Predictors of health activation for patients with chronic kidney disease undergoing hemodialysis

Introduction: the quality of self-care in patients with chronic kidney disease (CKD) is important to improve quality of life, increase survival and reduce complications. Self-care can be evaluated by measuring the health activation of these patients. Objectives: evaluating the health activation of patients with CKD undergoing hemodialysis (HD) compared to a normative group (health self-reported subjects), and to identify the social, demographic and clinical determinants that are associated with the health activation. Method: cross-sectional, analytical, descriptive and quantitative study approved by the local ethics committee and conducted in a public and a private outpatient hemodialysis clinic. Participants were patients with CKD on HD (focal group) and subjects on a normative group. All of them answered the questionnaire of sociodemographic and clinical characterization and the instrument "Patient Activation Measure" (PAM13). For scores comparisons were used the Mann-Whitney test. Regarding the evaluation of the linear effect of the variables of profile on PAM13, multiple linear regression was used, including the evaluation of the two groups and only for patients with CKD. Results: the study included in each group. Regarding the characteristics of the CKD patients, there was a predominance of males (59%), incomplete high school or less (68%). Most of them too was from a private administration clinic (53%) and reported having already presented some type of complication stemming from CKD (57%). Regarding the evaluation of activation, the activation scores did not differ between the two groups (median of 56.4 in CKD patients and 56.4 in normative group, p > 0.05) and the activation scores of both groups corresponded to activation level 3 with 34.5% of prevalence (p > 0.05). When the two groups were analyzed together, schooling (Bi = 5.38; p= 0.002), practice physical activity (Bi = 4.2; p= 0.019) and the number of people who co-reside (Bi = -2.22; p= 0.001) influenced the activation score. In the CKD patients, independently, the variables that influenced the activation score were gender (Bi = -4.69; p = 0.050); schooling (Bi = 6.55; p = 0.008); type of clinic of origin (Bi = -5.48; p = 0.02) and the presence of complications related to CKD (Bi = -5.25; p = 0.026). Conclusion: activation scores did not differ between the patients with CKD on HD and the health subjects. Schooling, practice physical activity and number of people residing with the individual were predictors of health activation in both groups. For the CKD patients group, the variables that influenced positively the activation was schooling; and that influenced negatively was the gender, type of clinic of origin and the presence of complications related to CKD

Quality of life in individuals with chronic renal disease under dialysis

Introduction: Chronic Kidney Disease (CKD) is responsible for numerous negative repercussions on the physical and biopsychosocial aspects of the quality of life of its patients. And the dialysis treatment intensifies this impact. Objectives: To measure the quality of life of individuals with CKD; to compare whether there is a statistical difference between QoL in patients with CKD in relation to a normative group and to identify which social, demographic and clinical determinants are associated with the best QoL between these groups. Method: A cross-sectional, analytical and descriptive study, with a quantitative approach and approved by the local Ethics Committee. Performed in a public institution and a private hemodialysis clinic, in a municipality in the interior of Minas Gerais. There were two categories of participants, one study group (patients with CKD on hemodialysis) and one normative group (general population). The sociodemographic and clinical characterization questionnaires and WHOQOL-Bref were applied. We used statistical tests according to the variables of interest. We adopted a significance level of 0.05. Results: In the study group, there was a predominance of men (59%), incomplete high school education level (68%) and 55% said they did not have a married partner. The majority (53%) were from a private institution and 57% reported having some kind of complication. The variables age, marital status and schooling were different between groups (p <0.05). The results of the Whoqol-Bref study showed that only the physical and psychological domains were different between groups (p <0.05). The total QOL score of the hemodialysis group was 57.14 and the normative group was 71.43 (p <0.001). In the comparison between the two groups, the variables that most interfered with QOL were: smoking (domain "perception of quality of life") (Bi = -0.4061; p = 0.032); to perform hemodialysis (domain "satisfaction with health") (Bi = - 0.3029, p = 0.034); hemodialysis (Bi = -14.07 and p = <0.001) ("physical domain"); hemodialysis ("psychological domain") (Bi = -5.26 and p = 0.025); living together with another person (in the domain "social relations") (Bi = 5.22 and p = 0.041); (Bi = 5.4504, p = 0.011) and income (Bi = 0.0016, p = 0.018) (in the "Environment" domain). The variables that most interfered with the QOL in the hemodialysis group were: having a conjugal partner (Bi = 0.379, p = 0.042), income (Bi = 0, p = 0.006), doing hemodialysis in the public service (Bi = -0.513; p = 0.007) and smoking (Bi = -0.527; p = 0.039) (domain "perception of quality of life"); to perform hemodialysis in public service (domain "satisfaction with health") (Bi = -0.626; p = 0.003); (Bi = -3.951, p = 0.019), hemodialysis in public service (Bi = -7,024, p = 0,044), schooling (Bi = 10,391, p = 0,01), age (Bi = 0,23; p = 0.05), number of people in the residence (Bi = 2.292, p = 0.036) and hemodialysis session time (Bi = 0.222, p = 0.002) ("physical domain"); (Bi = 12.368, p = 0.001), income (Bi = -4.166, p = 0.002) and hemodialysis in public service (Bi = -11.0, p = 0.001) ("psychological domain"); age (Bi = 0.286, p = 0.02) and time of hemodialysis sessions (Bi = 0.291; p = <0.001) ("social relationships"); (Bi = 11,302, p = 0.001), age (Bi = 0.367, p = <0.001) and time of hemodialysis sessions (Bi = 0.117; p = 0.039) (environment domain). Conclusion: The total WHOqol score of the group of patients with CKD on hemodialysis were significantly lower compared to the normative group. Several social and demographic variables influence, both positively and negatively, on the QoL scores and should be considered in the clinical evaluation of these patients.UNEMAT - Universidade do Estado de Mato GrossoTrabalho de Conclusão de Curso (Graduação)Introdução: A Doença Renal Crônica (DRC) é responsável por inúmeras repercussões negativas nos aspectos físicos e biopsicossociais da qualidade de vida de seus portadores. E o tratamento dialítico intensifica esse impacto. Objetivos: Mensurar a qualidade de vida de indivíduos com DRC; comparar se há diferença estatística dos escores de qualidade de vida (QV), entre pacientes com DRC em relação a um grupo normativo e identificar quais os determinantes sociais, demográficos e clínicos estão associados a melhor QV entre esses grupos. Método: Estudo transversal, de caráter analítico e descritivo, de abordagem quantitativa e que foi aprovado pelo Comitê de Ética local. Realizado em uma instituição pública e uma clínica privada de hemodiálise, em um município do interior de Minas Gerais. Houve duas categorias de participantes, um grupo de estudo (pacientes com DRC, em hemodiálise) e um grupo normativo (população geral). Foram aplicados os questionários de caracterização sócio-demográfica e clínica, e o WHOQOL-Bref. Utilizamos testes estatísticos conforme as variáveis de interesse. Adotamos índice de significância de 0,05. Resultados: No grupo de estudo, houve predominância de homens (59%), nível educacional de ensino médio incompleto (68%) e 55% referiram não ter companheiro conjugal. A maioria (53%) era de instituição privada e 57% referiram ter apresentado algum tipo de complicação. As variáveis idade, estado civil e escolaridade foram diferentes entre os grupos (p<0,05). Os resultados do Whoqol-Bref mostraram que apenas os domínios físico e psicológico foram diferentes entre os grupos (p<0,05). Na comparação entre os dois grupos, das variáveis que mais interferiram com a QV foram: fumar (domínio “percepção de qualidade de vida”) (Bi = -0,4061; p = 0,032); fazer hemodiálise (domínio “satisfação com a saúde”) (Bi = - 0,3029; p = 0,034); fazer hemodiálise (Bi= -14,07 e p = <0,001) (“domínio físico”); fazer hemodiálise (“domínio psicológico”) (Bi = -5,26 e p = 0,025); viver conjugalmente com outra pessoa (no domínio “relações sociais”) (Bi = 5,22 e p = 0,041); ter maior escolaridade (Bi = 5,4504; p = 0,011) e renda (Bi = 0,0016; p = 0,018) (no domínio “Meio Ambiente”). E as variáveis que mais interferiram com a QV no grupo de hemodiálise foram: ter companheiro conjugal (Bi = 0,379; p = 0,042), renda (Bi = 0; p = 0,006), fazer hemodiálise no serviço público (Bi = -0,513; p = 0,007) e fumar (Bi = -0,527; p = 0,039) (domínio “percepção de qualidade de vida”); fazer hemodiálise em serviço público (domínio “satisfação com a saúde”) (Bi = -0,626; p = 0,003); comorbidades (Bi = -3,951; p = 0,019), fazer hemodiálise em serviço público (Bi = -7,024; p = 0,044), escolaridade (Bi = 10,391; p = 0,01), idade (Bi = 0,23; p = 0,05), número pessoas na residência (Bi = 2,292; p = 0,036) e tempo de sessão da hemodiálise (Bi = 0,222; p = 0,002) (“domínio físico”); escolaridade (Bi = 12,368; p = 0,001), renda (Bi = -4,166; p = 0,002) e fazer hemodiálise em serviço público (Bi = -11,0; p = 0,001) (“domínio psicológico”); idade (Bi = 0,286; p = 0,02) e tempo das sessões de hemodiálise (Bi =0,291; p = <0,001) (“relações sociais”); escolaridade (Bi = 11,302; p = 0,001), idade (Bi = 0,367; p =< 0,001) e tempo das sessões de hemodiálise (Bi = 0,117; p = 0,039) (domínio “meio ambiente”). Conclusão: O escore total do Whoqol do grupo de pacientes com DRC, em hemodiálise, foram significativamente menores comparado ao grupo normativo. Várias variáveis sociais e demográficas influenciam, tanto positivamente como negativamente, nas pontuações da QV e devem ser consideradas na avaliação clínica desses pacientes