Quality of Life and Symptom Burden among Chronic Kidney Disease of Uncertain Etiology (CKDu) Patients in Girandurukotte, Sri Lanka

Physical symptoms distress and demoralization among haemodialysis patients; the mediating effect of spirituality and self-compassion. A cross-sectional questionnaire survey

Background

Long-term haemodialysis patients often experience physical symptom distress (PSD) and varying levels of demoralization. Spirituality and self-compassion can help patients to cope these challenges. However, the interrelations between these variables remain underexplored, necessitating further investigation.

Objectives

To examine the effect of PSD on demoralization among haemodialysis patients and to determine whether spirituality and self-compassion mediate these relationships.

Design

A cross-sectional correlational study.

Settings

A convenience sample was used to recruit from two haemodialysis clinics.

Methods

Self-report questionnaires were the Physical Symptom Distress Scale, Demoralization Scale, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12, and Self-Compassion Scale. Relationships and mediators were examined with Pearson's correlations and multiple linear regression analysis, respectively.

Results

A total of 156 participants participated. Mean age of participants was 61.3 years (SD = 11.3). Most participants were male (66 %) and had received dialysis for ≥ 5 years (61.5 %). Pearson's correlation indicated higher scores for PSD were significantly associated with lower levels of spirituality and self-compassion and higher levels of demoralization. There was a significant total and direct effect of PSD on demoralization. Mediation analysis indicated that the relationship between PSD and demoralization was partially and significantly mediated by spirituality and self-compassion. Demoralization can be explained by 46.83 % variance accounted by these predictors in the mediation model.

Conclusion

Long-term haemodialysis can cause chronic symptom distress and feelings of demoralization. The mediating effects of spirituality and self-compassion on PSD and demoralization suggest that these qualities may act as emotional regulators that enable haemodialysis patients to be more accepting of symptom distress, which results in lower levels of demoralization. Our findings imply that developing strategies to increase spirituality and self-compassion could help patients manage chronic symptom distress associated with haemodialysis, reduce demoralization, and ultimately improve their quality of life.

Efficacy of eHealth Interventions for Hemodialysis Patients: Systematic Review and Meta-Analysis

BACKGROUND

Within hemodialysis patient populations, eHealth interventions have been considered as an alternative and complementary option to routine care services. However, the efficacy of eHealth interventions for hemodialysis patients remains poorly understood owing to a lack of rigorous quantitative evidence synthesis.

OBJECTIVE

This meta-analysis aimed to evaluate the efficacy of eHealth interventions in improving quality of life, treatment adherence, and psychological outcomes (anxiety and depression) among hemodialysis patients. In addition, the study sought to identify specific intervention components and methodological quality associated with enhanced quality of life and health outcomes in this population.

METHODS

A comprehensive search was performed across PubMed, Web of Science, Embase, CINAHL, Cochrane Library, PsycINFO, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and China BioMedical Literature Database databases from their inception to September 7, 2024. Randomized controlled trials on eHealth interventions for hemodialysis patients published in English or Chinese were included. Critical appraisal was carried out independently by 2 reviewers to assess the bias risk of the studies included. Quantitative synthesis of the outcomes of interest was conducted using a random-effects model. The quality of evidence for the outcomes was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS

A total of 17 randomized controlled trials involving 1728 participants were included in this meta-analysis out of 5741 articles identified in the initial database search and additional search references. In the 17 studies, 8 kinds of eHealth intervention delivery formats were used, including text messages, telephone sessions, video, network platforms, social media, computers, websites, and mobile apps. The majority of research studies used a single form of eHealth intervention, and 7 studies adopted a combined approach of 2 or more eHealth technologies. The duration of eHealth interventions demonstrated substantial variability across studies, spanning from 4 weeks to 12 months, of which 3 months was the most common. A total of 14 (82%) studies were considered to have "some concern" about selection bias. In addition, 15 (88%) trials were classified as having a "high risk" of performance and detection bias, and all trials were judged to be at "low risk" of attrition and reporting bias. The pooled results revealed a significant difference between the eHealth interventions and control groups on quality of life (standardized mean difference [SMD]=0.87, 95 % CI 0.38 to 1.37, low certainty evidence), treatment adherence (SMD=1.11, 95 % CI 0.30 to 1.91, moderate certainty evidence), anxiety (SMD=-2.11, 95 % CI -3.25 to -0.97, moderate certainty evidence), and depression (SMD=-2.46, 95 % CI -3.68 to -1.25, moderate certainty evidence).

CONCLUSIONS

eHealth interventions could be a beneficial approach for improving quality of life and treatment adherence and reducing anxiety and depression among hemodialysis patients. However, future high-quality randomized controlled trials are essential to draw more reliable conclusions.

TRIAL REGISTRATION

PROSPERO CRD42024589799; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024589799.

Distressing symptoms and health-related quality of life in patients with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is an incapacitating illness associated with distressing symptoms (DS) that have negative impact on patients' health-related quality of life (HRQOL).

AIM

To assess the severity of DS and their relationships with HRQOL among patients with CKD in Jordan.

METHODS

A descriptive cross-sectional design was used. A convenience sampling approach was used to recruit the participants. Patients with CKD (n = 140) who visited the outpatient clinics in four hospitals in Amman between November 2021 and December 2021 were included.

RESULTS

The Edmonton Symptom Assessment System was used to measure the severity of the DS while the Short Form-36 tool was used to measure the HRQOL. Participants' mean age was 50.9 (SD = 15.14). Most of them were males (n = 92, 65.7%), married (n = 95, 67.9%), and unemployed (n = 93, 66.4%). The highest DS were tiredness (mean = 4.68, SD = 2.98) and worse well-being (mean = 3.69, SD = 2.43). The highest HRQOL mean score was for the bodily pain scale with a mean score of 68.50 out of 100 (SD = 32.02) followed by the emotional well-being scale with mean score of 67.60 (SD = 18.57).

CONCLUSION

Patients with CKD had suboptimal HRQOL, physically and mentally. They suffer from multiple DS that have a strong association with diminished HRQOL such as tiredness and depression. Therefore, healthcare providers should be equipped with the essential knowledge and skills to promote individualized strategies that focusing on symptom management.

Health-related quality of life and its predictors among chronic kidney disease patients: A hospital-based cross-sectional study

Chronic kidney disease (CKD) has a significant impact on the health-related quality of life (HRQoL) of affected individuals due to its progressive and disabling nature. The aim of this study was to evaluate the HRQoL and its predictors among CKD patients. A cross-sectional study was carried out at kidney foundation Hospital and research Institute at Dhaka, Bangladesh. Kidney Disease Quality of Life (KDQoL™ -36) questionnaire were used to measure the HRQoL of CKD patients. The study also used kidney-targeted KDQoL-36 Summary Score (KSS). Socio-demographic and medical records were also collected. Descriptive statistics, and multiple linear regression were performed. Out of 430 patients, 77.9% were in moderate to advanced stage of CKD. Patients aged, occupation, income, co-morbidities such as diabetes or hypertension, medication used, and serum hemoglobin were found significantly (p <0.05) associated at different stages of CKD. The mean domain scores of physical component summary (PCS), mental component summary (MCS), burden of kidney disease (BKD), effect of kidney disease (EKD), symptoms and problems of kidney disease (SPKD) subscales were 37.19, 45.94, 31.49, 63.95, and 73.35, respectively. The KSS was 63.24. The stage of CKD has been documented as an important predictor of HRQoL of all subscales of KDQoL-36 as well as KSS. The older age group also showed a clear link with a lower HRQoL in all subscales of KDQoL-36, except SPKD. In multiple linear regression analysis, stage of CKD, patients age, employment status and use of medication were found significant predictors of KSS. Further, higher levels of education, being married, absence of diabetes and heart disease were all independent predictors of a higher MCS. Whereas retirement, low duration of CKD and the use of three or more drugs strongly linked to worse scores of PCS. By addressing the determinants of poor HRQoL, healthcare providers can tailor treatment plans to better meet the needs of these individuals and ultimately enhance their overall well-being.

The effect of video training on symptom burden, comfort level, and quality of life in hemodialysis patients: Clustered randomized controlled trial

OBJECTIVE

Use of video in patient education is becoming widespread due to its low cost, time management, ease of application, and permanent learning. The study aimed to investigate the effect of video training on the symptom burden, comfort level, and quality of life of patients undergoing hemodialysis treatment.

METHODS

In this clustered randomized controlled trial, the patients were randomly assigned to groups by lottery method according to hemodialysis treatment days and sessions. Individuals in the intervention group(n = 26) were screened one episode of the training video in each session for three episodes per week for 12 weeks. Individuals in the control group(n = 22) received only conventional hemodialysis without video training.

RESULTS

At the third and fourth measurement times, in intervention group, mean scores of symptom burden decreased compared to baseline (respectively:40,12 ± 21,63; 22,31 ± 14,08;21,54 ± 16,78), mean scores of comfort level increased (respectively:102,42 ± 13,45; 111,42 ± 8,00;115,04 ± 9,73)(p < 0.05), while there was no significant difference in control group(p > 0.05). This study observed a statistically significant difference between quality of life scale scores individuals in intervention group(p < 0,05).

CONCLUSION

It was concluded that video training delivered to patients undergoing hemodialysis treatment decreased symptom burden of patients and increased their comfort level, and quality of life.

PRACTICE IMPLICATIONS

Video training can be utilized in the educational program of hemodialysis patients.

An analytical observational study on chronic kidney disease of unknown etiology at a rural tertiary care hospital in West Bengal

Background

Chronic kidney disease of unknown etiology (CKDu) has been a growing concern in the Indian population causing significant morbidity and mortality in these recent years. Thus, it is vital to understand the probable risk factors associated with its manifestation. This study aims to assess the distribution of various etiologies among CKD patients, investigate all the probable risk factors associated with CKDu, and estimate the health-related quality of life (QoL) among all CKDu patients in the study area.

Materials and Methods

It was an analytical, observational, cross-sectional study where one objective had a case-control study design. It was conducted at Bankura Sammilani Medical College in Bankura district, West Bengal, during July 2022-August 2022. A total of 198 patients have been studied through detailed interviews using a predesigned, pretested, semi-structured schedule. Potential risk factors and their strength of association were analyzed with the help of multivariate logistic regression.

Results

It was found that the prevalence of CKDu was almost 71% in the study population, mostly affecting agricultural workers (67.17%), daily laborers (46.46%), and construction workers. Perceived heat stress, excessive daily dietary intake of salt, and drinking contaminated water are the factors that had shown the strongest association with the occurrence of CKDu in this population. The deterioration in QoL in CKDu pretty much mirrors that of CKD.

Conclusion

CKDu is definitely an occupational disease, mostly affecting the wage workers and farmers spending long hours in unhealthy work environments. Environmental exposure to heavy metals must be checked and dietary modification must be done through counseling to regulate salt intake. CKDu, as a rising public health concern certainly needs special attention and immediate planning as it has a different etiopathology than CKD and the affected population, disease progression, and risk factors are markedly distinctive as well.

Prevalence and Severity of Lower Gastrointestinal Symptoms amongst Non-Dialysis Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Chronic kidney disease (CKD) patients experience a wide range of symptoms that deteriorate their health-related quality of life (HRQoL). We aimed to estimate the prevalence and severity of lower gastrointestinal (GI) symptoms in non-dialysis CKD adult outpatients, and to summarize the relationships between these symptoms and HRQoL, laboratory test results, and clinical data. The protocol of the study was preregistered (PROSPERO CRD42021255122). We searched MEDLINE, Scopus, Web of Science, and grey literature sources from the databases' inception up until 27 November 2021. Wide citation chasing was conducted. Single proportions (prevalence of functional constipation, self-reported constipation, diarrhea, abdominal bloating, fecal incontinence, and abdominal/rectal pain) were pooled using generalized linear mixed models. A total of 37 studies with 12,074 patients were included. We found that lower GI symptoms, especially self-reported abdominal bloating [CKD G1-2: 48.45% (95% CI: 43.5-53.4%; 2 studies); G3: 46.95% (95% CI: 45.0-48.9%; 2 studies), G4-5: 36.1% (95% CI: 25.4-48.5%; 8 studies)] and constipation [CKD G1-2: 31.8% (95% CI: 13.9-54.9%); G3: 29.8% (95% CI: 21.2-40.1%; 4 studies); G4-5: 38.8% (95% CI: 30.9-47.4%); 22 studies)], were common in non-dialysis CKD patients. The severity of the symptoms was limited. Self-reported constipation was most consistently associated with worse HRQoL, whereas hard stool consistency was associated with higher uremic toxins levels. To conclude, since lower GI symptoms are common in CKD, using symptom questionnaires that do not take them into account cannot provide full insight into the patient's experience. Further studies are needed to cover identified knowledge gaps, including the exploration of the pathophysiology of GI symptoms in CKD with multi-omics data.

Factors influencing health-related quality of life in people with chronic kidney disease: A structural equation modelling approach

AIMS AND OBJECTIVES

To test whether the revised Wilson and Cleary model could identify which factors contribute to health-related quality of life in chronic kidney disease.

BACKGROUND

Chronic kidney disease affects a person's health-related quality of life detrimentally although nursing practice informed by theory is only beginning to emerge.

DESIGN

A cross-sectional study reported using the STROBE guidelines.

METHODS

About 886 participants with chronic kidney disease (varying grades) completed validated measures of symptoms (renal version of the Integrated Palliative care Outcome Scale), and general health perceptions and health-related quality of life (European Quality of Life five-dimension three-level). Socio-demographic and renal characteristics were also collected. Data were analysed using descriptive statistics and structural equation modelling.

RESULTS

Biological function (decreased kidney function and haemoglobin and greater number of comorbidities), directly contributed to increased symptom burden. Symptoms demonstrated strong negative relationships with both general health perceptions and health-related quality of life. General health perceptions had a direct positive relationship with health-related quality of life. As age increased, health-related quality of life decreased. The only environmental characteristic of significance was the distance between home and hospital although it was not directly associated with health-related quality of life. Overall, the model explained approximately half of the deterioration in health-related quality of life.

CONCLUSIONS

The model demonstrated how various factors influence alteration of health-related quality of life in people with chronic kidney disease. Early identification of these factors could assist nurses to introduce effective management strategies into patient care plans proactively.

RELEVANCE TO CLINICAL PRACTICE

Comprehensive symptom assessment needs to occur not only in kidney failure but in earlier chronic kidney disease grades to enable timely interventions targeted at improving people's wellbeing.

PATIENT OR PUBLIC CONTRIBUTION

Validated interviewer administered questionnaires were completed by participants with chronic kidney disease in this study.

Association Between Exercise Self-Efficacy and Health-Related Quality of Life Among Dialysis Patients: A Cross-Sectional Study

Background

Exercise self-efficacy is a vital determinant of an individual’s active participation in regular exercise, and exercise is a critical component of improving health-related quality of life (HRQOL) in dialysis patients. This study aimed to describe the relationship between exercise self-efficacy and HRQOL in dialysis patients.

Materials and Methods

A cross-sectional study was conducted in Shanghai, China. Structured questionnaires distributed to the patients collected socio-demographic and disease-related information. Physical activity was assessed by a self-administered questionnaire, and the exercise self-efficacy scale (ESES) was used to measure exercise self-efficacy. HRQOL was evaluated by the kidney disease quality of life instrument-short form version 1.3 (KDQOL-SF™ v1.3). Data were analyzed using a univariate generalized linear model, Spearman correlation, and hierarchical multiple regression.

Results

A positive association was observed between exercise self-efficacy and HRQOL (r = 0.310, p &lt; 0.001). Physical activity as a predictor variable explained 9.8% of the variance in overall HRQOL (p &lt; 0.001). Exercise self-efficacy explained an additional 7.1% of the HRQOL variance. In total, 24.6% of the variation in the HRQOL was explained by the socio-demographic variables, disease-related factors, physical activity, and exercise self-efficacy.

Conclusion

Overall, only 16.9% of the change in HRQOL was explained by physical activity and exercise self-efficacy. Future research is still needed to further explore the factors influencing the HRQOL in dialysis patients. However, this finding suggests the need to consider the importance of HRQOL and physical activity as well as exercise self-efficacy when developing intervention programs.

Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study

People with end stage renal disease and undergoing hemodialysis experience a high symptom burden that impairs quality of life. This study aimed to assess the prevalence, dynamicity and determinants of symptom burden among middle-aged and older adult hemodialysis patients. A descriptive cross-sectional study together with a longitudinal assessment was used. A total of 118 and 102 hemodialysis patients were assessed at baseline and at a 6-month follow-up. Validated questionnaires were used to assess the symptom burden, stress, illness perception and social support. Multiple linear regression analysis was used to determine the factors associated with symptom burden. The median number of symptoms experienced was 21 (Interquartile Range (IQR); 18−23) and 19 (IQR; 13−22) at baseline and 6 months, respectively. Having elevated stress (β = 0.65, p ≤ 0.005) and illness perception (β = 0.21, p = 0.02) were significantly predicted symptom burden at baseline (F (4, 112) = 55.29, p < 0.005, R2 = 0.664). Stress (β = 0.28, p = 0.003), illness perception (β = 0.2, p = 0.03), poor social support (β = −0.22, p = 0.01) and low body weight (β = −0.19, p = 0.03) were the determinants for symptom burden at 6 months (F (5, 93) = 4.85, p ≤ 0.005, R2 = 0.24). Elevated stress, illness perception level, poor social support and low post-dialysis body weight were found to be determinants for symptom burden. Attention should be given to psychosocial factors of hemodialysis patients while conducting assessment and delivering care to patients.

Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review

Increasing prevalence of endemic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is a major health problem since the 1990s. Despite numerous studies on CKDu, research groups have been unable to develop a comprehensive approach to mitigate the disorder, and thereby to identify research gaps. We conducted a systematic literature review of 119 publications on CKDu in Sri Lanka from Pubmed, Google Scholar, and Scopus, published until end September 2020. A higher CKDu prevalence in the working population of the North Central Province was reported with recent studies indicating patients from non-endemic regions as well. A majority were etiological studies that recorded conflicting and inconclusive evidence on CKDu etiology. Studies on clinico-pathological, diagnostic, biochemical, and molecular biological aspects of CKDu, studies analyzing CKDu symptom burden, anthropological, and behavioral impacts of CKDu, were reviewed as well. A dearth of research exists on nutritional, demographical, immunological, and microbial aspects of CKDu. The overview of the reviewed literature indicated the absence of a comprehensive plan of action to mitigate this situation. Hence, we propose the "One Health" approach with a systems dynamics model as a potential way forward to alleviate the CKDu epidemic in Sri Lanka. This enables the representation of multiple causative agents (and interactions thereof) among environmental, animal, and human systems, in concert with the "exposome" that provides the totality of exposure the individual has undergone since birth.

Alterations in symptoms and health-related quality of life as kidney function deteriorates: A cross-sectional study

AIMS AND OBJECTIVES

To compare symptoms and health-related quality of life and to examine the relationship between these as kidney function deteriorates.

BACKGROUND

Chronic kidney disease is a global health problem, and while knowledge of symptom burden and health-related quality of life is understood in kidney failure (previously end-stage kidney disease), there is limited understanding about symptoms and health-related quality of life across the chronic kidney disease trajectory.

DESIGN

Cross-sectional design reported using the STROBE guidelines.

METHODS

Eight hundred eighty-six adults with varying levels of kidney function (chronic kidney disease grades 3b-5 including those receiving dialysis) completed the renal version of the Integrated Palliative care Outcome Scale and the Quality of Life Short Form-36 version 2. Socio-demographic and renal characteristics were also collected. Data were analysed using descriptive and inferential statistics.

RESULTS

Participants had a mean age of 57 years and were mostly male. Regardless of chronic kidney disease grade, pain, poor mobility, weakness, anxiety and depression were the most prevalent and severe symptoms reported. Health-related quality of life was significantly associated with physical and psychological symptom scores. As kidney function deteriorated, both physical and mental health-related quality of life decreased, and prevalence and severity of symptoms increased.

CONCLUSIONS

There is substantial symptom burden irrespective of chronic kidney disease grade, which overwhelmingly affects health-related quality of life. Early identification by nurses would enable proactive management plans to be implemented.

RELEVANCE TO CLINICAL PRACTICE

Nurses, whether in specialist renal services or in primary healthcare, are ideally placed to regularly assess symptoms and health-related quality of life in those with chronic kidney disease. Timely assessment could assist in the targeting of earlier interventions designed to reduce symptom burden and to increase health-related quality of life.

Progression of potential etiologies of the chronic kidney disease of unknown etiology in Sri Lanka

Chronic kidney disease of unknown etiology (CKDu) is a major health issue in agricultural areas in Sri Lanka. Despite many attempts to identifying causative factors of CKDu, the real cause/s remain/s elusive to date. Understanding the progression of potential etiologies may provide valuable insight into this quest. Literature relevant to CKDu addresses several etiologies, including quality of drinking water in the affected areas including hardness, fluoride, ionicity, agrochemical and heavy metal contaminations, consumption of contaminated food, and the genetic makeup of vulnerable populations. Progression of the etiologies revealed persistent interest in heavy metals of multiple origins: waterborne, foodborne, or soilborne. Secondary factors, such as water hardness, fluoride, and ionicity appear to act synergistically, aggravating the role of heavy metals on the onset, and the progression of CKDu. Demographical factors, such as male sex, over 50 years of age, agriculture-related occupation, and the consumption of contaminated water and food are intricately related with the disease progression while other minor risk factors such as smoking, alcohol consumption, etc. exasperate the disease condition. Since, none of these etiologies are examined adequately, conducting laboratory exposure studies under in-vivo and in-vitro settings to understand their role in CKDu is crucial.

Associations of Socio-Demographic, Clinical and Biochemical Parameters with Healthcare Cost, Health- and Renal-Related Quality of Life in Hemodialysis Patients: A Clinical Observational Study

We examined factors associated with healthcare cost, health-related quality of life (HRQOL), and kidney disease quality of life (KDQOL) in hemodialysis patients. We conducted a cross-sectional study on 160 patients from January to April 2019 at a hemodialysis center. Socio-demographic, clinical, and laboratory parameters and quality of life (QOL) (using KDQOL-SF-v1.3) were assessed. Monthly healthcare costs were extracted from the hospital information system. The means of healthcare cost, HRQOL, and KDQOL were VND 9.4 ± 1.6 million, VND 45.1 ± 21.9 and VND 51.3 ± 13.0, respectively. In the multivariate analysis, the healthcare cost was higher in patients with a longer hemodialysis vintage (regression coefficient (B): 0.74; 95% confidence interval (95% CI): 0.25; 1.23), comorbidity (B: 0.77; 95% CI: 0.24; 1.31); and lower in those with a higher hematocrit concentration (B: −0.07; 95% CI: −0.13; −0.01). Patients that lived in urban areas (B: 9.08; 95% CI: 2.30; 15.85) had a better HRQOL; those with a comorbidity (B: −14.20; 95% CI: −21.43; −6.97), and with hypoalbuminemia (B: −9.31; 95% CI: −16.58; −2.04) had a poorer HRQOL. Patients with a higher level of education (B: 5.38~6.29) had a better KDQOL; those with a comorbidity had a poorer KDQOL (B: −6.17; 95% CI: −10.49; −1.85). In conclusion, a longer hemodialysis vintage, a comorbidity and a lower hematocrit concentration were associated with higher healthcare costs. Patients who lived in urban areas had a better HRQOL and a higher level of education led to a better KDQOL. Patients with a comorbidity had a lower HRQOL and KDQOL. Malnourished patients had a lower HRQOL.