Rev. Latino-Am. Enfermagem
Original Article
2012 Sept.-Oct.;20(5):838-46 www.eerp.usp.br/rlae
Quality of life in people with chronic hemodialysis: association with sociodemographic, medical-clinical and laboratory variables1
Verónica Guerra-Guerrero2 Olivia Sanhueza-Alvarado3 Mirtha Cáceres-Espina4
Aim: determine the quality of life for people in chronic hemodialysis and its association with sociodemographic, medical-clinical and laboratory variables. Method: exploratory, descriptive, cross-sectional study with stratified probability sampling. Quality of life was assessed using the KDQOL-36TM. Data were analyzed using SPSS statistical software. Results: 354 people in chronic hemodialysis had low scores on most dimensions of quality of life, mainly Burden of Disease, Physical and Mental Component. Age, sex, education, income, time on dialysis, etiology of the disease, smoking, hospitalizations, albumin, creatinine and transplants were related. The results reveal multiple factors related to quality of life. Conclusion: there is a need to research on other aspects that permit focusing and optimizing the nursing care for these people. Descriptors: Quality of Life; Hemodialysis; Chronic Renal Failure.
1
Paper extrated from Doctoral Dissertation “Factores que influyen significativamente en la adherencia y calidad de vida de las personas en hemodiálisis, considerando su experiencia de vida”, presented to Universidad de Concepción, Chile.
2
PhD, Professor, Departamento de Enfermería, Universidad Católica del Maule, Chile.
3
PhD, Professor, Departamento de Enfermería, Universidad de Concepción, Chile.
4
MSc, Professor, Departamento de Enfermería, Universidad Católica del Maule, Chile.
Corresponding Author: Verónica Guerra Guerrero Universidad Católica del Maule. Departamento de Enfermería Avenida San Miguel n° 3605 Talca, Chile E-mail:
[email protected]
839 Qualidade de vida de pessoas em hemodiálise crônica: relação com variáveis sociodemográficas, médico-clínicas e de laboratório Objetivo: determinar a qualidade de vida de pessoas em hemodiálise crônica e sua relação com variáveis sociodemográficas, médico-clínicas e de laboratório. Método: estudo exploratório, descritivo, transacional com amostragem de probabilidade estratificada. Qualidade de vida foi avaliada mediante o instrumento KDQOL-36TM. Os dados foram analisados com o programa estatístico SPSS. Resultados: 354 pessoas em hemodiálise crônica apresentaram pontuações baixas na maioria das dimensões de qualidade de vida, principalmente carga da doença, componente físico e mental. Foram encontradas associações com idade, sexo, escolaridade, renda, tempo em diálise, etiologia da doença, cigarro, hospitalizações, quantidade de remédios, albumina, creatina e transplantes. Os resultados revelam múltiplos fatores relacionados à qualidade de vida. Conclusão: existe a necessidade de se investigar outros aspectos que permitam enfocar e otimizar o cuidado da enfermagem dirigido a essas pessoas. Descritores: Qualidade de Vida; Hemodiálise; Insuficiência Renal Crônica.
Calidad de vida de personas en hemodiálisis crónica: relación con variables sociodemográficas, médico-clínicas y de laboratorio Objetivo: determinar la calidad de vida de personas en hemodiálisis crónica y su relación con variables sociodemográficas, médico-clínicas y de laboratorio. Método: estudio exploratorio, descriptivo, transaccional con muestreo probabilístico estratificado. Calidad de vida fue evaluada mediante el instrumento KDQOL-36TM. Los datos fueron analizados con el programa estadístico SPSS. Resultados: 354 personas en hemodiálisis crónica presentaron puntuaciones bajas en la mayoría de las dimensiones de calidad de vida, principalmente Carga de la Enfermedad, Componente Físico y Mental. Edad, sexo, escolaridad, ingresos económicos, tiempo en diálisis, etiología de la enfermedad, cigarrillo, hospitalizaciones, número medicamentos, albúmina, creatinina, trasplantes resultaron relacionados. Los resultados revelan múltiples factores relacionados con la calidad de vida. Conclusión: existe necesidad de investigar otros aspectos que permitan enfocar y optimizar el cuidado de enfermería dirigido a estas personas. Descriptores: Calidad de Vida; Hemodiálisis; Insuficiencia Renal Crónica.
Introduction Terminal chronic renal failure (TCRF) is a disease
Moreover, it is associated with high social and economic
with high prevalence and incidence levels around the
costs for health systems(8). Although dialysis therapy
world(1-2). In recent decades, the number of patients has
allows people to extend their lives and guarantee their
significantly increased in Chile as well . It is a disease
survival(9), it also affects the accomplishment of activities
with mortal outcomes in the short or medium term(4)
of daily living and, in the long term, patients’ quality
and affects many body structures, which is why it is also
of life. Moreover, the reduced quality of life has been
associated with a worse quality of life (QoL)(5-6).
associated with increased morbidity and mortality risks
(3)
Until date, there is no cure, although treatments permit
the
Hemodialysis
maintenance (HD)
the
most
extension frequent
of
life.
The quality of life construct has been largely
therapy
studied in different illnesses and TCRF because of its
globally(1,4,7) and in Chile as well(2). The treatment
characteristics and treatment. It represents a permanent
is highly complex, demanding and potentially very
concern for health professionals. In 1994, the World
restrictive and implies profound lifestyle changes(5).
Health Organization defined it as “individuals’ perception
www.eerp.usp.br/rlae
is
and
in this population(6).
840
Rev. Latino-Am. Enfermagem 2012 Sept.-Oct.;20(5):838-46.
of their position in life in the context of the culture and
to 673 people until August 2010. The following centers
value systems in which they live and in relation to
participated: Talca (Unidad de diálisis y Trasplante
their goals, expectations, standards and concerns”(10).
Hospital Regional de Talca: 27 out of 50 participants;
Recently, it has been studied as one of the main results
Enferdial: 42 out of 83 participants; Hemodiálisis Talca:
of renal replacement therapy in distinct groups of
47 out of 92 participants; Intermédica Diálisis Talca:
people and countries, and as one of the main indicators
42 out of 82 participants); Linares (Nefrodial Linares:
of health and wellbeing(7-8). Studies and interest in
31 out of 60 participants; Hemodiálisis Linares: 45 out
the theme have increased in recent years, in line with
of 86 participants); Curicó (Diálisis Curicó Limitada:
the progressive increase in the number of people with
46 out of 83 participants); Constitución (Intermédica
TCRF and their extended life. Studies agree that QoL is
Diálisis Constitución: 11 out of 22 participants; Servicios
worse in HD patients than in the general population and
Hospitalarios del Centro: 7 out of 11 participants); Parral
even in kidney transplantation patients
Another
(Hemodiálisis Parral: 43 out of 83 participants); and San
consensus is that the most deteriorated dimension or
.
Javier (Nefrodial San Javier: 13 out of 21 participants).
area is the physical dimension, underlying the mental
The sample included people over 18 years of age, who
dimension(12). Research has also centered on identifying
attended dialysis sessions thrice a week, submitted
the factors that influence quality of life with a view to the
to dialysis for at least three months, medically stable,
establishment of intervention strategies. Some factors
without diagnosed mental or cognitive deterioration and
related to QoL are: hemoglobin, albumin, creatinine,
who agreed to participate voluntarily.
(6-7,11)
hematocrit levels; psychosocial factors like marital
Data collection started after ethical evaluation by
status, depression and anxiety; sociodemographic and
the School of Medicine at Universidad de Concepción,
clinical factors like age, gender, duration of kidney
approval from the Scientific Ethics Committee at
disease and dialysis, and concomitant illnesses
Servicio de Salud del Maule and authorization from each
.
(12-13)
It is an actual problem that chronic and terminal
dialysis center. All participants were informed about the
illnesses like TCRF affect people’s QoL, as these influence
research, voluntarily signed the Informed Consent term
different areas of their lives. QoL assessment is an
and agreed to participate.
important outcome measure, especially in long-term
For QoL assessment, the Kidney Disease Quality of
illnesses like TCRF, and generic and specific instruments
Life (KDQOLTM) instrument was applied, developed by the
can be used for this purpose(8). Studies to identify the
Kidney Disease Quality of Life Working Group as a specific
QoL of HD patients and its determinant factors are a
self-reported health-related quality of life measure for
fundamental aspect to evaluate in this population with
kidney disease patients undergoing hemodialysis(14). The
a view to effective interventions. That is particularly the
short version of the KDQOLTM was used in this study:
case in nursing, which is directly related to this kind
the KDQOL-36TM. This instrument consists of 36 items
of treatment, as health-related quality of life (HRQoL)
or questions, divided in two components: one general
is often evaluated to determine the effectiveness
component, including 12 quality of life questions based
of healthcare and treatment, as well as resource
on the SF-12 (short version of the SF-36), and a specific
distribution and health policy development .
24-question component about the kidney disease. At the
(7)
In spite of the above, in Chile, studies on HRQoL
same time, each item or question is regrouped in five
in this population are still incipient. The same is true
subscales or dimensions, where the general component
for its association with socio-demographic, medical-
groups
clinical and laboratory variables. The aim in this study
(questions 1-12) and SF-12 subscale Mental Functioning
is to determine the relation between these variables and
(questions 1-12); while the specific component groups
quality of life among chronic hemodialysis patients in
the subscales Burden of Kidney Disease (questions 13-
the Seventh Region of Chile.
16), Symptoms and Problems (questions 17-28) and
SF-12
subscale
Physical
Functioning
Effects of Kidney Disease on Daily Life (questions 29-36)
Methods Exploratory,
the
. Item scores range from 0 to 100, with 0 indicating
(15)
descriptive
and
cross-sectional
correlation study. Stratified probabilistic sampling was applied in function of the dialysis centers in the total number of TRCF patients under HD, in 11 out of 13 dialysis centers in the Seventh Region of Chile, corresponding
the worst and 100 the best quality of life. The KDQOL36TM was validated in a Chilean population(16) and is available in Spanish for public use(17). Sociodemographic, medical-clinical and laboratory data were collected on an individual form, based on the clinical files, dialysis files, nursing registers and database at each center. www.eerp.usp.br/rlae
841
Guerra-Guerrero V, Sanhueza-Alvarado O, Cáceres-Espina M. Registers for the three months before data collection
Table 1 - (continuation)
were considered. Data were collected through structured
n
Percentage %
Mean
Max/Min
Urban Residence
245
69.2
-
-
Rural Residence
109
30.8
-
-
electronically. SPSS statistical software, version 15.0
Years of education (Years)
354
100
7.84
20/0
for Windows, was used for data analysis. The authors’
Religious
322
91
-
-
worksheet was used to calculate the patients’ QoL
Not religious
31
8.8
-
-
Other
1
0.3
-
-
Employed
71
20.1
-
-
Unemployed
10
2.8
-
-
Inactive
273
77.1
-
-
-
-
interviews, held during the patients’ dialysis sessions, between August and November 2010. Data
were
ordered,
coded
and
processed
scores(17). Frequency distribution, central trend and dispersion measures were used for descriptive analysis of the samples. Pearson’s correlation coefficient (numerical variables), ANOVA and Student’s t-test (categorical variables) were used to establish the relation between the quality of life subscales and sociodemographic, medical-clinical and laboratory variables and to compare means. Statistical significance was set as p 100,000
156
78.05*
60.13*
38.70*
38.58
45.67*
No income
10
77.29
55.62
27.50
40.67
40.48
Gender
Type relationship
Family situation
Residence
Occupation
Income
Mean scores KDQOL-36TM Medical-clinical variables
n
Symptoms and Problems
Effects of the Kidney disease
Burden of the Kidney disease
SF-12 Physical functioning
SF-12 Mental functioning
Diabetic Nephropathy
92
70.22
54.24
27.85
34.53*
42.05
Hypertensive Nephropathy
79
75.97
53.64
35.83
38.38*
44.11
Obstructive Uropathy / Glomerulonephritis
22
78.21
61.93
38.06
45.92*
45.20
Unknown
105
75.61
59.61
30.95
37.15*
43.84
Others
56
74.61
58.93
32.25
39.25*
43.62
Yes
35
78.21
59.11
41.79*
41.02*
41.41
No
319
74.21
56.68
30.80*
37.25*
43.72
Yes
48
72.22
52.01
31.25
34.11*
40.66
No
306
74.99
57.69
31.99
38.18*
43.94
Yes
26
82.45*
58.17
52.88*
43.67*
47.63
No
328
73.99*
58.82
30.22*
37.14*
43.16
Etiology of the disease
Smoking
Hospitalizations
Transplantations
Student’s T (t); Bilateral significance (p). Assistential/None (A/N). Fondo Nacional de Salud (F). *p
