Hypertension Control, Apparent Treatment Resistance, and Outcomes in the Elderly Population With Chronic Kidney Disease

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.

MR-SPLIT: A novel method to address selection and weak instrument bias in one-sample Mendelian randomization studies

Mendelian Randomization (MR) is a widely embraced approach to assess causality in epidemiological studies. Two-stage least squares (2SLS) method is a predominant technique in MR analysis. However, it can lead to biased estimates when instrumental variables (IVs) are weak. Moreover, the issue of the winner's curse could emerge when utilizing the same dataset for both IV selection and causal effect estimation, leading to biased estimates of causal effects and high false positives. Focusing on one-sample MR analysis, this paper introduces a novel method termed Mendelian Randomization with adaptive Sample-sPLitting with cross-fitting InstrumenTs (MR-SPLIT), designed to address bias issues due to IV selection and weak IVs, under the 2SLS IV regression framework. We show that the MR-SPLIT estimator is more efficient than its counterpart cross-fitting MR (CFMR) estimator. Additionally, we introduce a multiple sample-splitting technique to enhance the robustness of the method. We conduct extensive simulation studies to compare the performance of our method with its counterparts. The results underscored its superiority in bias reduction, effective type I error control, and increased power. We further demonstrate its utility through the application of a real-world dataset. Our study underscores the importance of addressing bias issues due to IV selection and weak IVs in one-sample MR analyses and provides a robust solution to the challenge.

Clinical care & blood pressure control among hypertensive people living with human immune deficiency virus: Prospective cohort study

BACKGROUND

Hypertension has emerged as a new threat to the health and well-being of people living with human immune deficiency virus (PLHIV). However, no data exist on care delivery and blood pressure control over time in Ethiopia. We assessed clinical care & level of blood pressure control among hypertensive people living with Human Immune Deficiency Virus (HIV).

METHODS

We conducted a prospective cohort study among adult hypertensive PLHIV and HIV-negative patientsat chronic care clinics of Jimma University Medical Center in Ethiopia. We explored self-management practices and blood pressure control of study participants. Multivariable Cox-regression was used to identify the predictors of the outcome.

RESULTS

A total of 303 eligible participants with mean age of 43.30 ± 12.55years were followed and males comprised of 52.1%. After 12 months of follow-up, 60.2% of HIV-positive and 53% of HIV-negative patients showed uncontrolled blood pressure. The overall perception of self-management behaviors was 2.10 ± 0.77 (p = 0.122), which was at moderate level. An increased waist circumference [AHR: 2.16; 95% CI: (1.58-5.18);p = 0.021],chronic disease co-morbidity[AHR:3.94;95%CI:(2.24-8.74);p = 0.046],alcohol use history[AHR:1.26; 95%CI:(1.08-2.23);p = 0.031], HIV infection[AHR:3.06;95%CI:(1.93-11.34);p=0.042], infrequent use of fruits & vegetables [AHR:3.77;95%CI: (1.34-10.57);p=0.012], infrequent engagement on physical exercise[AHR:3.48;95%CI:(1.48-8.17);p = 0.004],frequent use of high fats food [AHR:2.56;95%CI: (1.25-5.25);p = 0.011] were an independent predictors of uncontrolled blood pressure.

CONCLUSION

The rate of uncontrolled blood pressure is significantly higher in the HIV- infected population. There was a gap in the clinical care of hypertension in terms of hypertension self-management among hypertensive HIV-positive patients. Our study highlights the need for better integration of hypertension care to HIV clinical setting.