Sleep quality, depression, and quality of life in elderly hemodialysis patients

Noise levels in the dialysis unit and its relationship with sleep quality and anxiety in patients receiving HD: A pilot study

INTRODUCTION

HD unit is a noisy environment for patients, and noise can affect anxiety levels and sleep quality.

METHODS

The aim of the study is to determine noise level, the relationship between noise levels, and sleep quality and anxiety in patients in HD unit. A descriptive and observational study design was used. Three Benetech GM1351 manual sound-level meters were used to measure noise. A patient information form, the State Anxiety Inventory, and the modified Post-Sleep Inventory were used for data collection.

RESULTS

The noise range detected in the HD unit ranges from 48.40 to 72 dB(A). Our findings show that patients in the HD unit are exposed to high noise levels and the noise significantly negatively impacts quality of sleep and anxiety level of the patients.

CONCLUSIONS

It is important to be aware that HD patients are constantly exposed to high levels of noise and to plan nursing interventions to reduce this noise level.

A Narrative Review of Management Strategies for Common Symptoms in Advanced CKD

Patients with advanced chronic kidney disease (CKD) experience multiple bothersome symptoms, undermining their quality of life (QOL). With growing attention to the importance of symptom management in advanced CKD, the evidence regarding symptoms is increasing. In this review, we briefly summarize the current evidence of effective pharmacologic and nonpharmacologic interventions to improve symptoms and QOL in patients with advanced CKD, including those on dialysis. We focused on symptoms that are commonly experienced by patients, such as pain, fatigue, sleep disturbances, itching, nausea and vomiting, cognitive impairment, and anxiety and depression. We noted that research in symptom science focused on improving symptom management in CKD is still very limited. In addition to the lack of clinical practice guidelines to address those common symptoms, the major gaps in the current literature include the evidence regarding mechanistic pathways to inform the development of effective symptom management for CKD populations, the evidence to confirm effective pharmacologic interventions in other populations for CKD populations, and research on how to incorporate effective symptom management approaches into clinical care. Although improving mortality remains as an important area in the kidney community, there is an urgent need to focus on improving symptom management to improve QOL in advanced CKD.

Depression and quality of life in older adults on hemodialysis

Objective:

Depression is highly prevalent in hemodialysis patients, but few studies have evaluated older hemodialysis patients. The aim of this study was to evaluate the prevalence of depression, its associated factors and its impact on quality of life in an older population on hemodialysis.

Methods:

This was a cross-sectional study including 173 hemodialysis patients aged 60 years or older in Recife, Brazil. Depression was evaluated using the Mini-International Neuropsychiatric Interview when depressive symptoms (according to the 5-item Geriatric Depression Scale) were present. Quality of life was assessed with the Control, Autonomy, Self-realization and Pleasure Questionnaire (CASP-16). Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin, and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics.

Results:

Depression was present in 22.5% of the sample. Depressed patients presented low CASP-16 quality of life scores (31.6 vs. 24.2, p < 0.001), twice the odds of albumin levels < 3.8 g/dL (OR 2.36; 95%CI 1.10-5.07; p = 0.027) and higher parathormone levels (OR 1.06; 95%CI 1.00-1.13; p = 0.05).

Conclusion:

Older hemodialysis patients have a high prevalence of depression. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels. Teams dealing with older hemodialysis patients should include depression and quality of life assessments in care protocols.

The effects of megestrol acetate on nutrition, inflammation and quality of life in elderly haemodialysis patients

PURPOSE

Malnutrition, inflammation and poor quality of life are prevalent among elderly haemodialysis patients. Megestrol acetate (MA) is a synthetic progestin that is widely used to increase appetite and weight in various clinical settings. MA has been indicated to be effective in improving quality of life in patients with cancers. The aim of the present study was to evaluate the efficacy and safety of MA in treating malnourished elderly haemodialysis patients.

METHODS

A randomized controlled study involving 46 hypoalbuminemia haemodialysis patients aged 70 years or older was conducted. The patients in MA-treated group (n = 23) took 160 mg of MA daily, while those in control group (n = 23) were enrolled without any intervention. Anthropometric parameters and laboratory results, including height, dry weight, body mass index, and modified subjective global assessment score as well as serum albumin, triglyceride, total cholesterol, hsCRP, IL-1b and IL-6 concentrations were measured in all patients before and after the intervention. Health-related quality of life was also evaluated using the KDQOL-SF 1.3.

RESULTS

In the MA-treated group, a total of 18 patients finished the therapy over a 3-month period. Appetite was reported as improved by 15 patients, and a statistically significant increase was observed in dry weight (53.36 ± 6.15 vs. 54.24 ± 6.32, P < 0.01) and serum albumin concentration (29.05 ± 3.91 vs. 37.67 ± 4.88, P < 0.01) in the MA-treated group compared to those of the control group. The quality of life in both the physical domain (46.73 ± 18.17 vs. 63.37 ± 22.35, P < 0.01) and the mental domain (50.28 ± 20.36 vs. 68.02 ± 25.48, P < 0.01) was also improved in the same group. There was no significant change in the inflammatory marker concentrations after the intervention. No serious or unexpected adverse events were observed except that one patient who withdrew due to excessive fluid gain between haemodialysis sessions.

CONCLUSION

Our data suggest that MA can be effective in improving nutritional status and quality of life by increasing appetite in elderly haemodialysis patients with acceptable side effects; however, MA might not ameliorate inflammation.

A holistic approach to factors affecting depression in haemodialysis patients

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

Role of resilience and social support in alleviating depression in patients receiving maintenance hemodialysis

BACKGROUND

Patients who undergo hemodialysis encounter challenges including role changes, physical degeneration, and difficulty in performing activities of daily living (ADLs) and self-care. These challenges deteriorate their physiological and psychosocial conditions, resulting in depression. High resilience (RES) and social support can alleviate stress and depression. This study evaluated the importance of RES and social support in managing depression in elderly patients undergoing maintenance hemodialysis (HD).

PATIENTS AND METHODS

In this descriptive, correlational study, 194 older patients undergoing HD were enrolled from the HD centers of three hospitals in northern Taiwan. The Barthel ADL Index, RES scale, Inventory of Socially Supportive Behavior, and Beck Depression Inventory-II were used. Hierarchical regression analysis was applied to evaluate the interaction of RES and social support with illness severity, demographics, and ADLs.

RESULTS

Of the total participants, 45.9% experienced depressive symptoms. Demographic analysis showed that men and those with high educational level and income and financial independence had less depression (p<0.01). Patients with a higher Barthel Index (n=103), RES scale (n=33), and social support (n=113) showed less depressive symptoms (p<0.01). We found a significant negative correlation between depressive symptoms and social support (r=-0.506, p<0.01) and RES (r=-0.743, p<0.01). Hierarchical regression analysis showed that RES could buffer the effects of symptom severity on depression (b=-0.436, p<0.01), but social support did not exert a buffering effect.

CONCLUSION

The severity of illness symptoms and ADLs were the major determinants of depressive symptoms. High RES could alleviate depressive symptoms in the older patients undergoing HD.

The impact on quality of life of dialysis patients with renal insufficiency

AIM

The aim of the study was the subjective assessment of the quality of life (QoL) of 140 patients treated with dialysis (peritoneal dialysis and hemodialysis).

BACKGROUND

Chronic kidney disease and the methods of its treatment play an important part in shaping the QoL of patients receiving dialysis. As a result, kidney failure causes many limitations in patients' physical, mental, and social activities.

METHODS

The instrument to measure the QoL was the authors' own questionnaire made on the basis of Kidney Disease and Quality of Life Short Form version 1.2 (KDQOL - SF 1.2) and their selection of areas influencing the perceived QoL of chronically ill patients.

RESULTS

The research showed that patients receiving peritoneal dialysis assessed their QoL in its different dimensions as much higher than patients receiving hemodialysis. The parameter having the biggest negative impact on the QoL of patients receiving hemodialysis was an impeded possibility to continue work or studies and a change of life plans. The will to live was more highly assessed by patients receiving peritoneal dialysis as compared to patients receiving hemodialysis.

CONCLUSION

In order to improve the functioning of hemodialysis patients in a manner most similar to healthy persons, the renal replacement therapy should consider patients' individual needs and expectations, ie, guarantee flexible hours of work or study and of receiving dialysis. In addition, patients treated with hemodialysis should receive psychological care, in particular those demonstrating emotional problems, in order to achieve better results in therapy and improve their QoL.

Relationship of Hemodialysis Shift With Sleep Quality and Depression in Hemodialysis Patients

This descriptive correlational study was aimed at determining the relationship of hemodialysis shift with sleep quality and depression in 310 hemodialysis patients. Demographic and Clinical Questionnaires, the Pittsburgh sleep quality index, and Beck's Depression Inventory were used to ascertain the aforementioned relationship. Among the patients, 59.6% reported poor sleep quality and 44.8% reported experiencing depression. Results show that these conditions were significantly related to many factors. Although dialysis shift was not significantly related to sleep quality and depression, sleep quality was found significantly associated with age, female gender, illiteracy, unemployment, residence in rural areas, diabetes, addiction to sedatives, and phosphorus levels. A significant relationship was also found between depression and phosphorus levels. Logistic regression predicted age, gender, illiteracy, unemployment, residence in rural areas, and addiction to sedatives as factors for poor sleep quality. A body mass index (BMI) above 30, decreased urea, and increased phosphorus were predicted as factors for increased depression.

Association between Serum Vitamin D Levels and Sleep Disturbance in Hemodialysis Patients

Sleep disturbance is a frequent and serious complication of hemodialysis (HD). Low serum vitamin D levels have been associated with sleep quality in non-HD subjects. Our aim was to examine the possible association between serum vitamin D levels and the presence of sleep disturbance in HD patients. We recruited 141 HD patients at the HD center of the First Affiliated Hospital of Jiaxing University during 2014–2015. Serum levels of 25-hydroxyvitamin D (25(OH)D) were determined by the competitive protein-binding assay. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Demographic, clinical and laboratory data were recorded. Meanwhile, 117 healthy control subjects were also recruited and underwent measurement of 25(OH)D. Eighty-eight patients (62.4%) had sleep disturbance (PSQI scores ≥ 5). Patients with sleep disturbance showed lower levels of 25(OH)D as compared to those without sleep disturbance (85.6 ± 37.4 vs. 39.1 ± 29.1 nmol/L, p < 0.001). In multivariate analyses, serum levels of 25(OH)D (≤48.0 nmol/L) were independently associated with sleep disturbance in HD patients (OR 9.897, 95% CI 3.356–29.187, p < 0.001) after adjustment for possible variables. Our study demonstrates that low serum levels of vitamin D are independently associated with sleep disturbance in HD patients, but the finding needs to be confirmed in future experimental and clinical studies.

Sleep Quality and Depression and Their Association with Other Factors in Hemodialysis Patients

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.

Relationship between dialysis adequacy and sleep quality in haemodialysis patients

AIM AND OBJECTIVES

The aim of this study is to examine the relationship between dialysis adequacy and sleep quality in haemodialysis patients.

BACKGROUND

Sleep problems are common in haemodialysis patients. Dialysis adequacy is one of the factors associated with sleep quality. Studies evaluating the association between dialysis adequacy and sleep quality in haemodialysis patients present different results.

DESIGN

Descriptive and cross-sectional study.

METHODS

This study was performed with a total of 119 patients who had applied to dialysis centres for haemodialysis treatment between January and March 2014. The data collection form consists of socio-demographic and medical characteristics as well as laboratory parameters. A modified Post-Sleep Inventory was used to examine sleep quality in the research.

RESULTS

There were no statistically significant relationship between sleep quality and dialysis adequacy (p > 0·05). When the Post-Sleep Inventory scores were evaluated according to sleep quality, 63·0% of patients had poor sleep quality, and 37·0% had good sleep quality. Sleep quality was worse in unemployed patients (X(2) = 4·852; p = 0·025) and patients who smoked heavily (Z = 2·289; p = 0·022).

CONCLUSIONS

In this study, there is no statistically significant relationship between dialysis adequacy and sleep quality. However, it was found that the majority of haemodialysis patients had poor sleep quality.

RELEVANCE TO CLINICAL PRACTICE

Even if the dialysis adequacy of patients is at the recommended level, their sleep qualities may be poor. Therefore, evaluations of the sleep quality of haemodialysis patients during the clinical practice must be taken into consideration.

[Analysis of the physical aspects of quality of life of kidney recipients]

OBJECTIVE

To identify the main factors of the physical domain modified after kidney transplantation and analyze the influence of those aspects in the perception of Overall quality of life (QOL).

METHOD

Longitudinal study, conducted with 63 chronic kidney patients, evaluated before and after kidney transplant, using the quality of life scale proposed by the World Health Organization.

RESULTS

We observed significant improvement in the physical aspects of QOL after kidney transplantation. Significant correlations were observed between physical aspects and the Overall QOL.

CONCLUSION

The kidney transplant generated improvement in all physical aspects of QOL. The factors that showed stronger correlation with the Overall QOL before the transplant were the capacity to work and pain. After the transplant, the perception of need for treatment was the factor that showed stronger correlation with the Overall QOL.

Effect of Regular Exercise Program on Depression in Hemodialysis Patients

Background and Aim. Depression is the most common psychological disorder in hemodialysis patients which decreases their quality of life and increases the mortality. This study was conducted to assess the effect of regular exercise on depression in hemodialysis patients. Methods. In a randomized clinical trial, 51 hemodialysis patients were allocated in two groups. Beck Depression Inventory (BDI) scale was used to assessing depression rate in participants. Designed program was educated using poster and face-to-face methods for case group. Intervention was carried out three times a week for ten weeks. At the beginning and the end of the study, depression rate of the subjects was assessed. Data was analyzed by SPSS16 software and descriptive and inferential statistics. Findings. According to the results of this study, there were no differences between case and control groups in depression rate at the beginning of the study, but there was significant difference after intervention (P = 0.016). In the beginning of the study, the mean and SD of depression in case group were 23.8 ± 9.29 and reduced to 11.07 ± 12.64 at the end (P < 0.001). Conclusion. The regular exercise program could reduce the depression in hemodialysis patients; therefore it is suggested for training this program for hemodialysis patients. This trial is registered with Iranian Registry of Clinical Trial (IRCT) number IRCT201205159763N1.

Sleeping problems in mothers and fathers of patients suffering from congenital central hypoventilation syndrome

PURPOSE

Advanced medical technology has resulted in an increased survival rate of children suffering from congenital central hypoventilation syndrome. After hospitalization, these technology-dependent patients require special home care for assuring ventilator support and the monitoring of vital parameters mainly during sleep. The daily challenges associated with caring for these children can place primary caregivers under significant stress, especially at night. Our study aimed at investigating how this condition affects mothers and fathers by producing poor sleep quality, high-level diurnal sleepiness, anxiety, and depression.

METHODS

The study included parents of 23 subjects with congenital central hypoventilation syndrome and 23 healthy subjects. All parents filled out the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI).

RESULTS

A comparison between the two groups showed that parents of patients had poorer sleep quality, greater sleepiness, and higher BDI-II scores compared to that of parents of healthy subjects (respectively, PSQI score 6.5 vs 3.8, ESS score 6.2 vs 4.3, BDI-II score 8.4 vs 5.7). Specifically, mothers of patients showed poorer sleep quality and higher BDI-II scores compared to that of mothers of controls (respectively, PSQI score 7.5 vs 3.8, BDI-II score 9.3 vs 5.9), whereas fathers of patients showed greater levels of sleepiness with respect to fathers of healthy children (respectively, ESS score 6.8 vs 4.0). These differences emerged in parents of younger children.

CONCLUSIONS

Congenital central hypoventilation syndrome impacts the family with different consequences for mothers and fathers. Indeed, while the patients' sleep is safeguarded, sleeping problems may occur in primary caregivers often associated with other psychological disorders. Specifically, this disease affects sleep quality and mood in the mothers and sleepiness levels in the fathers.

Spiritual coping, religiosity and quality of life: a study on Muslim patients undergoing haemodialysis

AIM

The number of haemodialysis patients globally is increasing and spiritual resources may help overcome adjustment problems among such patients. This study examined the relationships between spiritual/religious, demographic and clinical variables and quality of life among Iranian Muslims undergoing haemodialysis.

METHODS

Using a cross-sectional design, 362 haemodialysis patients were surveyed from three general hospitals located in Tehran, Iran. Spiritual coping strategies, Duke University Religion Index, EQ-5D 3L and a demographic questionnaire were administered. Hierarchical regression was used to identify predictors of quality of life and health status.

RESULTS

The distribution of reported problems across dimensions of quality of life was: mobility (59.4%), usual activities (30.4%), self-care (21.3%), pain/discomfort (47.8%) and anxiety/depression (29.3%). Univariate analysis showed that factors such as age, sex, marital status, location, number of children, body mass index, serum albumin, having diabetes mellitus or other comorbidity, as well as spiritual/religious factors that were related to quality of life, health status or both. Regression models revealed that demographics, clinical variables and especially spiritual/religious factors explained about 40% of variance of quality of life and nearly 25% of the variance in health status.

CONCLUSION

Spiritual resources may contribute to better quality of life and health status among haemodialysis patients. Further longitudinal studies are needed to determine whether these associations are causal and the direction of effect.

The effect of Benson's relaxation technique on the quality of sleep of Iranian hemodialysis patients: a randomized trial

OBJECTIVE

This study was performed to evaluate the effectiveness of Benson's relaxation technique in the quality of sleep of hemodialysis patients.

DESIGN

It was a randomized controlled trial with a pre-post-test design. A total of 86 hemodialysis patients referring to hemodialysis units were assigned to either the intervention (receiving Benson's relaxation technique) or the control group (routine care) through block randomization.

SETTING

The study was performed in two hemodialysis units affiliated to Shiraz University of Medical Sciences, Shiraz, Iran.

INTERVENTION

The patients in the intervention group listened to the audiotape of Benson's relaxation technique twice a day each time for twenty minutes for eight weeks.

MAIN OUTCOME MEASURES

The global score of Pittsburgh Sleep Quality Index (PSQI) as well as its components was computed in both the intervention and the control group before and at the 8th week of the intervention.

RESULTS

The results of ANCOVA indicated significant differences between the two groups regarding the scores of Pittsburgh Sleep Quality Index subscales, such as sleep disturbance, daytime dysfunction, the use of sleep medication, and subjective sleep quality and as well as its global scores at the 8th week of the intervention (p<0.05).

CONCLUSIONS

This study highlighted the importance of Benson's relaxation technique in improvement of the sleep quality of the patients on hemodialysis. Thus, educational sessions are recommended to be planned on this cost effective and easy to use relaxation technique in order to improve hemodialysis patients' sleep quality. Further studies are needed to assess the effectiveness of this technique in other groups of patients.