Improving wellbeing in patients undergoing dialysis: Can meditation help?

Feasibility of the Hemomindful Program: a mindfulness-based program performed during hemodialysis

INTRODUCTION

Recent evidence indicates that mindfulness-based programs (MBPs) improve overall well-being and the ability to cope with kidney failure and hemodialysis stressors. However, intradialytic MBPs are poorly investigated.

OBJECTIVE

The aim of this study was to describe the study protocol, evaluate the feasibility and perceived effects of the Hemomindful Program.

METHODS

The results presented are from a mixed-methods randomized controlled trial. Thirty-two adults with kidney failure were randomized into the Hemomindful Program, which consisting of 8 weekly individual sessions of 1 hour delivered at chairside during hemodialysis combined with the treatment as usual (TAU), or TAU alone. Feasibility was assessed based on retention of the study protocol, adherence to the Hemomindful Program, its safety, and participant satisfaction. Semi-structured interviews were conducted with participants in the intervention arm immediately following treatment. Data were analyzed using descriptive statistics and discursive textual analysis.

RESULTS

The overall rate of adherence to the study protocol was 84.38%. Among the participants in the Hemomindful Program (n = 16), 15 had four or more sessions (93.7%) and 12 completed the protocol (75%). Degree of importance attributed to the intervention was 8.58 (SD = 2.06) and intention to maintain the formal and informal mindfulness practices after the intervention was 6.67 (SD = 2.93) and 8.5 (SD = 2.31). The qualitative analysis indicated satisfaction with the perceived changes (greater awareness in daily activities, less reactivity, management of pain and discomfort) and the structure of the program.

CONCLUSION

The Hemomindful Program showed positive indicators of feasibility, with good retention, acceptability and safety.

Examining the acceptability and feasibility of the Compassionate Mindful Resilience (CMR) programme in adults living with chronic kidney disease: the COSMIC study findings

BACKGROUND

Individuals with chronic kidney disease experience difficult physical and psychological symptoms, that impact quality of life, and are at increased risk of anxiety and depression. Access to specialist psychological support is limited. This study aimed to support a new service development project, in collaboration with Kidney Care UK, to implement the Compassionate Mindful Resilience (CMR) programme, developed by MindfulnessUK, which provides accessible mindfulness techniques and practices to enhance compassion and resilience, and explore its feasibility for people living with stage 4 or 5 kidney disease and transplant.

METHODS

A multi-method feasibility design was utilised. Participants over 18 years, from the UK, with stage 4 or 5 kidney disease or post-transplant, and who were not currently undergoing psychotherapy, were recruited to the four-week CMR programme. Data was collected at baseline, post-intervention and three-months post to measure anxiety, depression, self-compassion, mental wellbeing, resilience, and mindfulness. The acceptability of the intervention for a kidney disease population was explored through qualitative interviews with participants, and the Mindfulness Teacher.

RESULTS

In total, 75 participants were recruited to the study, with 65 completing the CMR programme. The majority were female (66.2%) and post-transplant (63.1%). Analysis of completed outcome measures at baseline and post-intervention timepoints (n = 61), and three-months post intervention (n = 45) revealed significant improvements in participant's levels of anxiety (p < .001) and depression (p < .001), self-compassion (p = .005), mental wellbeing (p < .001), resilience (p.001), and mindfulness (p < .001). Thematic analysis of interviews with participants (n = 19) and Mindfulness Teacher (n = 1) generated three themes (and nine-subthemes); experiences of the CMR programme that facilitated subjective benefit, participants lived and shared experiences, and practicalities of programme participation. All participants interviewed reported that they found programme participation to be beneficial.

CONCLUSION

The findings suggest that the CMR programme has the potential to improve psychological outcomes among people with chronic kidney disease. Future randomized controlled trials are required to further test its effectiveness.

Study of effect of guided meditation on quality of life in patients of end stage renal disease (ESRD) on maintenance hemodialysis – a randomised controlled trial

Background

There is paucity of data regarding effects of guided meditation (Yoganidra) on quality of life among patients of chronic kidney disease on maintenance hemodialysis. Our objective was to study effects of guided meditation on physical, emotional, and cognitive dimensions of well-being and quality of life in patients undergoing maintenance hemodialysis.

Method

We collected baseline and post intervention data in control and intervention groups on hemodialysis and studied the effect of Guided mediation provided for 6 weeks.

Result

Eighty patients (forty in control and intervention group each) were studied. Mean age was 51 years. Hypertension and Diabetes were the most common etiological condition (28.75%) followed by undermined aetiology (25.00%). 8.75% of the patients had dialysis vintage of less than 1 year. There was statistically significant difference in qualities of happiness and all measures of physical general wellbeing. There was statistically significant difference in burden and effect of kidney disease as well as symptoms of kidney disease post intervention in Kidney Disease Quality of Life score. We carried out Qualitative analysis in our study by maintaining a diary of their subjective experiences related to listening music/guided meditation during the study period in which the feeling of peace and feeling inspired to manage the illness/ do regular work were the most common experiences (97.5%) reported by participants. 

Conclusion

Guided meditation resulted in statistically significant improvement in happiness, enthusiasm, inspiration, activeness, alertness, awareness, degree of stability, self-confidence, clarity of thoughts, control over anger, self-reflection intervention in the intervention group. It reduced perceived stress. It improved burden and effect of kidney disease, symptoms of kidney disease and total Kidney Disease Quality of Life score. In qualitative dimensions of wellbeing (as emerging from analysis of results of diary), feeling of peace and feeling inspired to manage the illness/ continue regular work, clarity of thoughts, happiness, concentration, reduction of laziness, improved sleep pattern, reduction in anger among other psychological components.

Trial registration

This trial has been registered under clinical trial registry of India. (CTRI number-CTRI/2020/02/023438) (Date: 19/02/2020).

Examining the Acceptability and Feasibility of the Compassionate Mindful Resilience (CMR) Programme in Adult Patients with Chronic Kidney Disease: The COSMIC Study Protocol

Kidney disease is often progressive, and patients experience diminished health-related quality of life. In addition, the impact of the coronavirus (COVID-19) pandemic, and its associated restrictions, has brought many additional burdens. It is therefore essential that effective and affordable systems are explored to improve the psychological health of this group that can be delivered safely during the COVID-19 pandemic. The aim of this study is to support a new service development project in partnership with the UK’s leading patient support charity Kidney Care UK by implementing the four-session Compassionate Mindful Resilience (CMR) programme, developed by MindfulnessUK, and explore its effectiveness for patients with stage 4 or 5 chronic kidney disease or have received a kidney transplant. The study will utilise a quasi-experimental, pretest/posttest design to measure the effect of the CMR programme on anxiety, depression, self-compassion, the ability to be mindful, wellbeing, and resilience, using pre- and posttests, alongside a qualitative exploration to explore factors influencing the feasibility, acceptability, and suitability of the intervention, with patients (and the Mindfulness Teacher) and their commitment to practice. Outcomes from this study will include an evidence-based mindfulness and compassion programme for use with people with kidney disease, which is likely to have applicability across other chronic diseases.

Depressive Disorders Are Associated With Risk of Falls in People With Chronic Kidney Disease

OBJECTIVES

People with chronic kidney disease (CKD) are at increased risk for falls and fall-related injuries. Depressive disorders (DEP) are common in individuals with CKD and may increase the risk of falls and fall-related injuries. However, not much is known about the relationship between DEP and falls in people with CKD. The purpose of this study was to determine the influence of DEP on the relationship between CKD, falls, and fall-related injuries.

METHOD

Using the Behavioral Risk Factor Surveillance System, we identified 16,574 adults with CKD. Patients with CKD were stratified by history of self-reported DEP (SRDEP), and multivariate logistic regression was conducted to determine the odds for falls and fall-related injuries among those with and without SRDEP.

RESULTS

In unadjusted regression analysis, falls (OR = 2.40, 95% CI = 2.08-2.76) and fall-related injuries (OR = 2.12, 95% CI = 1.72-2.59) were higher in individuals with CKD and history of SRDEP compared to those with CKD and no history of SRDEP. Adjustment for confounders had little effect on the relationship between a history of SRDEP and either falls (AOR = 1.87, 95% CI = 1.60-2.19) or fall-related injuries (AOR = 1.58, 95% CI = 1.26-1.97).

CONCLUSIONS

People with CKD and DEP are at increased odds for falls and fall-related injuries even after adjustment for sociodemographic, lifestyle factors, and comorbidities. Prospective studies are warranted to further understand this relationship, but it may be prudent for clinicians, in particular nurses, to consider fall risk when treating DEP in patients with CKD.

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review

INTRODUCTION

Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies.

METHODS

We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936).

RESULTS

Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1).

CONCLUSIONS

MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.

Clinical Observation on the Nursing Effect of Mindfulness-Based Stress Reduction Combined with Solution-Focused Brief Therapy in Uremic Peritoneal Dialysis Patients and Influence on Nutritional Status

Objective

To explore the nursing effect of mindfulness-based stress reduction (MBSR) combined with solution-focused brief therapy (SFBT) in uremic peritoneal dialysis (PD) patients and its influence on nutritional status.

Methods

A prospective study was conducted on 108 uremia patients undergoing PD who were admitted to the First People's Hospital of Wenling from March 2018 to December 2020. In accordance with the wishes of the patients, according to random number method, the patients were divided into control group (n = 54) and experimental group (n = 54). Patients in the control group were given routine care. Patients in the experimental group were given MBSR combined with SFBT. The clinical data, biochemical indicators, complication, compliance, nutritional status, and quality of life of the two groups were compared.

Results

After intervention, the serum hemoglobin, serum albumin levels, and urea clearance index of the experimental group were higher than those of the control group (P < 0.05). Compared with the control group, the experimental group had a lower incidence of complications (P < 0.05). After intervention, the compliance score of the experimental group was higher than that of the control group (P < 0.05). After intervention, the malnutrition inflammation score of the experimental group was lower than that of the control group (P < 0.05). After intervention, the Kidney Disease and Quality of Life-36 scores of the experimental group were higher than those of the control group (P < 0.05).

Conclusion

MBSR combined with SFBT has a good nursing effect in uremia patients undergoing PD and can increase the patient's treatment compliance, improve the quality of life, and improve the nutritional status.

Brief Mindfulness Intervention vs. Health Enhancement Program for Patients Undergoing Dialysis: A Randomized Controlled Trial

Background: Between 20–50% of patients undergoing maintenance dialysis for end-stage kidney disease experience symptoms of depression and/or anxiety, associated with increased mortality, greater health care utilization, and decreased quality of life. It is unknown whether mindfulness-based interventions can improve depression and anxiety symptoms in patients receiving this treatment. Methods: We conducted an 8-week multicenter randomized controlled trial comparing a brief mindfulness intervention (BMI) vs. an active control (Health Enhancement Program [HEP]) in 55 patients receiving dialysis with symptoms of depression and/or anxiety. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) depression scores, with a primary analysis in participants with baseline PHQ-9 ≥ 10, and a secondary analysis including all participants. The secondary outcome was change in Generalized Anxiety Disorder-7 (GAD-7) anxiety scores with corresponding primary and secondary analyses. Results: Both BMI and HEP reduced depressive symptoms, with no difference between trial arms (PHQ-9 change = −7.0 vs. −6.1, p = 0.62). BMI was more effective than HEP in reducing anxiety (GAD-7 change = −8.7 vs. −1.4, p = 0.01). Secondary analyses revealed no differences between arms. Conclusions: For patients undergoing dialysis, both BMI and HEP may be helpful interventions for depression symptoms, and BMI may be superior to HEP for anxiety symptoms. Mindfulness-based and other psychosocial interventions may be further evaluated in those undergoing dialysis as treatment options for symptoms of depression and anxiety.

Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression

OBJECTIVE

Respiratory abnormalities are a hallmark of anxiety symptomatology and may serve as clinically useful modifiers for alleviating anxiety symptoms. However, gold-standard anxiety treatments (e.g., cognitive-behavioral interventions) often do not directly address respiratory components despite their theoretical utility and clinical accessibility. This review examined the clinical effectiveness of respiratory interventions, interventions that directly target respiration abnormalities and processes, in treating trait anxiety symptoms.

METHODS

The final analysis included 40 randomized controlled trials including at least one measure of trait anxiety, a respiratory-focused intervention group, and a non-respiratory control-group (active or inactive treatment). Overall effects of respiratory focused interventions were examined, as well as the effect of hypothesized moderators.

RESULTS

Respiratory component interventions yielded significantly greater improvements (moderate to large effect) in anxiety symptoms than controls, with the stronger effects observed in comparison to inactive, rather than active, control conditions. Significant heterogeneity in findings suggests that variability in intervention design, population, and control comparison may obfuscate interpretation of findings.

CONCLUSIONS

Evidence supports the clinical utility of respiratory interventions as either an independent anxiety treatment, or as an adjunct to other interventions. Clinical and research implications of findings along with recommendations for ongoing investigations in this domain are discussed.

The role of mind-body interventions in pre-dialysis chronic kidney disease and dialysis patients - A systematic review of literature

INTRODUCTION

With the rise in complementary medicine usage, mind-body interventions (MBI), encompassing therapies like yoga and music therapy, have been gaining interest. The use of MBI in non-chronic kidney disease (CKD) patients have demonstrated efficacy for ameliorating pain, stress and anxiety symptoms. As CKD patients often suffer from these symptoms, MBI may serve as potential adjunctive therapies. This review aimed to summarize the studied indications of MBI among CKD patients.

METHODS

A systematic review was performed in Medline®, Embase®, Scopus®, CINAHL®, CENTRAL® and PsycInfo® in accordance to the PRISMA and SWiM checklists. Randomised controlled trials (RCTs) which evaluated the use of MBI among adult CKD patients were included. The efficacy of each MBI was determined by reduction in symptoms severity scores. All adverse reactions were documented.

RESULTS

Of the 7,417 articles screened, 32 RCTs were included. Music therapy (n = 11), relaxation therapy (n = 9) and spiritual therapy (n = 6) were the most well studied MBIs. Frequently studied indications for MBIs were anxiety symptoms (n = 12), pain (n = 7) and depressive symptoms (n = 5). Music and spiritual therapies were shown to reduce 8.06-43.5 % and 36.1-41.1 % of anxiety symptoms respectively. For pain relief, music (41.8 %-61.5 %) and yoga therapies (36.7 %) were shown to be effective for reduction of pain. Lastly, spiritual therapy was shown to reduce depressive symptoms by 56.8 %. No adverse effects were reported for any MBI.

CONCLUSION

Music therapy, relaxation and spiritual therapies are more well-studied MBIs which were shown to reduce anxiety, depressive symptoms and pain in CKD patients. Larger RCTs are required to confirm the efficacy and safety of promising MBIs.

The effects of a short-term meditation-based mindfulness protocol in patients receiving hemodialysis

Mindfulness-based approaches that promote health, improve quality of life, and reduce the impact of comorbidities are key aspects in chronic diseases management. We aimed to verify the impact of a short-term meditation protocol on psychosocial and physiological parameters in chronic hemodialysis patients. We enrolled twenty-two patients, median age of 69.5 years old, into a 12-week meditation protocol that occurred during each hemodialysis session for 10-20 minutes, 3x/week, in a private tertiary hospital. We then evaluated clinical, psychological, and laboratorial parameters pre- and post-meditation. Patients exhibited a better control of serum phosphorus (-0.72 mg/dL; P = 0.002), a decrease in systolic blood pressure (-1.90 mmHg; P = 0.009), a 23% decrease in depressive symptoms (P = 0.014), and an increase of 7% in the self-compassion scale (P = 0.048) after meditation. To note, we observed an increase in 13% of the mindfulness score (P = 0.019). Our preliminary study describes the effects of a short-term meditation protocol in chronic hemodialysis setting. We observed a decrease in depressive symptoms and in blood pressure values, an improvement in self-compassion and serum phosphorous levels. In conjunction with the promising results of meditation in chronic kidney disease setting, this encouraging preliminary study supports the need for additional clinical trials.

Psychosocial Issues and Lifestyle Changes for the Renal Patient

This article provides an overview of the psychosocial issues faced by those with renal disease. The article discusses the physiologic connection between anxiety, depression, and pain-symptoms commonly seen in renal disease and other chronic illnesses. The application of integrative medicine or nonallopathic medicine and its role in the management of anxiety, depression, and pain are presented. Also presented is evidence surrounding several frequently used nonallopathic modalities appropriate for incorporation into a comprehensive management regimen for renal patients to reduce symptom burden. The article concludes with a discussion on the role of palliative care in treatment decisions for renal patients.