The Association between Health-Enhancing Physical Activity and Quality of Life in Patients with Chronic Kidney Disease: Propensity Score Matching Analysis

We investigate the association between health-enhancing physical activity and the quality of life in patients with non-dialysis chronic kidney disease. We performed data analysis on 1618 of 2238 patients from 2011 to 2016, obtained from the KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD). Health-related quality of life was measured using the Korean version 1.3 of Kidney Disease Quality of Life short-form questionnaire. Health-enhancing physical activity was defined as 150 min of moderate-intensity or 75 min of vigorous-intensity aerobic physical activity throughout the week. Propensity score matching analysis and linear regression was performed to estimate the effect of health-enhancing physical activity on health-related quality of life. The estimate of average treatment effects was 2.60 in the kidney component summary score, 4.45 in the physical component summary score, and 4.24 in the mental component summary score. In all component summary scores and most of their subscales, health-enhancing physical activity showed a significant association with health-related quality of life. Subgroup and sensitivity analyses also showed robust results. This study suggests that health-enhancing physical activity elevated quality of life in patients with non-dialysis chronic kidney disease. The results can contribute to encourage physical activity in patients with chronic kidney disease.ope

Factors Affecting Quality of Life in Patients with End Stage of Renal Disease on Hemodialysis , Ras Al Khaimah-United Arab Emirates

Background: Nowadays, a dramatically increase on the incidence and prevalence of End Stage Renal Disease (ESRD) were more than one million ESRD suffer worldwide, thus, ESRD is an important public health concern for it has considerable repercussion on the quality of life (QoL) of patients and the community’s increased social and health care needs. Purposes: Were to describe the quality of life in patients with end stage of renal disease on hemodialysis and to examine the contributing factors that may affect quality of life. Methodology: A cross sectional design was used to describe the QoL in patients with ESRD on hemodialysis and to determine the contributing factors that may affect quality of life; and a correlational design was utilized to examine associations among the independent variables (demographic characteristics and biological factors) that may influence the dependent variable (QoL). Setting of the study: It was at dialysis unit located in Ibrahim Bin Hamad Obaidulla Hospital (IBHOH), affiliated to the Ministry of Health , Medical District in Ras Al-Khaimah Emirate - UAE which provided the medical services to all patients regularly attending the in-patient hemodialysis (Emirates citizens and Non- Emirates citizens) and were managed by medical and paramedical staff working within the same hospital. Sampling: A purposive sampling was conducted and the accessible population was comprised of 129 regular patients. Out of 129 patients, 74 patients were qualified in the inclusion criteria to participate in the research. Participants were interviewed individually to measure Health Related Quality of Life (HRQoL) using Kidney Disease Quality of Life-36TM (KDQoL 36TM) scale and compared KDQoL scores by demographic factors, and biological factors. Results: the overall quality of life of patients with ESRD on hemodialysis was low, with M+SD(39.57+16.13). Increase poor quality was independently associated with female gender, aged >60 years, low educational level, unemployment status have poor QoL. The Physical Component Summary (PCS) domain came in the first rank with the lowest rated and scored with M+SD (32.66+17.30), whereas the mean of the Burden of Kidney Disease domain came in second rank with M+SD (34.61+12.26). Meanwhile, the Symptoms and Problems domain came in third rank with M+SD (38.56+22.8), followed by the Effects of Kidney Disease on Daily Life domain that came in fourth rank with M+SD (42.22+10.56), and then lastly, Mental Component Summary (MCS) domain came in fifth rank with M+SD (49.84+17.73). In this study, the results revealed that the level of serum albumin and gender were the most significant predictors that influence QoL in patients with (ESRD) undergoing hemodialysis at (P>0.05). Conclusion and Recommendation: The results of the present study shown the evidence that patients with ESRD have poor QoL. Lowest score of KDQoL 36TM scale was found in the "PCS , while highest score was MCS. Furthermore , the study revealed that level of the serum albumin was the most significant predictor influence QoL in patients with ESRD and the most modifiable factor which has a strong association with poorer HRQoL was education, whereas non-modifiable factor was female gender. Because of those factors attention should be given to the nurses and other health care providers as formal caregivers for early interventions that prevent further morbidity and minimize the mortality as well as provide the evidence-based for clinical practice that assist the nurses to have a comprehensive assessment of their patients’ lives and integrated all these crucial aspects in inclusive plan for appropriate nursing intervention and improve quality of patient’s life and HRQoL. Keywords : End stage renal disease, hemodialysis, Quality of lif

Κατάθλιψη και Μετατραυματικό Στρές (PTSD) στους σσθενείς που πάσχουν από Χρόνια Νεφρική Ανεπάρκεια και είναι σε μέθοδο υποκατάστασης νεφρικής λειτουργίας (αιμοκάθαρση)

Εισαγωγή: Η ΧΝΑ, ως μια προοδευτική και μη αναστρέψιμη έκπτωση της φυσιολογικής λειτουργίας των νεφρών, αποτελεί μια νοσολογική οντότητα που αυξάνεται συνεχώς τα τελευταία έτη λόγω της αύξησης του προσδόκιμου ζωής και των εξελίξεων της ιατρικής. Ως χρόνια νόσος συνοδεύεται από ποικίλες επιπλοκές, συμπεριλαμβανομένων και των ψυχικών διαταραχών. Η αιμοκάθαρση, ως θεραπευτική αντιμετώπιση του τελικού σταδίου της νόσου, έχει τα ίδια χαρακτηριστικά και η επίπτωση της κατάθλιψης και του PTSD παρουσιάζεται αυξημένη μεταξύ των εν λόγω ασθενών. Σκοπός: Η καταγραφή των ποσοστών εμφάνισης της κατάθλιψης και PTSD μεταξύ αιμοκαθερόμενων ασθενών καθώς και η διερεύνηση των παραγόντων που επηρεάζουν την εμφάνιση των δύο αυτών ψυχολογικών διαταραχών. Υλικό-Μέθοδος: Το δείγμα αποτέλεσαν 142 αιμοκαθερόμενοι ασθενείς στην Μονάδα Τεχνητού Νεφρού στο Αττικό Θεραπευτήριο Κυψέλης. Η συλλογή των δεδομένων έγινε με τη χρήση ερωτηματολογίων, με το πρώτο να περιλαμβάνει δημογραφικά και ατομικά χαρακτηριστικά του δείγματος. Χρησιμοποιήθηκε η κλίμακα BDI-II για την καταγραφή των καταθλιπτικών συμπτωμάτων και η IES-R για την αξιολόγηση της πιθανότητας ύπαρξης PTSD. Η στατιστική ανάλυση έγινε με τη χρήση του προγράμματος SPSS. Αποτελέσματα: Στην παρούσα μελέτη βρέθηκε ήπια κατάθλιψη, 17,32±11,7, και ισχυρή υποψία εμφάνισης PTSD, 28,54±15,9. Οι δημογραφικοί παράγοντες που βρέθηκαν να συσχετίζονται με την εμφάνιση PTSD ήταν η ηλικία, p=0,040, το φύλο, p=0,004, η οικογενειακή κατάσταση, p=0,004 και η ύπαρξη παιδιών, p=0,025. Τα χαρακτηριστικά της θεραπείας που συσχετίσθηκαν με την εμφάνιση PTSD ήταν τα έτη υπό αιμοκάθαρση, p=0,004, και η συχνότητα συνεδριών, p=0,005. Αναφορικά με τα ατομικά χαρακτηριστικά η μειωμένη ενεργητικότητα βρέθηκε να επηρεάζει την εμφάνιση της διαταραχής, p=0,005 και ενώ ο σακχαρώδης διαβήτης ήταν το κυριότερο συνοδό νόσημα, μόνο η υπέρταση συσχετίσθηκε με το PTSD, p=0,009. Η εμφάνιση PTDS είναι προγνωστικός παράγοντας εμφάνισης κατάθλιψης και αντιστρόφως, p=0,000. Τα συχνότερα αναφερόμενα καταθλιπτικά συμπτώματα ήταν οι διαταραχές του ύπνου, η μειωμένη ενεργητικότητα, η ανησυχία και η κόπωση. Συμπεράσματα: To PTSD και η κατάθλιψη είναι ψυχολογικές διαταραχές που επηρεάζουν δυσμενώς την ποιότητα ζωής των αιμοκαθερόμενων ασθενών. Η αναγνώριση των συμπτωμάτων τους και η έγκαιρη αντιμετώπισή τους είναι απαραίτητες για την ολιστική παροχή φροντίδας στους αιμοκαθερόμενους ασθενείς

Biobehavioral Relationships and Health Related Quality of Life in Persons with End Stage Renal Disease on Hemodialysis

The study of immune status and biobehavioral measures is limited in professional nursing. The purpose of the pre-pilot study was to describe levels of cytokines prior to, during, and after dialysis, examine changes in cytokine levels from immediate pre-dialysis to immediate post-dialysis, and to compare cytokine patterns prior to and after dialysis. A within subject descriptive study was conducted as part of a larger pilot study to describe levels of cytokines prior to, during, and after dialysis, examine changes in cytokine levels from immediate pre-dialysis to immediate post-dialysis, and to compare cytokine patterns prior to and after dialysis. Serum cytokine samples were collected pre-dialysis and every 30 minutes during the dialysis treatment and immediately post-dialysis from a convenience sample of 10 patients. Mean age of subjects was 53.5 years and 60% were African American. The sample was equally divided between female and male. Statistical analysis using a nonparametric paired difference test showed that only MIP-1β showed a significant increase from pre-dialysis to post-dialysis. Based on the results of this study, a second descriptive study was conducted. The purpose of the second study was to examine the relationships among disease related factors, perceived stress, depressive symptoms, immune indicators, and HRQOL among patients requiring hemodialysis for ESRD using a PNI framework. Using a descriptive design, participants completed the Perceived Stress Scale (PSS), the Center for Epidemiologic Studies Depression Scale (CES-D), and one quality of life measure, the Functional Assessment of Cancer Therapy-General scale (FACT-G), during the first hour of the dialysis treatment. In addition, blood samples were collected immediately prior to dialysis for cytokine measurement and demographic information was collected from the medical record. The sample included 75 adults with ESRD requiring dialysis who consented and were enrolled in the study. Regression analysis showed significant correlations among the psychosocial variables (p = \u3c0.0001, r = 0.65). Negative correlations were found between perceived stress and health-related quality of life (p = 0.024) and depressive symptoms with health-related quality of life (p = 0.0003). MIP-1 ß was the only cytokine significantly (and positively) correlated with health-related quality of life ( p = 0.0419). Principal component analysis of the cytokine data revealed three factors. A three-factor solution described the cytokine data; Factors 1 and 3 represented a pro-inflammatory response and Factor 2 represented a mixture of pro-inflammatory and anti-inflammatory responses. There was a significant correlation between Factor 1 and depressive symptoms (p = 0.0069). Significant differences in the distributions of Factors 2 and 3 were associated with the presence of cardiovascular disease (CVD) (Chi-square = 4.0, df = 1, p = 0.047), (Chi-square = 4.1, df = 1, p = 0.043), respectively, and Factor 3 with hypertension (HTN) (Chi-square = 7.6. df = 1, p = 0.006). However no relationships were found between the cytokine factors and QOL, PSS, and other variables. Findings suggest that there are relationships among psychosocial variables and possibly biological interactions that may affect perceptions of health-related quality of life among persons with ESRD on hemodialysis