Different aspects of fatigue experienced by patients receiving maintenance dialysis in hemodialysis units

The Effects of Dialysis Modality and Emotional Distress on Fatigue in Patients Undergoing Dialysis

INTRODUCTION

Fatigue is a common but often overlooked symptom in dialysis patients. Factors affecting fatigue in dialysis patients are currently unclear. There are few studies on the effects of mental factors and dialysis modality on fatigue. This study aims to explore the potential relationship between fatigue and insomnia, as well as psychiatric disorders such as anxiety and depression among patients who undergo peritoneal dialysis (PD) or hemodialysis (HD).

METHODS

There were 96 HD patients and 160 PD patients at our hospital who voluntarily participated in the survey. A questionnaire survey was conducted to gather general characteristics of the patients and to evaluate fatigue, sleep quality, anxiety, and depression levels among PD and HD patients.

RESULTS

The overall fatigue score was 53.83 ± 14.22 for the PD group and 57.92 ± 16.35 for the HD group. Notably, the fatigue level was lower in the PD group compared to the HD group (p < 0.05). Univariate analysis indicated that fatigue was associated with occupational status and income in the PD group, as well as educational level and income in the HD group (p < 0.05). Correlation analysis revealed that patients in both groups who were older and had higher scores for insomnia, anxiety, and depression experienced more severe fatigue. Moreover, body mass index was positively correlated with fatigue status in the PD group, while duration of dialysis showed a positive association with fatigue in the HD group. Multivariate regression analysis identified income and depression as major factors influencing fatigue in the PD group, and duration of dialysis, income, and depression in the HD group.

CONCLUSION

Patients who undergo dialysis exhibit high levels of fatigue, with the severity of fatigue being less pronounced in the PD group compared to the HD group. Fatigue in these patients is associated with the duration of dialysis, income level, and presence of depression.

Causes of chronic kidney disease in the general population of Iran: A systematic review and meta-analysis

Chronic kidney disease is a significant public health problem worldwide. However, the causes of chronic kidney disease in Iran are unclear. This systematic review and meta-analysis identified the causes of chronic kidney disease in the general population of Iran. International databases (PubMed, Web of Science, Scopus, and Google Scholar) and national databases (Scientific Information Database and Magiran) were searched for studies published until March 1, 2018. The quality of the studies was assessed using the checklist developed by Hoy et al. Of 2518 retrieved studies, 26 studies involving 34,683 patients with chronic kidney disease stages 1 to 5 were included in the meta-analysis. The mean age of the cohort was 53.6±15.02 years. The results of the random-effects model showed that the three leading causes of chronic kidney disease were diabetes, hypertension, and glomerulonephritis, with an overall prevalence of 27.7%, 27.6%, and 6.4%, respectively. These results indicate the importance of addressing these risk factors at the national level to reduce disease prevalence.

Contribution of anxiety and dialysis factors to the event of fatigue in hemodialysis patient

Introduction: Fatigue is one of the most common symptoms felt by chronic renal failure patients undergoing hemodialysis (HD). The prevalence ranges from 42-97% with levels varying from low to severe. Fatigue is not only detrimental to physical and social functioning but is also associated with poor quality of life for HD patients and is associated with death in patients undergoing chronic hemodialysis. For this reason, it is necessary to know the factors associated with the incidence of fatigue so that appropriate interventions can be carried out, both pharmacologically and non-pharmacologically.Objective: To evaluate the influence of anxiety and dialysis factors on the incidence of fatigue in patients undergoing hemodialysis at Ciamis Hospital.Material and Method: A cross sectional approach with a total sample of 88 people was used.Results: The results showed that 78 respondents (88.6%) who experienced fatigue complaints and anxiety had a relationship with the incidence of fatigue (OR: 9.0; p=0.019).Conclusions: Psychological factors, such as anxiety, are associated with the fatigue experienced by patients on hemodialysis.

Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review

BACKGROUND

Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis.

METHODS

A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists.

RESULTS

Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status.

CONCLUSION

Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.

Avaliação de fadiga e fatores associados em pessoas submetidas à hemodiálise

Introdução: o sintoma de fadiga é considerado incapacitante e afeta a qualidade de vida das pessoas com doença renal crônica, em tratamento de hemodiálise. Objetivo: avaliar a prevalência, intensidade e severidade do sintoma de fadiga em pessoas com doença renal crônica em tratamento hemodialítico. Materiais e Método: Estudo quantitativo descritivo, do qual participaram 335 pessoas em tratamento hemodialítico. Para a coleta dos dados foram utilizadas as escalas Visual Analog Scale” de 100mm, escala de severidade de fadiga e um questionário sociodemográfico. Foram analisadas as variáveis dependentes das escalas de fadiga, com as independentes de caracterização sociodemográfica e clínica. Resultados: Identificaram-se 58% do sexo masculino, idade entre 20-59 anos em 52,2%, predomínio de cor branca em 68,2%, 68,6% com baixa escolaridade, aposentadoria como principal renda em 55,7%, renda entre R$ 800,01 e R$1760,00 em 42,4%, a prevalência de fadiga foi de 63,0%, fadiga severa em viúvos (35,2%) e mulheres (27,6%), sendo que a principal comorbidade foi a Hipertensão Arterial Sistêmica (40,9%). A intensidade de fadiga teve o valor médio de 42,3(DP=32,2) e a severidade de fadiga teve valor médio de 35,8(DP=17,8). Conclusões: evidenciou-se que o fator socioeconômico e as comorbidades influenciam no sintoma de fadiga em mulheres, viúvos e idosos. O uso de instrumentos de avaliação pode contribuir para melhorar a abordagem da Enfermagem, e em consequência, o bem-estar e a qualidade de vida destas pessoas.

Online hemodiafilteration use in children: a single center experience with a twist

Background

Haemodiafilteration (HDF) is a promising new modality of renal replacement therapy (RRT). It is an improvement in the quality of hemodialysis (HD) and thus in the quality of patients’lives. The main obstacle to using HDF is the cost, especially in developing countries. The purpose of this study was to evaluate the benefits of incorporating HDF with different regimens in the treatment of children with end stage renal disease (ESRD).

Methods

Thirty-four children with ESRD on regular HD in Pediatric Dialysis Unit, Children’s Hospital, Ain Shams University were followed up in 2 phases: initial phase (all patients: HD thrice weekly for 3 months) and second phase, patients were randomized into 2 groups, HDF group and HD group, the former was subdivided into once and twice weekly HDF subgroups. Evaluation using history, clinical and laboratory parameters at 0, 3, 9 and 18 months was carried out.

Results

On short term, we found that the HDF group was significantly superior to HD group regarding all clinical and laboratory parameters. Also, twice HDF subgroup was significantly superior to once HDF subgroup. This was confirmed on long term follow up, but the once HDF proved comparable to twice subgroup.

Conclusions

Incorporating online hemodiafilteration (OL-HDF) in the RRT of children was beneficial in most of the clinical and laboratory parameters measured. It’s not all or non; OL-HDF, even once a week, can improve outcomes of HD without significantly affecting the cost.

Effect of a Virtual Reality-Based Exercise Program on Fatigue in Hospitalized Taiwanese End-Stage Renal Disease Patients Undergoing Hemodialysis

The purpose of this study was to evaluate the short-term effect of a virtual reality-based exercise program on fatigue in patients with end-stage renal disease (ESRD) who receive hemodialysis (HD). In this quasi-experimental study design, an experimental group (n = 32) received virtual reality training that promoted exercise, and a control group (n = 32) received routine care (advice on physical activities). Fatigue and physiologic parameters were assessed pretest (before intervention) as well as posttest (4 weeks after the onset of intervention). Our results showed that patients in the experimental group had significantly lower levels of overall fatigue, reduction in vigor and motivation, distress and loss of control in mood, and higher hemoglobin levels compared with the control group. ANCOVA revealed that there were no differences in overall fatigue and different domains of fatigue. Exercise only increased the blood urea nitrogen (BUN) and creatinine levels significantly in the intervention group.

Short sleep duration is related to kidney-related biomarkers, but not lipid profile and diet quality in diabetic nephropathy patients

Objectives: Diabetic nephropathy may adversely influence on sleep duration. The quality of diet may also be affected by both sleep duration and diabetes nephropathy. Therefore, lower diet quality in short sleepers-diabetic nephropathy patients might be related to higher metabolic abnormalities. In the present study, we investigated if sleep duration is related to diet quality indices and biochemical markers in diabetic nephropathy patients. Method: This cross-sectional study was conducted among 237 diabetic nephropathy patients, randomly selected from patients attending in the Alzahra University Hospital, Isfahan, Iran. Usual dietary intake was assessed using validated food frequency questionnaire. Diet quality indices (including diet diversity score, dietary energy density, mean adequacy ratio, and nutrient adequacy ratio) were calculated based on standard definitions. Sleep duration was estimated using self-reported nocturnal hours of sleep. Results: Short sleepers (5-6 h) had higher blood urea nitrogen and creatinine compared with those who slept more than 7.5 h (20.26 + 0.23 mg/dl vs. 17.61 + 0.30 mg/dl, P < 0.0001, and 1.98 + 0.27 mg/dl vs. 1.90 + 0.24 mg/dl, P = 0.03, respectively). Serum triglyceride levels were positively correlated with sleep duration (P = 0.02). Diet quality indices were not significantly associated with sleep duration. Conclusion: Higher sleep duration is significantly related to lower kidney-related biomarkers in diabetic nephropathy patients. Diet quality indices were not associated with sleep duration in diabetic nephropathy patients. More longitudinal studies are required to evaluate the associations of sleep duration, diet quality and biochemical markers in diabetic nephropathy patients.

Translation and psychometric properties of the persian version of the dialysis symptom index in hemodialysis patients

Background:

Hemodialysis patients have a high physical and psychosocial symptom burden. There is no valid and reliable tool for assessing symptoms of hemodialysis patients in Iran.

Objectives:

The aim of this study was to determine psychometric properties of the Persian version of the dialysis symptom index (DSI).

Patients and Methods:

The forward-backward procedure was applied to translate the DSI from English into Persian (Iranian language). The scale (Persian Version) was tested with a convenience sample of 95 patients with end-stage renal disease referred to main hemodialysis centers from December 2012 to June 2013. Validity was assessed using content, face and convergent validity. To test reliability, the kappa values were calculated for test-retest stability and the Cronbach alpha coefficients were also calculated for internal consistency.

Results:

The mean age of patients was 50.4 (SD = 15.72) years and % 61.1 of patients were male. The most commonly reported symptoms were fatigue, being irritable and nervous. Divergent validity was mostly supported by the pattern of association between DSI and SF-36 (r = -0.18– -0.48, P< 0.05). Cronbach’s alpha of the DSI was 0.90 and the weighted kappa ranged from 0.21 to 0.93, and it was greater than 0.4 for 25 of the 30 items.

Conclusions:

The Iranian version of the DSI had good psychometric properties and can be used to assess symptoms of hemodialysis patients.