Evaluation of psychological distress using the K6 in patients on chronic hemodialysis

Relation among hope, self-efficacy, and psychological distress in hemodialysis patients: a path analysis

BACKGROUND

Psychological distress is a major problem among hemodialysis patients. Certain prior studies suggest that psychological distress is negatively associated with hope and self-efficacy. The way hope and self-efficacy are linked with psychological distress, as well as the strength of these correlations in hemodialysis patients, may vary across cultures. Also, it is unclear whether self-efficacy mediates the relationship between hope and psychological distress. The purpose of this study was to look into the effects of hope, self-efficacy, and demographic characteristics on psychological distress, as well as to verify the mediating role of self-efficacy in the relationship between hope and psychological distress in a sample of Iranian hemodialysis patients.

METHODS

This cross-sectional descriptive-analytical study was conducted in 2022. Total population sampling was used. The data collection tools were distributed to 345 eligible hemodialysis patients from six dialysis centers in Southern Khorasan province, Iran. Among them, 215 patients completed the questionnaires. Data were collected using a demographic questionnaire, the Chronic Kidney Disease Self-Efficacy instrument, the Kessler Psychological Distress Scale, and the Herth Hope Index. Data were analyzed using SPSS version 24 and AMOS version 22.

RESULTS

The final predictors of psychological distress were hope (β = -0.44, P < 0.001), self-efficacy (β = -0.29, P < 0.001), and duration of hemodialysis (β = -0.15, P = 0.003). These variables collectively predicted 46% of the variance of psychological distress. Path analysis with good model fit indices indicated the significant direct effect of hope on psychological distress (ß = - 0.47, P < 0.001), the significant direct effect of self-efficacy on psychological distress (ß = - 0.29, P < 0.001), the significant direct effect of hope on self-efficacy (ß = 0.49, P < 0.001), and the significant indirect effect of hope on psychological distress (ß = - 0.19, [95% CI = -0.32, -0.08], P < 0.001).

CONCLUSION

It is crucial to consider hope, self-efficacy, and the duration of hemodialysis when designing interventions aimed at reducing psychological distress in hemodialysis patients. According to this study, hope has a significant influence on reducing psychological distress by enhancing self-efficacy. Therefore, implementing programs that improve hope and self-efficacy simultaneously may reduce psychological distress in hemodialysis patients.

Cost-Effectiveness of Radiofrequency Renal Denervation for Uncontrolled Hypertension in Japan

Radiofrequency renal denervation (RF RDN) is a novel therapy for uncontrolled hypertension. In the recent sham-controlled SPYRAL HTN-ON MED study, office-based systolic blood pressure (oSBP) and nighttime BP were reduced significantly. This study examined the cost-effectiveness of RF RDN in the context of the Japanese healthcare system based on this latest clinical evidence. Clinical events, costs, and quality-adjusted life-years (QALYs) were projected using a decision-analytic Markov model adjusted to Japanese incidence data. Risk reduction in clinical events from changes in oSBP was calculated based on a published meta-regression of 47 trials of intentional hypertension treatment. Demographics and results from the SPYRAL HTN-ON MED trial (oSBP effect size -4.9 mmHg vs. sham) were utilized in the base case analysis. Additional scenarios were explored including the potential added benefit of improved night-time control. Costs were sourced from claims data and published literature. The incremental cost-effectiveness ratio (ICER) was evaluated against a cost-effectiveness threshold of ¥5 000 000 per QALY gained. RF RDN was projected to reduce clinical events (10-year relative risks: 0.80 for stroke, 0.88 for myocardial infarction, and 0.75 for heart failure). Over lifetime, RF RDN added 0.36 QALYs at the incremental cost of ¥923 723, resulting in an ICER of ¥2 565 236 per QALY gained. Under the assumption of added night-time benefit, the ICER decreased to ¥2 155 895 per QALY. Cost-effectiveness findings were robust across all tested scenarios. The findings of this model-based analysis suggest that RF RDN can provide meaningful clinical event reductions and is a cost-effective treatment option in the Japanese healthcare system.

Psychological distress between chronic hemodialysis patients with and without low back pain

OBJECTIVE

The aim of this study was to compare psychological distress between patients on chronic hemodialysis with and without chronic low back pain (CLBP).

SUBJECTS AND METHODS

A total of 72 patients on chronic hemodialysis, aged 72.9 ± 10.8 years, were enrolled in this cross-sectional study. Psychological distress using the K6, questionnaire for CLBP, and physical activity using the tri-accelerometer were evaluated.

RESULTS

Twenty-nine patients (40.3 %) were having CLBP. The K6 scores were 4.0 ± 4.6 and physical activity (n = 55) was 1.0 ± 1.0 METs h/day. K6 scores in patients on chronic hemodialysis with CLBP were significantly higher than those in patients on chronic hemodialysis without CLBP even after adjusting for sex, age, duration of hemodialysis and physical activity.

CONCLUSION

These results suggest that higher psychological distress was a fundamental feature in patients on chronic hemodialysis with CLBP.