclusion criteria. Approximately, 75% of the study sample had neither CKD nor ECs, 13.3% had ECs only, 5.7% had CKD only, and 5.5% had both CKD and ECs. In the adjusted analyses, adults with both CKD and/or ECs complications exhibited significantly lower HRQoL compared to those with neither CKD nor ECs. Mental illness and psychological distress were higher among adults with both CKD and ECs compared to those with neither CKD nor ECs. Furthermore, adults with CKD and/or ECs had higher polypharmacy, inpatient and emergency services use compared to those with neither CKD nor ECs.

CONCLUSIONS

The results indicate that the presence of both CKD and/or ECs was negatively associated with poor HRQoL, poor mental health, higher psychological distress and healthcare utilization in adults with diabetes. The findings emphasize the need for routine assessment and treatment for diabetes-related CKD and/or ECs complications to improve the quality of care for individuals with diabetes.