Quality of life of caregivers of end-stage kidney disease patients: Caregivers or care recipients?

The perceived levels of stress, anxiety and depression among family caregivers of patients undergoing haemodialysis and their association with quality of life

BACKGROUND

Acknowledging the impact of chronic kidney disease on caregivers' quality of life (QoL) and psychological well-being has become a global priority, highlighting the need for supportive interventions specifically aimed at caregivers.

AIMS

This study aimed to assess the prevalence of stress, anxiety and depression among family caregivers of Omani patients undergoing haemodialysis and to explore its association with QoL.

METHOD

The study employed a cross-sectional design. A sample of 326 participants completed the study's surveys, including the Depression Anxiety Stress Scale, WHOQOL-BREF scale and a demographic scale.

RESULTS

The survey indicated that 68.4% of the participant caregivers experienced varying degrees of depression. In addition, 48.4% of caregivers reported experiencing stress levels ranging from mild to extremely severe. For anxiety, 65.6% (n = 214) of caregivers noted varying levels, from mild to extremely severe anxiety. Significant negative associations were found among caregiver age, number of chronic illnesses, number of medications, daily hours spent on caregiving, physical health, stress, anxiety and depression, on the one hand, and the physical domain of QoL, on the other hand. Regarding the psychological domain of QoL, significant negative associations were observed with daily caregiving hours, physical health, stress, anxiety and depression.

CONCLUSION

This study highlights the significant psychological burden faced by caregivers of patients undergoing haemodialysis. Systematic screening and practical interventions, such as support groups and mental health programmes, are essential to improve caregiver well-being. Future research should explore the effectiveness of these interventions and the long-term impact of caregiving.

Determinants of Caregiver Burden Among Spouses of Patients With Kidney Failure: A Qualitative Study

RATIONALE & OBJECTIVE

Spousal caregivers participate extensively in the care of patients with kidney failure. Although previous studies suggested that these caregivers experience a high burden, a comprehensive understanding of the determinants of this burden and strategies to alleviate it are needed. Therefore, this study sought to explore the contributing and alleviating determinants of burden in spousal caregivers of patients with kidney failure.

STUDY DESIGN

A qualitative interview study with 15 spousal caregivers.

SETTING & PARTICIPANTS

Dutch-speaking, adult spousal caregivers were recruited and interviewed by the Dutch Kidney Patients Association for the Kidney Decision Aid.

ANALYTICAL APPROACH

A directed qualitative content analysis using the stress-appraisal model of caregiver burden as a framework to inform a disease-specific model on spousal caregiver burden for kidney failure that characterizes the impact of care provision on all aspects of spousal caregivers' lives, the burden associated with it, and possible mitigating factors.

RESULTS

Providing care for patients with kidney failure is complex and burdensome for spousal caregivers and results in many lifestyle changes, which are largely caused by kidney failure-specific tasks and the shifting responsibility for daily life tasks. Spouses identified disease-specific determinants of burden including the impact of kidney disease on spouses with the disease as well as the associated caregiver tasks, such as adjusting to dietary restrictions and attending dialysis appointments. Dialysis options (eg, the choice for home or in-center dialysis) were kidney failure-specific moderators of burden. Support of spousal caregivers by health care providers plays a key role in preventing overburdening.

LIMITATIONS

Potential limited transferability owing to the study of only Dutch-speaking spouses willing to be interviewed and videotaped.

CONCLUSIONS

This comprehensive overview of the contributing and alleviating determinants of burden experienced by spousal caregivers of patients with kidney failure highlights 4 principal areas: (1) personal and relational, (2) social environment, (3) health care, and (4) work and legislation, in which such burdens occur and may be alleviated.

PLAIN-LANGUAGE SUMMARY

Spousal caregivers are crucial for supporting patients with kidney failure, but they often experience significant stress and challenges. This study explored factors that contribute to spousal caregiver burden and ways to alleviate it. We interviewed 15 spousal caregivers of patients with kidney failure. We found that providing care for patients with kidney failure is complex, burdensome, and has a major impact on caregivers' lives. We identify factors that contribute to caregiver burden but also factors that may ease this burden. This study underlines the need for acknowledgement of spousal caregivers in 4 areas, namely (1) personal and relational, (2) social environment, (3) health care, and (4) work and legislation.

Prevalence and risk factors of pre-frailty and frailty in hemodialysis patients in central China

The current study was to explore the prevalence and risk factors elements of pre-frailty and frailty among patients undergoing hemodialysis (HD) in central China. A cross-sectional, multi-institutional investigation was conducted. From March to May 2024, using the convenience sampling method, a total of 408 HD patients from four hospitals in Xiangyang, China, were recruited for this study. The participants' demographics, lifestyle factors, factors related to dialysis treatment, the FRAIL scale, psychological resilience, and medical coping modes were assessed using a questionnaire. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population. Furthermore, to evaluate the independent relationship between frailty and psychological resilience, multiple regression analysis was used to adjust potential confounders and obtain odds ratios (OR) and 95% confidence intervals (CI). Pearson correlation analysis was used for correlation analysis among various scales. Among the 408 participants, the prevalence of pre-frailty and frailty among participants for all ages was 26.2% and 38.5%. Multivariate logistic regression analysis showed that smoking status, falls, heart disease, and psychological resilience are all associated with pre-frailty and frailty. The Pearson correlation analysis showed that resignation was positively related to frailty and negatively related to psychological resilience in patients. Confrontation and avoidance were positively related to psychological resilience. Frailty was negatively related to psychological resilience. Psychological resilience was independently linearly associated with pre-frailty (OR 0.49, 95% CI 0.32-0.75, p < 0.001) and frailty (OR  0.53, 95% CI 0.35-0.80, p = 0.003). Our findings point to the necessity for active screening prevalence and risk factors for pre-frailty (26.2%) and frailty (38.5%) in adult HD patients of all ages. Pre-frailty and frailty among HD patients are associated with lower psychological resilience and a higher likelihood of using negative coping mechanisms.

Predictors of quality of life among caregivers of patients with moderate to severe kidney disease: an Australian cross-sectional study

BACKGROUND

Little is known about the quality of life (QoL) of caregivers of patients with chronic kidney disease (CKD) along the disease continuum. We investigated factors associated with low QoL among caregivers of patients with CKD including those on dialysis. We also examined the relationship between kidney disease severity and the QoL of caregivers.

METHODS

We recruited caregivers of patients with CKD (stage 3 to 5) attending renal outpatient clinics as well as dialysis units of a tertiary hospital and patients from January 2018 to November 2023. Quality of life was assessed using a valid and reliable tool, the Adult Carer Quality of Life Questionnaire. Logistic regression analyses were performed to determine factors associated with low QoL among caregivers.

RESULTS

A total of 278 dyads of caregivers and patients were studied with a mean age of 56.6 ± 15.2 and 63.7 ± 15.3 years respectively. The proportion of caregivers reporting low to mid-range QoL scores ranged from 37 to 73.3% across the eight domains, with 48% having low to mid-range overall QoL scores. The severity of CKD had no impact on overall QoL of caregivers in the personal growth and carer satisfaction domains where caregivers of patients on dialysis reported worse scores compared to caregivers of predialysis patients. Female gender of caregivers and patients, longer caregiving time, diagnosis of diabetes and lower socioeconomic status of patients were all associated with lower scores in one or more domains.

CONCLUSION

This study identified several factors associated with low QoL among caregivers of patients with CKD. An understanding of these factors provides insight into the development of targeted interventions to improve the QoL of caregivers.

Informal caregiver burden in dialysis care and how it relates to patients' health-related quality of life and symptoms

Background

Informal caregivers play a crucial role in dialysis care but may experience significant burden, potentially affecting both caregiver and patient outcomes. Research on caregiver burden and health-related quality of life (HRQoL) and the relation to patient-reported outcomes (PROs) is lacking. Therefore, we aimed to (i) describe informal caregivers' experienced burden and HRQoL and (ii) investigate how these are related to dialysis patients' HRQoL and symptoms.

Methods

We conducted a cross-sectional study at dialysis initiation with 202 adult informal caregiver-dialysis patient dyads. Caregiver burden was measured with the Self-Perceived Pressure from Informal Care (SPPIC) questionnaire, HRQoL with the 12-item Short Form Health Survey (SF-12), and symptom number and burden with the Dialysis Symptom Index (DSI). Data were analysed using linear and logistic ordinal regression.

Results

Around 38% of caregivers experienced moderate to high burden. Patients' lower mental HRQoL [adjusted odds ratio (aOR) = 0.95, 95% confidence interval (CI) 0.92; 0.99], higher symptom number (aOR = 1.07, 95% CI 1.02; 1.12) and higher symptom burden (aOR = 1.03, 95% CI 1.01; 1.04) were associated with greater odds of higher caregiver burden. Patients' lower mental HRQoL (β = 0.30, 95% CI 0.15; 0.46), higher symptom number (β = -0.55, 95% CI -0.78; -0.31) and higher symptom burden (β = -0.17, 95% CI -0.25; -0.10) were also associated with a lower mental HRQoL in caregivers.

Conclusion

We show that a third of caregivers feel moderate to high burden and that caregiver burden is associated with patients' mental HRQoL and symptoms. These findings highlight the importance of recognizing informal caregivers and the nature of their burden.

Peer support groups and care burden in hemodialysis caregivers: a RCT in an Iranian healthcare setting

BACKGROUND

Chronic renal failure poses a significant global health challenge, exerting a substantial burden on both patients and their caregivers. Hemodialysis, a common treatment for end-stage renal disease, imposes extensive physical, emotional, and financial pressures on caregivers, often leading to a high care burden. This study uniquely examines the impact of peer support groups on reducing the care burden among caregivers of patients receiving hemodialysis in an Iranian healthcare setting, an aspect that has not been extensively explored before.

METHODS

A parallel-controlled clinical trial was conducted involving 60 caregivers, divided into intervention and control groups. The intervention group participated in an 8-session peer support program tailored to their identified needs, including coping with stress, social isolation, and financial challenges. The Zarit Care Burden Interview Scale was used to measure care burden before and after the intervention.

RESULTS

The study revealed statistically significant reductions in care burden, particularly in physical, social, and emotional dimensions, among caregivers in the intervention group compared to the control group. The total care burden score showed a marked decrease, indicating the effectiveness of the peer support intervention. While economic challenges remained a concern, the intervention had a limited impact in this domain.

CONCLUSION

This study demonstrates that peer support groups significantly alleviate the care burden experienced by caregivers of patients receiving hemodialysis, improving their well-being across several dimensions. The findings highlight the importance of integrating peer support strategies into healthcare programs for chronic disease management and underscore the need for supplementary economic support measures to comprehensively address caregivers' needs. Future research should explore the scalability and long-term sustainability of such interventions and address the unique economic challenges faced by these caregivers.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20220724055540N1 on 11/08/2022.

The mediating effect of family resilience between coping styles and caregiver burden in maintenance hemodialysis patients: a cross-sectional study

BACKGROUND

Primary caregivers of hemodialysis patients suffer from varying degrees of stress from their patients. Caring for hemodialysis patients can expose caregivers to many problems, leading to an increased burden of care and even impacting the quality of care. The purpose of our study was to examine whether family resilience could be a mediating variable moderating the relationship between patient coping styles and caregiver burden.

METHODS

The study was a cross-sectional and descriptive-analytical study that interviewed 173 pairs of hemodialysis patients and their caregivers at a blood purification center in a public hospital in China. The Brief Coping Styles Scale (Chinese version) was used to assess individuals' coping styles for disease and treatment. From the caregiver's perspective, the Family Resilience Assessment Scale (Chinese version) was used to understand the resilience of families, and the Zarit Caregiver Burden Scale was used to capture the caregiver's subjective experience of burden. Statistical analyses were conducted using SPSS version 23 and Amos version 26 to analyze the relationships between variables to examine for correlation and construct mediated effects models.

RESULTS

Coping styles showed a significant positive correlation with family resilience (r = 0.347, P < 0.01) and a negative correlation with caregiver burden (r = -0.379, P < 0.01). A significant negative correlation was found between family resilience and caregiver burden (r = -0.503, P < 0.01). In the mediation model, patient coping styles directly impacted caregiver burden significantly (95% CI [-0.372, -0.058]), and coping styles indirectly impacted caregiver burden by family resilience in a significant way (95% CI [-0.275, -0.098]).

CONCLUSIONS

Patient coping styles directly affect caregiver burden. Family resilience is a mediating variable between patients' coping styles and the burden on caregivers.

Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation

INTRODUCTION

Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD).

PURPOSE

To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups.

METHODS

A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools.

RESULTS

The majority of caregivers were females (67.2%), with a median age of 58 years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively).

CONCLUSION

Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.