I. INTRODUCTION AND PURPOSE OF THE WORK
End-stage renal disease belongs to the group of chronic diseases. Its chronic nature leads to many changes in everyday functioning and changes in the value system. Patients are qualified for treatment with renal replacement therapies. Chronic renal failure affects the deterioration of physical fitness, limits professional and social activity. The rhythm of life is subordinated to hemodialysis treatments. It forces patients to limit their current functions. Dialysis patients are aware of the loss of health, the need for dialysis
and independence. Dialysis is better experienced by patients who accept their health condition
and the need for dialysis, they are less anxious and less scared. At the same time, they have greater self-esteem, less fear for their future and are more resourceful in everyday life.
The main aim of the study is to assess the impact of disease acceptance on the quality of life of hemodialysis patients and to understand the factors that play a significant role in disease acceptance.
Detailed objectives:
- Assessment of the level of anxiety and depression in dialysis patients and examination of the influence of anxiety on the level of quality of life
-Evaluation of the impact of selected sociodemographic and clinical variables on the quality of life and disease acceptance.
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter the blood as they should. The disease is called chronic because kidney damage occurs slowly and over a long period of time. This damage can cause harmful toxins to build up in the body. CKD can also cause other health problems.
Figure 1. Location of the kidneys
Source: own study
The main job of the kidneys is to filter the extra water and waste from the blood to make urine. In order for the body to function properly, the kidneys balance the salts and minerals - such as calcium, phosphorus, sodium and potassium - that circulate in the blood. The kidneys also produce hormones that help control blood pressure, produce red blood cells, and keep bones strong.
Kidney disease often can get worse over time and can lead to kidney failure. If the liners fail, dialysis or a kidney transplant will be needed to stay healthy. The sooner the analyzed disease is diagnosed, the greater the possibilities of further protection of the kidneys [11].
Your risk of developing chronic kidney disease is increased when you have:
Diabetes mellitus is the leading cause of CKD. High blood glucose, also known as blood sugar, caused by diabetes can damage the blood vessels in the kidneys. Almost 1 in 3 people with diabetes have CKD.
Hypertension is the second most common cause of CKD. Like high blood glucose, high blood pressure can also damage the blood vessels in the kidneys.
Research shows a link between kidney disease and heart disease. People with heart disease are more likely to develop kidney disease, and people with kidney disease are more likely to develop heart disease. Scientists are working to better understand the link between kidney disease and heart disease.
Kidney disease tends to run in families (genetic inheritance).
It has been noted that early CKD may be asymptomatic. You can experience kidney damage without any symptoms because despite the damage, they still do enough work to ensure your well-being. For many people, the only way to find out if you have this condition is to have your kidneys tested with blood and urine tests.
As kidney disease worsens, the patient may develop swelling. It occurs when the kidneys cannot get rid of extra fluid and salt, and can occur in the legs, feet or ankles, less commonly in the hands or face.
The symptoms of advanced disease are [13]:
People with CKD can also develop anemia, bone disease and malnutrition. It is also noticed that kidney disease can lead to other health problems, such as heart disease. High blood pressure can both cause and result in kidney disease. High blood pressure damages the kidneys, and damaged kidneys do not help to control blood pressure.
Acute kidney failure occurs when the kidneys become unable to filter waste products from the blood. When the kidneys lose their ability to filter, dangerous amounts of waste products can build up and the blood chemistry can become out of balance.
Acute kidney failure - also called acute kidney failure or acute kidney injury - develops rapidly, usually in less than a few days. It is most common in people who are already hospitalized, especially in critically ill people who need intensive care.
Signs and symptoms of acute renal failure may include [15]:
Chronic kidney disease (CKD) is a global public health problem with the adverse effects of kidney failure, cardiovascular disease (CVD) and premature death. Simple definition and classification of kidney disease is essential to the international development and implementation of clinical practice guidelines.
CKD is defined as kidney damage or a glomerular filtration rate (GFR) <60 mL / min / 1.73 m2 for 3 months or longer, regardless of the cause. Kidney damage in many kidney diseases can be determined by the presence of albuminuria, defined as an albumin to creatinine ratio> 30 mg / g in two of the three urine spot samples. GFR can be estimated from the calibrated serum creatinine concentration and estimation equations such as the Modification of Diet in Renal Disease (MDRD) equation or the Cockcroft-Gault formula. The severity of kidney disease is divided into five stages depending on the level of GFR. [21]
5. Progression of chronic kidney disease
The National Kidney Foundation (NKF) has broken down kidney disease into five stages. This helps doctors provide the best care as each stage requires different tests and treatments.
Doctors use the glomerular filtration rate (GFR) to determine the stage of kidney disease, a mathematical formula based on age, sex, and serum creatinine levels (identified from a blood test). Creatinine, a waste product from muscle activity, is a key indicator of kidney function. When the kidneys are working well, they remove creatinine from the blood; but when kidney function slows down, the level of creatinine in the blood rises.
1. Stage 1 of chronic kidney disease
A person with Stage 1 Chronic Kidney Disease (CKD) has kidney damage with a normal or high glomerular filtration rate (GFR) above 90 ml / min. Usually there are no symptoms of kidney damage. Because the kidneys do a good job, even if they aren't 100 percent functioning, most people won't know they have stage 1 CKD. If they find out they are in stage 1, it's usually because they've been tested for another condition, such as diabetes or high blood pressure (the two main causes of kidney disease).
Symptoms of stage 1 kidney disease [10]:
Higher-than-normal levels of creatinine or urea in the blood
Blood or protein in the urine
Evidence of kidney damage by MRI, CT, US, or X-ray with contrast
Family history of polycystic kidney disease (PKD)
Treating kidney disease at this stage:
1. Regular testing of urine protein and serum creatinine can show whether kidney damage is progressing. Living a healthy lifestyle can slow the progression of kidney disease. It is recommended that patients with CKD stage 1:
2. They followed a healthy diet:
3. Maintaining blood pressure at the level of:
4. Keeping blood sugar or diabetes under control.
Living with Stage 1 Kidney Disease:
There is no cure for kidney disease, but it is possible to stop the progression of it, or at least slow the damage. In many cases, proper treatment and lifestyle changes can help you and your kidneys stay healthy longer.
2. Stage 2 of chronic kidney disease
A person with stage 2 chronic kidney disease (CKD) has kidney damage with a slight decrease in the glomerular filtration rate (GFR) of 60-89 ml / min. Usually there are no symptoms of kidney damage. Because the kidneys do a good job, even if they aren't 100 percent functioning, most people won't know they have stage 2 CKD. If they find out they are in stage 2, it's usually because they've been tested for another condition, such as diabetes or high blood pressure - the two main causes of kidney disease.
Symptoms of stage 2 kidney disease [11]:
Treatment of kidney disease in the stage of:
1. Regular testing of urine protein and serum creatinine can show whether kidney damage is progressing. Living a healthy lifestyle can help slow the progression of kidney disease.
It is recommended that in CKD stage 2:
2. Diet:
3. Keeping blood pressure level.
4. Keeping blood sugar or diabetes levels under control.
5. Taking medications as prescribed by your doctor.
In many cases, proper treatment and lifestyle changes can help your kidneys stay functioning longer.
3. Stage 3 of chronic kidney disease
A person with stage 3 chronic kidney disease (CKD) has moderate kidney damage. This step is divided into two: the decrease in glomerular filtration rate (GFR) for step 3A is 45-59 ml / min and the decrease in GFR for step 3B is 30-44 ml / min. As kidney function deteriorates, waste products can build up in the blood, causing a condition known as 'uremia'. In stage 3, a person is more prone to complications of kidney disease, such as high blood pressure, anemia (deficiency of red blood cells), and / or early bone disease.
CKD stage 3 symptoms [12]:
As Stage 3 progresses, the patient should see a nephrologist (a doctor who specializes in treating kidney disease). Nephrologists examine patients and run laboratory tests to gather information about their condition and offer the best treatment advice. The goal of the nephrologist is to help the patient keep the kidneys working for as long as possible. Adequate diet can help maintain kidney function and overall health.
In CKD stage 3, a healthy diet includes:
Many people who develop CKD have diabetes or high blood pressure. Keeping glucose levels under control and blood pressure under control can help keep your kidneys working. For both of these conditions, your doctor will likely prescribe a blood pressure medication. Studies have shown that inhibitors of ACE (angiotensin converting enzyme) and ARB (angiotensin receptor blockers) help slow the progression of kidney disease, even in people with diabetes who do not have high blood pressure. Patients should ask their doctors about all medications and take them exactly as prescribed.
In addition to eating properly and taking the prescribed medications, regular exercise and not smoking are helpful in prolonging kidney health. Patients should talk to their doctors about an exercise plan. Doctors can also give you tips on how to quit smoking.
4. Stage 4 of chronic kidney disease
A person with stage 4 chronic kidney disease (CKD) has advanced kidney injury with a severe drop in the glomerular filtration rate (GFR) to 15-30 ml / min. It is likely that a person with CKD stage 4 will require dialysis or a kidney transplant in the near future [12].
As kidney function deteriorates, waste products build up in the blood, causing a condition called uremia. In stage 4, a person is likely to develop complications of kidney disease, such as high blood pressure, anemia (deficiency of red blood cells), bone disease, heart disease, and other cardiovascular diseases.
Stage 4 symptoms include:
In stage 4, you will need to see a nephrologist (a doctor who specializes in treating kidney disease). The nephrologist examines you and orders laboratory tests to gather information to help you recommend treatment.
People with CKD stage 4 usually see their doctor at least every three months. They have blood tests for creatinine, hemoglobin, calcium, and phosphorus to see how well their kidneys are working. The doctor will also monitor other conditions such as high blood pressure and diabetes. In addition to helping you keep your kidneys working for as long as possible, your nephrologist will also help prepare you for dialysis or a kidney transplant.
People with CKD stage 4 who will require treatment will be informed about renal replacement methods and the possibility of co-deciding on the choice of treatment method [11]:
A person in stage 4 may also be referred to a dietitian. A proper diet can help maintain kidney function and overall good health.
In CKD stage 4, a healthy diet is characterized by:
It is recommended that people in stage 4 keep their blood pressure constant and people with diabetes keep their glucose levels under control. Taking all your medications as directed by your doctor may help prolong your kidney function.
In addition to eating properly and taking the prescribed medications, regular exercise and not smoking are helpful in staying healthy. Patients should talk to their doctors about an exercise plan.
National Kidney Foundation (NKF) guidelines recommend starting dialysis when kidney function has dropped to 15% or less.
5. Stage 5 of chronic kidney disease
A person with stage 5 chronic kidney disease has end stage renal disease (ESRD) with a glomerular filtration rate (GFR) of 15 mL / min or less. In this advanced stage of the disease, the kidneys have lost almost all of their ability to do their job efficiently, and eventually dialysis or a kidney transplant is needed to survive.
Symptoms that may occur in CKD stage 5 are [14]:
Because the kidneys are no longer able to remove toxins and fluids from the body. Toxins build up in the blood, making you feel generally unwell. The kidneys also perform other functions that they are no longer able to do, such as regulating blood pressure, producing a hormone that helps make red blood cells, and activating vitamin D for healthy bones.
Most people find that they feel much better after starting dialysis. As toxins are removed from the bloodstream, drugs replace functions that the kidneys can no longer perform, allowing them to enjoy a good quality of life.
After starting dialysis, you need to make changes to what you eat and drink.
A healthy diet for CKD stage 5 involves:
When a person learns that they have stage 5 kidney disease, they need to consult a nephrologist.
Early kidney disease is usually asymptomatic. Tests are the only way to find out how well your kidneys are working. It is recommended to test in this direction when the patient has [21]:
To find out if you have kidney disease, do the following:
In order to diagnose kidney disease, a GFR blood test is very important and the test results are [22]:
Figure 2. GFR blood test
Source: own compilation
You can't raise your GFR, but you can try to stop it from falling. For this, creatinine should be included, which is a byproduct of normal muscle breakdown in the body. Doctors use the amount of creatinine in the blood to estimate GFR. As kidney disease gets worse, creatinine levels increase. Another point to consider is the urine test for albumin. Albumin is a protein found in the blood. A healthy kidney does not allow albumin to pass into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better. Albumin in the urine is called albuminuria [16].
Figure 3. A healthy kidney does not release albumin into the urine. A damaged kidney lets some albumin pass into the urine
Source: own study
A healthcare professional can check the level of albumin in the urine in two ways [17]:
A urine sample is collected in a container in an office or laboratory. To test, a strip of chemically treated paper is placed in the urine. The strip changes color if albumin is present in the urine.
This test measures and compares the amount of albumin to the amount of creatinine in a urine sample. Doctors use the UACR to estimate how much albumin would leak into the urine in 24 hours.
The results of the study show that:
The most important step in treating kidney disease is controlling your blood pressure. High blood pressure can damage the kidneys. Protection consists in keeping your blood pressure within the normal range at or below the goal your doctor will prescribe. For most people, the target blood pressure is less than 140/90 mm Hg [15].
If this is the case, you should work with your doctor to develop a plan for achieving normal blood pressure levels. Steps you can take to achieve blood pressure maintenance may include eating a heart-healthy, low-sodium meal, quitting smoking, exercising, getting enough sleep, and taking your medications as prescribed. Blood glucose levels should be checked regularly to achieve the blood glucose target [21].
Typically, your doctor will also perform an HbA1c test. HbA1c is a blood test that measures the average blood glucose level over the last 3 months. This test is different from regular blood glucose checks. The higher the HbA1c value, the higher the blood glucose level in the last 3 months. The HbA1c target for many people with diabetes is below 7 percent. Achieving your goals will help protect your kidneys.
Kidney disease tends to worsen kidney function and function over time.
You can protect your kidneys by preventing or controlling additional diseases that affect kidney damage. In order to control the condition of the kidneys, it is recommended [23]:
1. Health check at the doctor
2. Making healthy food choices
Choose foods that are healthy for your heart and body: fresh fruit, fresh or frozen vegetables, whole grains, and low-fat or low-fat dairy products. It is recommended to eat healthy meals and limit salt and sugar intake.
3. Taking up physical activity
4. Striving to maintain weight
5. Sleep - Try to sleep 7 to 8 hours each night.
6.Reduction of alcohol consumption
Drinking too much alcohol can raise your blood pressure and add extra calories, which can lead to weight gain.
7. Controlling diabetes, high blood pressure and heart disease.
If you have diabetes, high blood pressure, or heart disease, the best ways to protect your kidneys from damage are:
To prevent heart attacks and strokes, keep your cholesterol levels within the target range. There are two types of cholesterol in the blood: LDL and HDL. LDL or 'bad' cholesterol can build up and clog blood vessels, which can cause a heart attack or stroke. HDL, or "good" cholesterol, helps to remove "bad" cholesterol from blood vessels. A cholesterol test can also measure another type of fat in your blood called triglycerides.
7. Hemodialysis as a method of renal replacement therapy
Hemodialysis is the most commonly used treatment for advanced and persistent renal failure. Since the 1960s, when hemodialysis first became a practical treatment for kidney failure, we have learned a lot about how to make hemodialysis treatments more effective and to minimize side effects. In recent years, more compact and simpler dialysis machines have made home dialysis increasingly attractive. However, even with better procedures and equipment, hemodialysis is still a complicated and inconvenient therapy that requires a coordinated effort by the entire medical team, including the nephrologist, dialysis nurse, dialysis technician, dietician, and social worker [8].
Healthy kidneys cleanse the blood by removing excess fluids, minerals and toxins. They also produce hormones that keep bones strong and blood healthy. When your kidneys are not working, harmful waste products build up in your body, your blood pressure may increase, and your body may retain excess fluid and not make enough red blood cells. When this happens, treatment is needed to replace the work of the damaged kidneys.
During hemodialysis, the blood passes through a filter called a dialyzer outside the body. The dialyzer is sometimes called an "artificial kidney". At the beginning of the hemodialysis procedure, the dialysis nurse checks the function of the fistula, punctures the fistula. Some patients, after appropriate training, puncture their fistula themselves. An anesthetic cream or spray can be used to reduce discomfort and pain. Each needle is attached to a soft tubing connected to the dialysis machine [9].
Figure 4. Diagram of hemodialysis
Source: own study
In hemodialysis, blood can flow, several ounces at a time, through a special filter that removes waste and extra fluids. Pure blood returns to the body. Removing harmful waste as well as extra salt and fluids helps to control blood pressure and maintain the proper balance of chemicals such as potassium and sodium in the body.
Figure 5. The hemodialysis process
Source: own study
One of the biggest changes to starting a hemodialysis session is keeping a strict schedule. Most patients go to the clinic - the dialysis center - three times a week, allocating 3 to 5 or more hours for each visit.
Researchers are investigating whether shorter daily sessions or longer sessions at night while the patient is asleep are more effective at removing waste. Newer dialysis machines make these alternatives more practical for home dialysis [23].
Figure 6. Hemodialysis
Source: own study
Even in the best of situations, it can be difficult to adapt to the effects of kidney failure and the time you spend on dialysis. You may have less energy during this period. Accepting a new reality can be very difficult. Many patients feel depressed when dialysis is started or after several months of treatment.
One of the important steps before starting hemodialysis is to prepare a vascular access, the place on the body from which blood is drawn and returned. Vascular access should be prepared weeks to months before starting dialysis. It will enable easier and more efficient removal and replacement of blood with fewer complications [28].
Figure 7. Arteriovenous fistula
Source: own study
The dialysis machine is the size of a dishwasher and is designed to:
• clean the patient's blood of toxic metabolic products
• remove excess water and ions
• correct metabolic disorders.
The dialyzer is a large container that contains thousands of tiny fibers that carry blood through them. The dialysis solution, a cleansing fluid, is pumped around these fibers. The fibers allow waste and extra fluid in the blood to pass into the drainage solution. A dialyzer is sometimes called an artificial kidney.
The dialysis center uses disposable equipment that is disposed of after the procedure is completed. Before each dialysis session, an "artificial kidney" undergoes a series of tests.
Figure 8. Structure of a hemodialysis machine
Source: own study
A dialysis solution, also known as a dialysate, is the fluid in your dialyzer that helps remove waste and extra fluid from your blood. It contains chemicals that make it act like a sponge.
Many people find that one of the most difficult parts of hemodialysis is puncturing the fistula with needles. However, most people admit that they get used to it after a few dialyses. If the needle is painful, you can put an anesthetic cream or spray on the skin. The cream or spray would temporarily numb the skin [23].
Most dialysis stations use two needles - one to carry blood to the dialyzer and the other to return purified blood to the body, and needles with two holes for bidirectional blood flow, but these needles are less efficient and require longer dialysis sessions. High-flow dialysis needles have to be slightly thicker than those used in conventional dialysis machines.
Figure 9. Arterial and venous needles
Source: own study
Some people prefer to insert their own needles. If this is the case, training in the correct insertion of needles is essential to prevent infection and protect vascular access. A "ladder" needle placement strategy can also be learned, where it "climbs" the entire length of an access session after a session so as not to weaken the area with a group of needle sticks. Another approach is the "buttonhole" strategy, which uses a limited number of places but sticks the needle back into the same hole made by the previous needle [24].
About once a month, the dialysis team tests the person's blood with one of two formulas - URR or Kt / V - to see that the treatments are removing enough waste. Both tests look at one specific waste product, called blood urea nitrogen (BUN), as an indicator of the overall level of waste products in your system.
The kidneys do much more than just remove toxins and extra fluid. They also produce hormones and balance chemicals in the body. When they stop working, problems can arise with anemia and with conditions that affect bones, nerves, and skin. Some of the most common conditions caused by kidney failure are extreme fatigue, bone problems, joint problems, itching, and "restless legs".
Anemia is a condition where the levels of red blood cells are low. Red blood cells carry oxygen to cells throughout the body. Without oxygen, cells cannot use the energy from food, so a person with anemia can tire easily and look pale. Anemia can also contribute to heart problems.
Anemia is common in people with kidney disease because the kidneys produce the hormone erythropoietin, which stimulates the bone marrow to produce red blood cells. Sick kidneys often don't make enough erythropoietin, so the bone marrow makes fewer red blood cells. Erythropoietin is commonly administered to dialysis patients [11].
Renal osteodystrophy or bone disease of kidney failure affects 90 percent of dialysis patients. This causes bones to become thin and weak or improperly formed, and it affects both children and adults. Symptoms may be seen in growing children with kidney disease before dialysis is started. Older patients and women who have gone through the menopause are at greater risk of developing this disease.
Many people treated with hemodialysis complain of itchy skin, which often worsens during or shortly after the procedure. Itching is common even in people who do not have kidney disease, but in kidney failure, itching can worsen due to waste in the bloodstream that the current dialyzer membranes are unable to clear from the blood [12].
The problem may also be related to high levels of parathyroid hormone (PTH). Some people feel great relief after having their parathyroid glands removed. The four parathyroid glands are located on the outer surface of the thyroid gland, which is on the trachea at the base of the neck, just above the collarbone. The parathyroid glands help control the levels of calcium and phosphorus in the blood. However, no cure for itching has been found that works for everyone. Phosphate binders seem to help some, these drugs act like sponges that absorb or bind phosphorus when it's in the stomach. Others find relief from exposure to ultraviolet light. Giving antihistamines and applying lanolin or camphor creams to the skin can soothe itching by suppressing nerve impulses. Keeping your skin dry is very important.
Patients on dialysis often suffer from insomnia, and some have a specific problem called sleep apnea syndrome, which is often indicated by snoring and pauses in snoring. Apnea episodes are actually pauses in breathing while you sleep. Over time, these sleep disturbances can lead to "day and night turns" (insomnia at night, daytime sleepiness), headaches and depression. Treatments that can help people with sleep apnea, whether they have kidney failure or not, include losing weight, changing your sleeping position, and wearing a mask that gently pumps air continuously into your nose (continuous positive pressure in the nose or CPAP).
Many people on dialysis have difficulty sleeping at night because of pain, discomfort, jittery or "restless" leg syndrome. You may feel a strong impulse to kick or throw your legs. Digging can occur while you are asleep and keep your partner in bed all night long. The causes of "restless" legs syndrome may include nerve damage or chemical imbalance [2].
Moderate exercise during the day can help, but exercising several hours before bedtime can make this worse. People with "restless" legs syndrome should limit or avoid caffeine, alcohol and tobacco, and some people also find relief from massage or warm baths. A class of drugs called benzodiazepines, often used to treat insomnia or anxiety, can also help.
Dialysis-related amyloidosis is common in people on dialysis for over 5 years. It develops when proteins in the blood build up on joints and tendons, causing pain, stiffness, and fluid in the joints, such as in arthritis. Working kidneys filter out these proteins, but dialysis filters are not as effective.
Eating the right food can help improve dialysis and your health. A healthcare facility usually has a dietitian who can help you plan your meals. Follow the advice of your dietitian to get the most out of your hemodialysis treatment. Here are some general tips:
• Fluids.
The amount of fluid you drink is regulated according to your urine output. You should drink fresh drinks in small sips, in small glasses or cups. Sucking on ice cubes and lemon slices is very helpful. Remember that many foods - such as soup, ice cream and fruit - it contains a lot of water [10].
• Potassium.
Potash is found in many products, especially vegetables, fruits and potatoes. It contributes to an even heartbeat, so eating too much of it can be very dangerous to the heart. To control your blood potassium levels, avoid foods such as oranges, bananas, tomatoes, potatoes, dried fruit, strawberries, and cherries.
• Phosphorus.
Phosphorus can weaken your bones and make your skin itchy if you eat too much of it. Controlling phosphorus may even be more important than calcium alone in preventing bone disease and related complications. Foods like milk and cheese, beans, peas, coca-cola, nuts, and peanut butter are high in phosphorus and should be avoided.
• Salt (sodium chloride).
Most canned and frozen foods contain high amounts of sodium. Eating too much of these foods makes you thirsty, you drink more fluids, your heart has to work harder to pump fluid through your body. Over time, this can cause high blood pressure and congestive heart failure. Try to eat fresh food that is naturally low in sodium and look for foods labeled "low in sodium".
• Protein.
Before undergoing dialysis, your doctor may advise you to follow a low-protein diet to help maintain kidney function. Most people on dialysis are encouraged to eat as much high-quality protein as possible. Protein helps maintain muscle and repair tissue, but protein is broken down in the body into urea (blood urea nitrogen or BUN). Some sources of protein, called high-quality proteins, produce less waste than others. The high-quality proteins come from meat, fish, poultry and eggs. Getting most of the protein from these sources can reduce the amount of urea in the blood [4].
• Calories.
Calories provide the body with energy. Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils - such as olive oil, canola, and safflower oil - are good sources of calories and do not contribute to cholesterol control problems. Hard candies, sugar, honey, jam, and jelly also provide calories and energy. However, if you have diabetes, you must be careful when eating sweets. Dietitian's tips are especially important for people with diabetes.
• Supplements.
Vitamins and minerals may be lacking in the diet because so many foods must be avoided. Dialysis also removes some vitamins from the body. Your doctor may prescribe a vitamin and mineral supplement designed specifically for people with kidney failure.
One important step before starting hemodialysis treatment is to perform minor surgery to create a vascular access. Vascular access will be the life line through which it will be possible to connect to the dialyzer. Dialysis moves blood rapidly through the filter. The blood flow is very strong. The machine backs up and returns nearly half a liter of blood to the body every minute. The access will be where needles are inserted on the body to allow blood to drain and return to the body at high speed during dialysis.
There are three types of vascular access [13]:
Work closely with your nephrologist and vascular surgeon - a blood vessel surgeon - to make sure timely access is provided.
The best type of long-term access is an AV fistula. The surgeon connects an artery to a vein, usually in the arm, to create an AV fistula. An artery is a blood vessel that drains blood from your heart. A vein is a blood vessel that carries blood back to the heart. When the surgeon connects the artery to the vein, the vein becomes wider and thicker, which makes it easier to insert the dialysis needles. The AV fistula is also large in diameter, which allows blood to flow quickly and back into the body. The goal is to allow high blood flow so that the largest amount of blood can pass through the dialyzer.
Figure 10. AV
AV is considered the best option as it provides the highest blood flow for dialysis and is less prone to infection or clotting. Most people can go home after a fistula is created on an outpatient basis. Local anesthesia is given to numb the area where the vascular surgeon is creating an AV fistula. Depending on the situation, you can receive general anesthesia and stay in the ward [13].
If venous problems are preventing an AV fistula, you may need an atrioventricular transplant instead. To create an AV graft, the surgeon uses an artificial tube to connect the artery to the vein. You can use an AV transplant for dialysis. However, you are more likely to have problems with infection and blood clots. Blood clots can block blood flow through the transplant and make dialysis difficult or impossible.
Figure 11. AV uses a synthetic tubing to connect the artery and vein for hemodialysis
Source: own study
If kidney disease progresses rapidly or a vascular venous catheter - a small, soft tube inserted into a vein in the neck, chest, or leg near the groin - is not accessed as a temporary access, the nephrologist places a venous catheter for dialysis [7].
Adjusting to the effects of kidney failure and the time spent on dialysis can be difficult. You may have to make changes in your work or everyday life, giving up some of the activities and responsibilities. It can be difficult to accept these changes [8].
To get the most out of hemodialysis, you should maintain an ideal 'dry weight'. The ideal dry weight is weight when you don't have excess fluid in your body. If you are careful about sodium in your diet and your hemodialysis is working, you can achieve your ideal dry weight at the end of each hemodialysis session. When hemodialysis treatments are working and an ideal dry weight is maintained, blood pressure should be well controlled.
In addition, blood tests can show how well hemodialysis treatments work. They should be performed once a month, whether the patient is on hemodialysis at home or in a dialysis center.
It is possible to have a problem with vascular access, which is the most common reason why a person undergoing hemodialysis has to go to the hospital. Any type of vascular access may occur [11]:
These problems can prevent effective treatment. You may need to use more replacement or repair access procedures to make it work properly. Sudden changes in the body's water and chemical balance during treatment can cause additional problems, such as:
Your doctor may change the dialysis solution to avoid these problems.
You may lose blood if the needle comes out of the access or if the tubing comes off the dialyzer. To prevent blood loss, dialysis machines have a blood leak detector that triggers an alarm. If this problem occurs at a Dialysis Station, the nurse can act immediately.
Some people need several months to adjust to hemodialysis. Always report concerns to healthcare professionals who can often treat side effects quickly and easily. Many side effects can be avoided by following a nutrition plan developed by a dietitian, restricting fluid intake, and taking medications as directed [22].
8. Quality of life in hemodialysis patients
Quality of life (QoL) is a multidimensional concept that usually includes subjective assessments of both positive and negative aspects of life [13]. What makes it difficult to measure is that while the term "quality of life" is relevant to almost everyone and every academic discipline, individuals and groups may define it differently. Philosophers were concerned about the nature of human existence and defined the "good life", ethicists discussed the change of the concept of "sanctity of life" into "quality of life" and social utility, ecologists emphasized the characteristics and conditions of the physical and biological environment, economists dealt with the allocation of resources to achieve alternating goals, psychologists considered human needs and their satisfaction, while sociologists developed the social systems approach, in which QoL indicators are viewed as variables throughout the system and its subsystems. Doctors focused on variables related to health and disease, and nurses, following a holistic approach in nursing, took the broadest view of defining quality of life, but due to their frequent preoccupation with the physiological state, they tend to contaminate the operationalization of this concept [6]. Within these disciplines, researchers defined quality of life from various perspectives, such as objective indicators, subjective view, life goals, satisfaction of needs, and elements of life. have adopted the broadest view of defining quality of life, however, due to their frequent preoccupation with the physiological state, they tend to contaminate the operationalization of this concept [6]. Within these disciplines, researchers defined quality of life from various perspectives, such as objective indicators, subjective view, life goals, satisfaction of needs, and elements of life. have adopted the broadest view of defining quality of life, however, due to their frequent preoccupation with the physiological state, they tend to contaminate the operationalization of this concept [6]. Within these disciplines, researchers defined quality of life from various perspectives, such as objective indicators, subjective view, life goals, satisfaction of needs, and elements of life.
While health is one of the important areas of overall quality of life, there are other areas as well - for example work, housing, schools, and the neighborhood. Aspects of culture, values and spirituality are also key aspects of overall quality of life which increase the complexity of its measurement [6,7]. Nevertheless, scientists developed useful techniques that helped to conceptualize and measure these multiple domains and how they relate to each other [8].
Health-related quality of life (HRQoL) has been adapted from the more general and broad-based concept of 'quality of life'. The concept of HRQoL and its determinants have evolved since the 1980s to include those aspects of overall quality of life that can have a clear impact on health - both physical and mental [9]. Health-related quality of life is a multi-dimensional concept that encompasses areas related to physical, mental, emotional and social functioning. It goes beyond direct measurements of population health, life expectancy and causes of death, and focuses on the impact of health status on quality of life [11].
In the field of medical research, medical sociologists and scientists have been concerned with assessing aspects of life that are affected by disease or treatment, hence the term health-related QoL has been used and included as a criterion to define disease and treatment outcome.
HRQoL refers to the physical, psychological, and social health domains that are unique to each individual. Each of these domains can be measured by an objective assessment of functioning or health, and subjective perceptions of health. There are other valuable aspects of life that are not commonly considered "health", including income, freedom and the environment. HRQoL has been defined as: "the patient's self-assessment of the impact of the disease and treatment on its physical, mental and social functioning." Another definition is: HRQoL can be defined as the functional impact of the disease and the resulting therapy on the patient, as perceived by the patient. Lehman, Rachuba and Postrado also suggested that HRQoL is the optimal level of mental and physical functioning, role and social functioning, including relationships and perceptions of health, fitness, life satisfaction and well-being. Bird et al. Have defined HRQoL as: the degree to which a person's worthwhile aspects of life are positively or negatively influenced by health and / or health-related interventions, such as medical care.
Over the years, there has been a consensus that HRQoL is a multidimensional concept. As such, HRQoL is broadly divided into 3 domains: physical, social, and psychological. In the physical sphere, the perception and observation of normal or disturbed bodily functions, such as mobility, pain and nausea, are assessed. In the social sphere, the performance of social functions is examined; these include activities of daily living and responsibilities at home and away from home, such as those related to family, friends and colleagues. In the psychological realm, it examines mental and emotional functioning - for example, patients' fears, distress and mood.
In the last 30 years, hemodialysis has seen significant therapeutic advances, thus improving the prognosis of chronic renal failure. Extending the survival of chronic hemodialysis patients creates new challenges in the treatment of these patients. The health issue of quality of life is particularly important in patients undergoing hemodialysis. The assessment of QDVS is a major public health problem in the case of chronic disease in general, and in chronic hemodialysis patients in particular.
Hemodialysis is a complex procedure for patients that requires frequent visits to the hospital or dialysis center three times a week, which means significant changes in the normal lifestyle of patients. nutrition. Acceptance of the disease is a very complex process that starts from the moment it is diagnosed. The patient goes through the following stages: rejection, rebellion, anger, breakdown, depression. People who are chronically ill know about the irreversibility of this process and hope that their health will deteriorate. improvement during treatment, which will improve quality of life, but not all people do this. Acceptance of the disease largely depends on the factors that determine the nature of the disease and its type, ailments caused by the disease, personal resources such as: gender, age, education and the ability to cope with stressful situations. The acceptance of the disease is fostered by a positive mood and optimism. People accepting the disease experience negative emotions less frequently and do not lose their self-esteem. By accepting the disease, the patient reduces the level of anxiety, mental discomfort and anxiety, which contributes to better adaptation.
Assessment of health-related quality of life is a predictive indicator of the course of the disease as well as a valuable research tool in assessing the effectiveness of therapeutic intervention, patient survival and hospitalization.
The research was conducted among hemodialysis patients at the Provincial Specialist Hospital in Wrocław at ul. Kamińskiego 73a - at the Dialysis Station.
100 people participated in the study. The study was conducted anonymously and each patient voluntarily consented to it. No one was excluded from the study.
Research tools:
· Disease Acceptance Scale (AIS)
· Hospital Scale for Anxiety and Depression (HADS)
· WHOQoL Quality of Life Assessment Questionnaire - BREF
· Own questionnaire
The Acceptance of Illness Scale - (AIS-Acceptance of Illness Scale). The AIS scale developed by B.J. Felton, TA Revenson and GA Henrichsen, and adapted to Polish conditions by Z. Juczyński, is used to measure the degree of disease acceptance. Greater acceptance of the disease reduces the feeling of mental discomfort and contributes to a better adaptation of the patient.
The AIS questionnaire consists of eight questions, each of which contains a five-point scale. The examined person assesses their current state of health by indicating the appropriate number: 1 - I strongly agree, 2 - I agree, 3 - I don't know, 4 - I disagree, 5 - I strongly disagree. Answer 1 means bad adaptation to the disease, and 5 - full acceptance of the disease. The sum of the points 8-40 is a measure of the degree of acceptance of the disease. It is assumed that points 8-18 mean the lack of acceptance of the disease, 19-29 the average level of acceptance, 30-40 - acceptance of the health situation at a good level [32].
The Hospital Anxiety and Depression Scale HADS - developed by AS Zigmond and RPSnaith. The questionnaire is helpful in assessing anxiety-depressive disorders among patients treated in hospitals and outpatients. The study used the Polish version of the test developed by M. Majkowicz, K.de Walden-Gałuszko and G. Chojnacka-Szawłowska. The scale has two subscales: depression and anxiety, with a total of 14 questions. Each subscale has seven items. In each of them you can get 0-21 points. The responses are rated on a four-point Likert scale, from 0 to 3. The HADS results define the severity of anxiety (HADS - A) and symptoms of depression (HADS - D). HADS Score Values:
· 0 - 7 - the standard,
· 8 - 10 - breakpoints (mild disorders),
· 11 - 21 - pathological values [31].
World Health Organization Quality of Life (WHOQOL - BREF) - is an abbreviated version of WHOQOL-100 and contains 26 questions. It allows you to obtain information on the quality of life in four areas:
· Physical field - concerns activities of daily living, work capacity, energy levels and fatigue, rest, sleep, pain, activity
· Psychological field - physical appearance, feelings, religious beliefs, cognitive processes, learning.
· The field of social relations - personal relationships, sexual behavior, social support.
· Environmental domain - home environment, material resources, access to health care, leisure and recreation opportunities, physical environment (climate, noise, traffic). The WHOQOL - BREF scale also includes two additional questions. They concern the overall quality of life and individual perception of one's own health. The increase in the number of questionnaire points is accompanied by an increase in the quality of life [29, 30].
The own questionnaire consists of 16 questions that take into account age, gender, place of residence, education, marital status, professional activity, financial situation, and questions relating to the patient's clinical situation. The next questions concern the cause of renal replacement therapy and the occurrence of complications related to dialysis therapy - accompanying ailments, limitations imposed by the disease and functioning in the sexual sphere.
The calculations were made in the IBM SPSS program. Frequencies were counted for qualitative variables and bar charts were made. Means were calculated for quantitative variables and histograms were made.
The Kolmogorov-Smirnov test was performed in order to check the consistency of the distribution of quantitative variables with the normal distribution, p <0.05 was assumed as the level of significance. In order to assess the significance of differences between the groups (for variables whose distribution of values was not consistent with the normal), the Mann-Whitney test for two independent variables and Kruskal-Wallis test for k independent samples was calculated, p <0.05 was considered statistically significant.
In order to present statistically significant differences between the groups graphically, box plots were made. In order to check the relationship between quantitative variables, whose value distributions were not consistent with the normal distribution, Spearman's correlations were made, p <0.05 was considered statistically significant. In order to present statistically significant correlations graphically, a scatter plot was made.
|
Table 1. Descriptive statistics for the age of the respondents |
||
|
Age |
||
|
N |
N |
100 |
|
|
Missing data |
0 |
|
Mean |
49.4900 |
|
|
Median |
50.0000 |
|
|
Dominant |
60.00 |
|
|
Standard deviation |
16.20730 |
|
|
Minimum |
21.00 |
|
|
Maximum |
85.00 |
|
Figure 1. Age distribution in the study group presented by means of a histogram
Table 2. Sex distribution in the study group
|
Sex |
|||
|
|
Frequency |
Percent |
|
|
N |
woman |
42 |
42.0 |
|
|
man |
58 |
58.0 |
|
|
Overall |
100 |
100.0 |
Figure 2. Gender distribution in the study group
|
Table 3. Place of residence of the respondents |
|||
|
|
Frequency |
Percent |
|
|
N |
city |
52 |
52.0 |
|
|
village |
37 |
37.0 |
|
|
Overall |
89 |
89.0 |
|
Missing data |
99 |
11 |
11.0 |
|
Overall |
100 |
100.0 |
|
Figure 3. Distribution of the place of residence of the respondents
|
Table 4. Education distribution of the respondents |
|||
|
|
Frequency |
Percent |
|
|
N |
basic |
4 |
4.0 |
|
|
professional |
13 |
13.0 |
|
|
medium |
55 |
55.0 |
|
|
higher |
28 |
28.0 |
|
|
Overall |
100 |
100.0 |
Figure 4. Distribution of education in the studied group
|
Table 5. Distribution of marital status in the studied group |
|||
|
|
Frequency |
Percent |
|
|
N |
free |
35 |
35.0 |
|
|
married |
50 |
50.0 |
|
|
widower / widow |
15 |
15.0 |
|
|
Overall |
100 |
100.0 |
Figure 5. Marital status distribution in the studied group
|
Table 6. Frequency distribution - Occupational activity of the respondents |
|||
|
|
Frequency |
Percent |
|
|
N |
employee |
65 |
65.0 |
|
|
student |
2 |
2.0 |
|
|
pensioner |
twenty |
20.0 |
|
|
pensioner |
13 |
13.0 |
|
|
Overall |
100 |
100.0 |
Figure 6. Distribution of the frequency of professional activity of the respondents
|
Table 7. Distribution of the financial situation of the respondents |
|||
|
|
Frequency |
Percent |
|
|
N |
very good |
16 |
16.0 |
|
|
Okay |
28 |
28.0 |
|
|
mean |
44 |
44.0 |
|
|
bad |
12 |
12.0 |
|
|
Overall |
100 |
100.0 |
Figure 7. Distribution of the financial situation of the respondents
|
Table 8. Distribution of answers to the question "How long have you been under dialysis?" |
|||
|
|
Frequency |
Percent |
|
|
N |
1-2 years |
thirty |
30.0 |
|
|
2-5 years |
29 |
29.0 |
|
|
5-10 years |
29 |
29.0 |
|
|
> 10 years |
12 |
12.0 |
|
|
Overall |
100 |
100.0 |
Figure 8. Distribution of the dialysis period in class intervals
|
Table 9. Distribution of what causes renal replacement therapy? |
||||
|
|
Answers |
Percentage of Observations |
||
|
|
N |
Percent |
|
|
|
|
hypertension |
44 |
37.3% |
44.0% |
|
|
diabetic nephropathy |
42 |
35.6% |
42.0% |
|
|
polycystic kidney disease |
18 |
15.3% |
18.0% |
|
|
genetic predispositions |
12 |
10.2% |
12.0% |
|
|
other |
2 |
1.7% |
2.0% |
|
Overall |
118 |
100.0% |
118.0% |
|
Figure 9. Distribution of causes of renal replacement therapy
|
Table 10. Distribution of answers to the question "Do you ever undergo dialysis more than 3 times a week?" |
||||
|
|
Frequency |
Percent |
Percentage of important |
|
|
Important |
often |
10 |
10.0 |
10.2 |
|
|
sometimes |
23 |
23.0 |
23.5 |
|
|
never |
65 |
65.0 |
66.3 |
|
|
Overall |
98 |
98.0 |
100.0 |
|
Missing data |
99 |
2 |
2.0 |
|
|
Overall |
100 |
100.0 |
|
|
Figure 10. Distribution of answers to the question "Do you have dialysis more than 3 times a week?"
|
Table 11. Distribution of answers to the question "What causes additional dialysis?" |
||||
|
|
Frequency |
Percent |
Percentage of important |
|
|
N |
swelling |
2 |
2.0 |
5.4 |
|
|
overhydration |
34 |
34.0 |
91.9 |
|
|
high potassium values |
1 |
1.0 |
2.7 |
|
|
Overall |
37 |
37.0 |
100.0 |
|
Missing data |
99 |
63 |
63.0 |
|
|
Overall |
100 |
100.0 |
|
|
Figure 11. Distribution of causes of additional dialysis
|
Table 12. Descriptive statistics of the number of hospital stays in the last year due to complications related to dialysis therapy |
||
|
|
||
|
N |
N |
64 |
|
|
Missing data |
36 |
|
Mean |
2.91 |
|
|
Median |
2.00 |
|
|
Dominant |
2 |
|
|
Standard deviation |
2,151 |
|
|
Minimum |
1 |
|
|
Maximum |
10 |
|
Figure 12. Distribution of the number of hospital stays over the last year due to complications related to dialysis therapy
|
Table 13. Distribution of answers to the question “Does the disease limit you in your everyday life? - fluid supply limitation " |
|||
|
|
Frequency |
Percent |
|
|
N |
always |
7 |
7.0 |
|
|
often |
26 |
26.0 |
|
|
sometimes |
61 |
61.0 |
|
|
never |
6 |
6.0 |
|
|
Overall |
100 |
100.0 |
Figure 13. Distribution of answers to the question “Does the disease limit you in your everyday life? - fluid supply limitation "
|
Table 14. Distribution of answers to the question “Does the disease limit you in your everyday life? - dietary restrictions " |
||||
|
|
Frequency |
Percent |
Percentage of important |
|
|
N |
always |
10 |
10.0 |
10.1 |
|
|
often |
27 |
27.0 |
27.3 |
|
|
sometimes |
59 |
59.0 |
59.6 |
|
|
never |
3 |
3.0 |
3.0 |
|
|
Overall |
99 |
99.0 |
100.0 |
|
Missing data |
99 |
1 |
1.0 |
|
|
Overall |
100 |
100.0 |
|
|
Figure 14. Distribution of answers to the question "Does the disease limit you in your everyday life? - dietary restrictions "
|
Table 15. Distribution of answers to the question “Does the disease limit you in your everyday life? - traveling" |
|||
|
|
Frequency |
Percent |
|
|
N |
always |
17 |
17.0 |
|
|
often |
17 |
17.0 |
|
|
sometimes |
54 |
54.0 |
|
|
never |
12 |
12.0 |
|
|
Overall |
100 |
100.0 |
Figure 15. Distribution of answers to the question "Does the disease limit you in your everyday life? - traveling"
|
Table 16. Distribution of answers to the question "Have you had depressive states during the course of your illness?" |
|||
|
|
Frequency |
Percent |
|
|
N |
often |
4 |
4.0 |
|
|
sometimes |
43 |
43.0 |
|
|
never |
53 |
53.0 |
|
|
Overall |
100 |
100.0 |
Figure 16. Distribution of the assessment of the frequency of depressive states in the course of the disease
|
Table 17. Distribution of answers to the question “Do you have sleep problems? - insomnia" |
|||
|
|
Frequency |
Percent |
|
|
N |
always |
3 |
3.0 |
|
|
often |
12 |
12.0 |
|
|
sometimes |
36 |
36.0 |
|
|
never |
49 |
49.0 |
|
|
Overall |
100 |
100.0 |
Figure 17. Distribution of the incidence of insomnia
|
Table 18. Distribution of answers to the question “Do you have sleep problems? - difficulty falling asleep " |
|||
|
|
Frequency |
Percent |
|
|
N |
always |
3 |
3.0 |
|
|
often |
14 |
14.0 |
|
|
sometimes |
33 |
33.0 |
|
|
never |
50 |
50.0 |
|
|
Overall |
100 |
100.0 |
Figure 18. Distribution of frequency of assessment of difficulties in falling asleep
|
Table 19. Distribution of answers to the question "Do you feel tired in connection with dialysis therapy?" |
|||
|
|
Frequency |
Percent |
|
|
N |
always |
3 |
3.0 |
|
|
often |
16 |
16.0 |
|
|
sometimes |
46 |
46.0 |
|
|
never |
35 |
35.0 |
|
|
Overall |
100 |
100.0 |
Figure 19. Distribution of dialysis-related fatigue
|
Table 20. Distribution of answers to the question "Do you experience any insomnia in connection with dialysis therapy?" |
|||
|
|
Frequency |
Percent |
|
|
N |
always |
3 |
3.0 |
|
|
often |
13 |
13.0 |
|
|
sometimes |
34 |
34.0 |
|
|
never |
50 |
50.0 |
|
|
Overall |
100 |
100.0 |
Figure 20. Distribution of the assessment of the occurrence of dialysis-related insomnia
|
Table 21. Distribution of responses "Do you experience muscle cramps in connection with dialysis therapy?" |
|||
|
|
Frequency |
Percent |
|
|
N |
often |
4 |
4.0 |
|
|
sometimes |
41 |
41.0 |
|
|
never |
55 |
55.0 |
|
|
Overall |
100 |
100.0 |
Figure 21. Distribution of the assessment of the occurrence of muscle spasms associated with dialysis therapy
|
Table 22. Distribution of responses to the question "Do you experience skin itching in connection with dialysis therapy?" |
|||
|
|
Frequency |
Percent |
|
|
N |
often |
2 |
2.0 |
|
|
sometimes |
15 |
15.0 |
|
|
never |
83 |
83.0 |
|
|
Overall |
100 |
100.0 |
Figure 22. Distribution of assessment of dialysis-related pruritus
|
Table 23. Distribution of responses to the question "Has the interest in sexual matters changed as a result of the disease?" |
|||
|
|
Frequency |
Percent |
|
|
N |
have not changed |
38 |
38.0 |
|
|
I have less interest |
28 |
28.0 |
|
|
have completely changed |
34 |
34.0 |
|
|
Overall |
100 |
100.0 |
Figure 23. Distribution of the assessment of changes in sexual interest
Table 24. Kolmogorov-Smirnov test
|
One-sample Kolmogorov-Smirnov test |
|||||
|
|
WHOQOL-BREF somatic domain |
WHOQOL-BREF psychological domain |
WHOQOL-BREF social domain |
WHOQOL-BREF domain environment |
|
|
N |
100 |
100 |
100 |
100 |
|
|
Normal distribution parameters |
Mean |
24.63 |
19.80 |
10.25 |
26.63 |
|
|
Standard deviation |
5.971 |
5.150 |
2.702 |
5.921 |
|
The biggest differences |
The absolute value |
0.181 |
0.132 |
0.149 |
0.176 |
|
|
Positive |
0.113 |
0.080 |
0.095 |
0.077 |
|
|
Negative |
-0.181 |
-0.132 |
-0.149 |
-0.176 |
|
Test Statistics |
0.181 |
0.132 |
0.149 |
0.176 |
|
|
p |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
|
Statistically significant differences were shown between the distribution of the values of individual subdomains of the WHOQOL-BREF questionnaire and the normal distribution (p <0.001). In order to analyze the above variables, non-parametric methods were used.
Table 25. Kolmogorov-Smirnov test
|
One-sample Kolmogorov-Smirnov test |
||||
|
|
AIS - total points |
HADS - anxiety |
HADS - depression |
|
|
N |
100 |
100 |
100 |
|
|
Normal distribution parameters |
Mean |
27.47 |
5.75 |
5.61 |
|
|
Standard deviation |
9.582 |
4.817 |
5.125 |
|
The biggest differences |
The absolute value |
0.162 |
0.172 |
0.189 |
|
|
Positive |
0.095 |
0.172 |
0.189 |
|
|
Negative |
-0.162 |
-0.116 |
-0.137 |
|
Test Statistics |
0.162 |
0.172 |
0.189 |
|
|
p |
<0.001 |
<0.001 |
<0.001 |
|
Statistically significant differences were found between the distribution of the values of the variables: AIS-sum of points, HADS-anxiety, HADS-depression, and the normal distribution (p <0.001). In order to analyze the above variables, non-parametric methods were used.
Table 26. Spearman correlations
|
Correlations |
|||
|
|
HADS - anxiety |
||
|
rho spearman |
HADS - anxiety |
Correlation coefficient |
1,000 |
|
|
|
p |
. |
|
|
|
N |
100 |
|
|
WHOQOL-BREF somatic domain |
Correlation coefficient |
-0.818 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF psychological domain |
Correlation coefficient |
-0.792 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF social domain |
Correlation coefficient |
-0.751 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF domain environment |
Correlation coefficient |
-0.826 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
Statistically significant negative correlations were found between the results of the HADS-anxiety questionnaire and the subdomains of the WHOQOL-BREF questionnaire (<0.001). Along with the increase in the intensity of anxiety, the quality of life decreases in the following areas: somatic, psychological, social, and the environment.
Dig. 25. Scatter plot for the correlation between the anxiety severity index and the psychological subdomain of the WHOQOL-BREF questionnaire.
.
Table 27. Spearman correlations
|
Correlations |
|||
|
|
Age |
||
|
rho spearman |
WHOQOL-BREF somatic domain |
Correlation coefficient |
-0.621 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF psychological domain |
Correlation coefficient |
-0.692 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF social domain |
Correlation coefficient |
-0.580 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF domain environment |
Correlation coefficient |
-0.654 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
AIS - total points |
Correlation coefficient |
-0.599 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
Statistically significant negative correlations were found between age and the results of the AIS questionnaire, and between age and the subdomains of the WHOQOL-BREF questionnaire (<0.001). The disease acceptance rate decreases with age. With age, the quality of life decreases in the following areas: somatic, psychological, social, and the environment.
Dig. 32. The scatter plot for the correlation between age and AIS disease acceptance scale.
|
|
||||||
|
Sex |
WHOQOL-BREF somatic domain |
WHOQOL-BREF psychological domain |
WHOQOL-BREF social domain |
WHOQOL-BREF domain environment |
AIS - total points |
|
|
woman |
Mean |
25.07 |
19.64 |
10.60 |
26.45 |
27.98 |
|
|
N |
42 |
42 |
42 |
42 |
42 |
|
|
Standard deviation |
5.321 |
4.627 |
2.359 |
5.739 |
8.224 |
|
|
Median |
27.00 |
21.00 |
11.00 |
29.00 |
29.50 |
|
|
Minimum |
8 |
10 |
6 |
12 |
11 |
|
|
Maximum |
32 |
28 |
15 |
34 |
40 |
|
man |
Mean |
24.31 |
19.91 |
10.00 |
26.76 |
27.10 |
|
|
N |
58 |
58 |
58 |
58 |
58 |
|
|
Standard deviation |
6.427 |
5.535 |
2.920 |
6.097 |
10.511 |
|
|
Median |
26.50 |
21.00 |
10.00 |
29.00 |
30.00 |
|
|
Minimum |
9 |
7 |
4 |
13 |
8 |
|
|
Maximum |
33 |
28 |
15 |
37 |
40 |
|
Test value |
|||||
|
|
WHOQOL-BREF somatic domain |
WHOQOL-BREF psychological domain |
WHOQOL-BREF social domain |
WHOQOL-BREF domain environment |
AIS - total points |
|
At Mann-Whitney's |
1211,500 |
1153,500 |
1095,000 |
1147,500 |
1205,000 |
|
At Wilcoxon |
2,922,500 |
2,056,500 |
2,806,000 |
2050,500 |
2108,000 |
|
FROM |
-0.046 |
-0.452 |
-0.867 |
-0.494 |
-0.091 |
|
p |
0.964 |
0.651 |
0.386 |
0.622 |
0.928 |
There were no statistically significant differences between the groups distinguished on the basis of gender in terms of the results of the WHOQOL-BREF questionnaire subdomains and the results of the AIS disease acceptance scale (p> 0.05). The quality of life in these areas and the level of acceptance of the disease do not differ statistically significantly between the sexes.
|
|
||||||
|
Domicile |
WHOQOL-BREF somatic domain |
WHOQOL-BREF psychological domain |
WHOQOL-BREF social domain |
WHOQOL-BREF domain environment |
AIS - total points |
|
|
city |
Mean |
24.37 |
19.85 |
10.10 |
26.33 |
27.58 |
|
|
N |
52 |
52 |
52 |
52 |
52 |
|
|
Standard deviation |
5.824 |
5.019 |
2.569 |
6.041 |
9.444 |
|
|
Median |
25.50 |
21.00 |
11.00 |
27.00 |
29.50 |
|
|
Minimum |
11 |
11 |
4 |
13 |
10 |
|
|
Maximum |
33 |
28 |
15 |
37 |
40 |
|
village |
Mean |
24.38 |
19.14 |
10.05 |
26.57 |
26.08 |
|
|
N |
37 |
37 |
37 |
37 |
37 |
|
|
Standard deviation |
6.361 |
5.339 |
2.768 |
5.824 |
9.982 |
|
|
Median |
27.00 |
19.00 |
11.00 |
29.00 |
29.00 |
|
|
Minimum |
8 |
7 |
4 |
14 |
8 |
|
|
Maximum |
32 |
27 |
15 |
37 |
39 |
|
Test value |
|||||
|
|
WHOQOL-BREF somatic domain |
WHOQOL-BREF psychological domain |
WHOQOL-BREF social domain |
WHOQOL-BREF domain environment |
AIS - total points |
|
At Mann-Whitney's |
930,000 |
900,000 |
956,000 |
952,500 |
870,000 |
|
At Wilcoxon |
2308,000 |
1603,000 |
2,334,000 |
1655,500 |
1573,000 |
|
FROM |
-0.267 |
-0.518 |
-0.050 |
-0.079 |
-0.767 |
|
p |
0.789 |
0.605 |
0.960 |
0.937 |
0.443 |
There were no statistically significant differences between the groups distinguished on the basis of the place of residence in terms of the results of the WHOQOL-BREF questionnaire subdomains and the results of the AIS disease acceptance scale (p> 0.05). The quality of life in the above-mentioned areas and the level of disease acceptance do not differ statistically significantly between urban and rural residents.
|
|
||||||
|
Marital status |
WHOQOL-BREF somatic domain |
WHOQOL-BREF psychological domain |
WHOQOL-BREF social domain |
WHOQOL-BREF domain environment |
AIS - total points |
|
|
free |
Mean |
26.60 |
22.40 |
10.57 |
28.94 |
30.69 |
|
|
N |
35 |
35 |
35 |
35 |
35 |
|
|
SD |
4.864 |
4.571 |
2.429 |
4.917 |
8.025 |
|
|
Me |
28.00 |
24.00 |
11.00 |
30.00 |
34.00 |
|
|
Min |
13 |
12 |
4 |
12 |
12 |
|
|
Max |
33 |
28 |
15 |
35 |
40 |
|
married |
Mean |
25.44 |
19.82 |
11.04 |
27.18 |
28.90 |
|
|
N |
50 |
50 |
50 |
50 |
50 |
|
|
SD |
5.380 |
4.364 |
2,321 |
5.340 |
8.534 |
|
|
Me |
27.00 |
21.00 |
11.00 |
29.00 |
30.00 |
|
|
Min |
8 |
11 |
6 |
13 |
11 |
|
|
Max |
31 |
28 |
15 |
37 |
40 |
|
Widower / widow |
Mean |
17.33 |
13.67 |
6.87 |
19.40 |
15.20 |
|
|
N |
15 |
15 |
15 |
15 |
15 |
|
|
SD |
4.923 |
3.599 |
1.922 |
4.356 |
6.592 |
|
|
Me |
16.00 |
13.00 |
7.00 |
20.00 |
12.00 |
|
|
Min |
9 |
7 |
4 |
13 |
8 |
|
|
Max |
27 |
21 |
11 |
thirty |
28 |
|
Test value |
|||||
|
|
WHOQOL-BREF somatic domain |
WHOQOL-BREF psychological domain |
WHOQOL-BREF social domain |
WHOQOL-BREF domain environment |
AIS - total points |
|
H Kruskal-Wallis |
23.208 |
28.445 |
24,457 |
25,402 |
25.344 |
|
df |
2 |
2 |
2 |
2 |
2 |
|
p |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
There were statistically significant differences between the groups distinguished on the basis of marital status, in terms of the results of the WHOQOL-BREF questionnaire subdomains and the results of the AIS disease acceptance scale (p <0.001). The quality of life in these areas and the level of acceptance of the disease is the lowest among widowed respondents. The quality of life in the social area is the highest in a married couple, while the quality of life in the somatic, psychological, and environmental areas is the highest in the case of free people. The disease acceptance rate is also highest in free individuals.
Table 34. Spearman correlations
|
Correlations |
|||
|
|
How long have you been on dialysis? |
||
|
rho spearman |
WHOQOL-BREF somatic domain |
Correlation coefficient |
-0.651 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF psychological domain |
Correlation coefficient |
-0.766 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF social domain |
Correlation coefficient |
-0.629 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
WHOQOL-BREF domain environment |
Correlation coefficient |
-0.748 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
|
|
AIS - total points |
Correlation coefficient |
-0.720 |
|
|
|
p |
<0.001 |
|
|
|
N |
100 |
Statistically significant negative correlations were found between the dialysis period and the subdomains of the WHOQOL-BREF questionnaire and the AIS disease acceptance scale (<0.001). The longer the dialysis period, the lower the quality of life in the following areas: somatic, psychological, social, environment and the lower the acceptance of the disease.
Fig.38. Scatterplot for the correlation between the dialysis period and somatic quality of life.
Table 35. Spearman correlations
|
Correlations |
|||
|
|
Do you have dialysis more than 3 times a week? |
||
|
rho spearman |
WHOQOL-BREF somatic domain |
Correlation coefficient |
0.496 |
|
|
|
p |
<0.001 |
|
|
|
N |
98 |
|
|
WHOQOL-BREF psychological domain |
Correlation coefficient |
0.369 |
|
|
|
p |
<0.001 |
|
|
|
N |
98 |
|
|
WHOQOL-BREF social domain |
Correlation coefficient |
0.422 |
|
|
|
p |
<0.001 |
|
|
|
N |
98 |
|
|
WHOQOL-BREF domain environment |
Correlation coefficient |
0.382 |
|
|
|
p |
<0.001 |
|
|
|
N |
98 |
|
|
AIS - total points |
Correlation coefficient |
0.428 |
|
|
|
p |
<0.001 |
|
|
|
N |
98 |
Statistically significant positive correlations were found between the intensity of the need for dialysis more than 3 times a week, and the subdomains of the WHOQOL-BREF questionnaire and the disease acceptance scale AIS (<0.001). The less often dialysis is needed more than 3 times a week, the higher the quality of life in the following areas: somatic, psychological, social, environment and the higher the acceptance of the disease. (Note - reverse interpretation due to the opposite direction of the dialysis intensity scale over 3 times a week and the WHOQOL-BREF, AIS scales).
Table 36. Descriptive statistics for HADS-depression in gender-specific groups.
|
|
||||||
|
HADS - depression |
||||||
|
Sex |
Mean |
N |
Standard deviation |
Median |
Minimum |
Maximum |
|
woman |
5.67 |
42 |
5.117 |
6.00 |
0 |
18 |
|
man |
5.57 |
58 |
5.175 |
4.50 |
0 |
18 |
|
Overall |
5.61 |
100 |
5.125 |
5.00 |
0 |
18 |
|
Test value |
|
|
|
HADS - depression |
|
At Mann-Whitney's |
1201,000 |
|
At Wilcoxon |
2912,000 |
|
FROM |
-0.119 |
|
p |
0.905 |
There were no statistically significant differences between genders in the results of the "depression" subscale of the HADS questionnaire (p = 0.905).
Quality of life (QoL) is a person's subjective perception of his or her life position. Tailoring care to the unique needs of a patient requires nurses and patients to have a similar understanding of patients' quality of life.
The World Health Organization (WHO) defines health not only as the absence of disease or disability, but as a state of complete mental, mental and social well-being. The definition of quality of life (QoL) is more complex. According to WHO, QoL is defined as individuals' perception of their life position in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.
QoL is a sense of total satisfaction with life, judged by an individual. This assessment is subjective and covers all areas of life, including elements of the biopsychosocial spiritual model. The use of the term "subjective" has different connotations for different people and may be viewed as unreliable because it is not objective. Subjectivism can amount to self-esteem.
Other definitions of QoL suggest that it is a global, personal assessment of a single dimension that may be causally sensitive to many other distinct dimensions: it is a one-dimensional concept with many causes. States, ideas and spheres of thoughts concerning the life of an individual or a community. Both objective and subjective quality of life can encompass cultural, physical, psychological, interpersonal, spiritual, financial, political, temporal, and philosophical dimensions. QoL implies a judgment of valuing community and group experiences.
Finally, it is suggested that QoL could theoretically encompass a wide variety of domains and components. These include functional capacity, the degree and quality of social interactions, psychological well-being, somatic experiences, happiness, life situations, life satisfaction, and the need for satisfaction. It also reflects life experiences, important life events and the current phase of life, and the factors that define the quality of life in this area also include gender, socio-economic status, age, and individual perspective.
Chronic kidney disease (CKD), as well as the methods of its treatment, have a significant impact on the quality of life of patients.
The issue of quality of life appeared in medical science in the 1970s, which was related to the definition of health proposed by the WHO (World Health Organization). There have been attempts in medicine to clarify the concept of quality of life. In 1990, Schipper defined the quality of life determined by the patient's condition as a functional consequence of the disease and its treatment experienced by the patient [31]. The definition of quality of life differs from that of health, although they are interconnected to some extent [10]. Health status is understood as an objective confirmation of symptoms, and quality of life as a subjective opinion that may change over time. The quality of life is influenced by multidimensional factors: physical, mental, social and also interpersonal. In the conservative period, kidney disease is associated with many limitations in the functioning of patients at home and in society. Renal replacement therapy minimizes the effects of uremia, but is associated with inconveniences in everyday life [11]. Renal replacement therapy is also associated with frequent hospitalization associated with many complications, which contributes to the development of depression, anxiety and sleep disorders [33].
Currently, there are more and more new studies on the quality of life of chronically ill people, analyzed from the point of view of various scientific fields. The task of medicine is not only to extend the life of patients, but also to improve their functioning in everyday life. The quality of life of healthy people is much better in the physical, mental and social spheres than those of CKD patients, especially in its declining stage [18].
The research conducted by Steciwko, Sapilak shows that the quality of life of dialysis patients is lower than that of non-dialysed patients. The factor with the greatest impact on lowering QOL is the degree to which the disease limits the performance of activities dependent on physical activity. The following parameters were decisive in lowering the quality of life: weakness, itching, muscle cramps, poor social conditions, lack of environmental support, and mood disorders [33].
In the author's own research, the dialysis period has a negative impact on the quality of life and the level of acceptance of the disease. The longer dialysis patients, the lower the quality of life.
The conducted study allows for the assessment of a different degree of quality of life depending on various factors. Undoubtedly, SNN influences many aspects of life, which is also confirmed by other researchers [6]. The results of the study show that the type of renal replacement therapy was related to the patients' quality of life. In most cases, people who underwent kidney transplantation could significantly improve their functioning and life satisfaction. Patients struggle with problems resulting from the symptoms of the disease and complications related to the applied method of renal replacement therapy [6].
Quality of life is related to health, and people on dialysis have to deal with many ailments. The quality of life - as my research shows - can be assessed on a multidimensional basis. Several dimensions of life should be taken into account, such as: health, mental state, physical fitness, professional activity, family, friends. Renal replacement therapy is certainly a burden for sick people, it makes it difficult for them to function efficiently in a normal life. The person has to constantly cope with the burdens of the disease and its treatment. Renal replacement therapy limits the professional functioning of patients, therefore their relatives who support them in everyday life play an important role. Therefore, it can be concluded that in chronically ill people, the quality of life began to occupy an equal place with life expectancy.
The above study addresses issues related to the quality of life of a hemodialysis patient. First, theoretical aspects were presented, based on the analysis of the literature on the subject, including: epidemiology, causes and risk factors, symptoms, classification, disease progression, treatment. Hemodialysis is also presented as a method of renal replacement therapy and the quality of life of hemodialysis patients.
In the course of my research, I can say that end-stage renal failure is a chronic disease and requires replacement therapy. The most common method of treating this disease is hemodialysis, which requires the patient to stay in hospital 3 to 4 times a week. The time that the patient has to spend on the procedure and traveling to the Dialysis Center is approximately 6-7 hours. Chronic renal failure, and above all the method of its treatment, is a great mental and physical burden for the patient, which may lead to a reduction in the quality of his / her life. Many patients are unable to come to terms with the new situation and cope with the new reality.
100 people of different ages took part in the study, each of them underwent hemodialysis at least once. The collected results were presented in a statistical form using the statistical tool - STATISTICA. The collected information was summarized in tables and graphs, on the basis of which the existence or not of statistical significance between the variables was determined.