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Liu S, Shen Y, Nie M, Fang C, Dai H, Yao M, Zhou X. The status and influencing factors of fatigue in kidney transplant recipients based on the theory of unpleasant symptoms: A cross-sectional study in China. Int J Nurs Pract 2024:e13256. [PMID: 38570821 DOI: 10.1111/ijn.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 10/13/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
AIMS This study describes the incidence of fatigue in kidney transplant recipients and analyses the relationship between physiological factors, psychological factors, situational factors and fatigue in kidney transplant recipients. BACKGROUND Fatigue, as a common symptom after kidney transplantation, is affected by many factors, but the influence of some factors on the fatigue of kidney transplant recipients is still controversial. DESIGN This cross-sectional study was designed based on the theory of unpleasant symptoms. METHODS Our survey involved 307 participants attending the kidney transplant outpatient clinic of a tertiary Class A hospital (Changsha, Hunan, China). Data were collected between February and April 2021 using a structured questionnaire and electronic medical records. Data were analysed using IBM SPSS 25.0 (SPSS Inc.) RESULTS: It was found that the incidence of fatigue in kidney transplant recipients was 53.1%. According to the binary logistic regression analysis, sleep quality, hypokalemia, anxiety, depression and education level were independent risk factors for fatigue in kidney transplant recipients. CONCLUSION The incidence of fatigue in kidney transplant recipients was high and was influenced by physical, psychological and situational factors. Clinical nurses should assess fatigue levels in a timely and multidimensional manner in clinical practice and provide effective and scientific guidance about fatigue self-coping and symptom management for kidney transplant recipients.
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Affiliation(s)
- Sai Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuehan Shen
- Department of Clinical Laboratory, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Manhua Nie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chunhua Fang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Helong Dai
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
- Clinical Immunology Center, Central South University, Changsha, China
| | - Ming Yao
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xihong Zhou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
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Sands I, Picariello F, Maple H, Chilcot J. Psychosocial and Clinical Associations of Fatigue Severity and Fatigue-Related Impairment in Kidney Transplant Recipients. Behav Med 2024; 50:153-163. [PMID: 36803685 DOI: 10.1080/08964289.2022.2159311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023]
Abstract
Debilitating fatigue is common in people living with kidney disease and often persists after a kidney transplant. Current understanding of fatigue is centered around pathophysiological processes. Little is known about the role of cognitive and behavioral factors. The aim of this study was to evaluate the contribution of these factors to fatigue among kidney transplant recipients (KTRs). A cross-sectional study of 174 adult KTRs who completed online measures of fatigue, distress, illness perceptions, and cognitive and behavioral responses to fatigue. Sociodemographic and illness-related information was also collected. 63.2% of KTRs experienced clinically significant fatigue. Sociodemographic and clinical factors explained 16.1% and 31.2% of the variance in the fatigue severity and fatigue impairment, respectively, increasing by 28% and 26.8% after adding distress. In adjusted models, all the cognitive and behavioral factors except for illness perceptions were positively associated with increased fatigue-related impairment, but not severity. Embarrassment avoidance emerged as a key cognition. In conclusion, fatigue is common following kidney transplantation and associated with distress and cognitive and behavioral responses to symptoms, particularly embarrassment avoidance. Given the commonality and impact of fatigue in KTRs, treatment is a clinical need. Psychological interventions targeting distress and specific beliefs and behaviors related to fatigue may be beneficial.
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Affiliation(s)
- Imogen Sands
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Maple
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Annema C, Bültmann U, Kema IP, Navis GJ, Berger SP, Bakker SJL. Sleep quality, fatigue, societal participation and health-related quality of life in kidney transplant recipients: a cross-sectional and longitudinal cohort study. Nephrol Dial Transplant 2023; 39:74-83. [PMID: 37418245 PMCID: PMC10730797 DOI: 10.1093/ndt/gfad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Fatigue and impaired health-related quality of life (HRQoL) are common among kidney transplant recipients (KTR). We hypothesized that both may partially be attributable to poor sleep. METHODS Cross-sectional and longitudinal data of KTR enrolled in the TransplantLines Biobank and Cohort Study were used. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire. Individual strength (i.e. a composite of fatigue, concentration, motivation and physical activity), societal participation and HRQoL were assessed using validated questionnaires. RESULTS We included 872 KTR (39% female, age 56 ± 13 years) and 335 healthy controls. In total, 33% of male KTR and 49% of female KTR reported poor sleep quality, which was higher compared with male and female healthy controls (19% and 28%, respectively, P < .001 for both). In logistic regression analyses, female sex, anxiety, active smoking, low protein intake, physically inactive lifestyle, low plasma magnesium concentration, using calcineurin inhibitors, not using mTOR inhibitors and using benzodiazepine agonists were associated with poor sleep quality. In adjusted linear regression analyses, poor sleep was strongly and independently associated with lower individual strength [standardized β (st.β) = 0.59, 95% confidence interval (CI) 0.45 to 0.74, P < .001], poorer societal participation (frequency: st.β = -0.17, 95% CI -0.32 to -0.01, P = .04; restrictions: st.β = -0.36, 95% CI -0.51 to -0.21, P < .001; satisfaction: st.β = -0.44, 95% CI -0.59 to -0.28, P < .001) and lower HRQoL (physical: st.β = -0.53, 95% CI -0.68 to -0.38, P < .001; mental: st.β = -0.64, 95% CI -0.78 to -0.50, P < .001). The associations with poorer societal participation and lower HRQoL were strongly mediated by individual strength (P < .001 for all), yet the suggested direct effects of poor sleep quality on HRQoL remained significant (Pphysical = .03, Pmental = .002). Longitudinal data of 292 KTR showed that sleep quality improves after kidney transplantation in males (P < .001), but not in females (P = .9). CONCLUSIONS Poor sleep quality is common among KTR, and may be a potential target to improve fatigue, societal participation and HRQoL among KTR.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Post A, Garcia E, Shalaurova I, Matyus SP, González-Delgado JM, Doorenbos CSE, van der Veen Y, Shah SH, Kraus WE, Kremer D, Knobbe TJ, Bakker SJL, Dullaart RPF, Connelly MA. Creatine and creatinine quantified using nuclear magnetic resonance: A method validation study and clinical associations between circulating creatine and fatigue in kidney transplant recipients. Clin Chim Acta 2023; 548:117517. [PMID: 37591418 DOI: 10.1016/j.cca.2023.117517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND A potential contributor to fatigue in kidney transplant recipients (KTR) may be impaired creatine homeostasis. We developed and validated a high-throughput NMR assay allowing for simultaneous measurement of circulating creatine and creatinine, and determined plasma creatine and estimated intramuscular creatine concentrations in KTRs, delineated their determinants and explored their associations with self-reported fatigue. METHODS An NMR assay was developed and validated for measurement of circulating creatinine and creatine concentrations. Plasma creatine and creatinine concentrations were measured in 618 KTR. Fatigue was assessed using the checklist individual strength. Associations of creatine parameters with fatigue was assessed using linear mixed effect models. RESULTS The NMR-based assay had good sensitivity, precision and demonstrated linearity across a large range of values. Among KTR, the mean age was 56 ± 13 years, 62% were men and eGFR was 54 ± 18 ml/min/1.73 m2. Plasma creatine concentration was 27 [19-39] µmol/L. Estimated intramuscular creatine concentration was 27 ± 7 mmol/kg. Higher plasma creatine concentration and higher estimated intramuscular creatine concentration were independently associated with a lower total fatigue score and less motivation problems. CONCLUSION An NMR method for measurement of circulating creatine and creatinine which offers the potential for accurate and efficient quantification was developed. The found associations suggest that improving creatine status may play a beneficial role in mitigating fatigue.
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Affiliation(s)
- Adrian Post
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, the Netherlands.
| | | | | | | | | | - Caecilia S E Doorenbos
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, the Netherlands.
| | - Yvonne van der Veen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, the Netherlands.
| | - Svati H Shah
- Division of Cardiology, Department of Medicine and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27710, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27710, USA.
| | - William E Kraus
- Division of Cardiology, Department of Medicine and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Daan Kremer
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, the Netherlands.
| | - Tim J Knobbe
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, the Netherlands.
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, the Netherlands.
| | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, the Netherlands.
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Worsley ML, Pai A, Gregg LP. Measurement of Fatigue in Patients Receiving Kidney Replacement Therapy. Am J Kidney Dis 2023; 82:7-10. [PMID: 37178092 DOI: 10.1053/j.ajkd.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Melandrea L Worsley
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
| | - Akshta Pai
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; Renal Section, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - L Parker Gregg
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; Research Service Line, Michael E. DeBakey VA Medical Center, Houston, Texas; Veterans Affairs Health Services Research & Development Center for Innovation in Quality, Effectiveness and Safety, Houston, Texas.
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Abstract
Sickness symptoms (depressive symptoms, anxiety, and fatigue) are common among people with chronic illness, often presenting as a symptom cluster. Sickness symptoms persist in many patients with chronic kidney disease, even after kidney transplantation (KT); however, little is known about sickness symptom-induced burden in KT recipients. This scoping review synthesizes available evidence for sickness symptoms in KT recipients, including findings on symptom prevalence, predictors, outcomes, interrelationships, and clustering. Among 38 reviewed studies, none identified sickness symptoms as a cluster, but we observed interrelationships among the symptoms examined. Fatigue was the most prevalent sickness symptom, followed by anxiety and depressive symptoms. Predictors of these symptoms included demographic, clinical, and psychosocial factors, and health-related quality of life was the most researched outcome. Future research should use common data elements to phenotype sickness symptoms, include biological markers, and employ sophisticated statistical methods to identify potential clustering of sickness symptoms in KT recipients.
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Affiliation(s)
- Choa Sung
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - Mark B. Lockwood
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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7
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Knobbe TJ, Kremer D, Douwes RM, Eisenga MF, Gomes-Neto AW, Annema C, Swarte JC, Klont F, Navis G, Berger SP, Bakker SJL, Bodewes FAJA, de Boer MT, Damman K, de Borst MH, Diepstra A, Dijkstra G, Doorenbos CSE, Erasmus ME, Gan CT, Hak E, Hepkema BG, Leuvenink HGD, Lexmond WS, de Meijer VE, Niesters HGM, Pelt LJV, Pol RA, Porte RJ, Ranchor AV, Sanders JSF, Siebelink MJ, Slart RJHJA, Touw DJ, van den Heuvel MC, van Leer-Buter C, van Londen M, Verschuuren EAM, Vos MJ, Weersma RK. Proton Pump Inhibitor Use, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients: Results From the TransplantLines Biobank and Cohort Study. Am J Kidney Dis 2023:S0272-6386(23)00532-2. [PMID: 36801431 DOI: 10.1053/j.ajkd.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/21/2022] [Indexed: 02/19/2023]
Abstract
RATIONALE & OBJECTIVE Prior studies report that the use of proton pump inhibitors (PPIs) can adversely affect gut microbiota and gastrointestinal uptake of micronutrients, in particular iron and magnesium, and are used frequently by kidney transplant recipients. Altered gut microbiota, iron deficiency, and magnesium deficiency have been implicated in the pathogenesis of chronic fatigue. Therefore, we hypothesized that PPI use may be an important and underappreciated cause of fatigue and reduced health-related quality of life (HRQoL) in this population. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Kidney transplant recipients (≥1 year after transplantation) enrolled in the TransplantLines Biobank and Cohort Study. EXPOSURE PPI use, PPI type, PPI dosage, and duration of PPI use. OUTCOME Fatigue and HRQoL, assessed using the validated Checklist Individual Strength 20 Revised questionnaire and Short Form-36 questionnaire. ANALYTICAL APPROACH Logistic and linear regression. RESULTS We included 937 kidney transplant recipients (mean age 56±13 years, 39% female) at a median of 3 (1-10) years after transplantation. PPI use was associated with fatigue severity (regression coefficient 4.02, 95% CI, 2.18 to 5.85, P<0.001), a higher risk of severe fatigue (OR 2.05, 95% CI, 1.48 to 2.84, P<0.001), lower physical HRQoL (regression coefficient-8.54, 95% CI, -11.54 to-5.54, P<0.001), and lower mental HRQoL (regression coefficient-4.66, 95% CI, -7.15 to-2.17, P<0.001). These associations were independent of potential confounders including age, time since transplantation, history of upper gastrointestinal disease, antiplatelet therapy, and the total number of medications. They were present among all individually assessed PPI types and were dose dependent. Duration of PPI exposure was only associated with fatigue severity. LIMITATIONS Residual confounding and inability to assess causal relationships. CONCLUSIONS PPI use is independently associated with fatigue and lower HRQoL among kidney transplant recipients. PPI use might be an easily accessible target for alleviating fatigue and improving HRQoL among kidney transplant recipients. Further studies examining the effect of PPI exposure in this population are warranted.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen.
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Rianne M Douwes
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Research, University Medical Center Groningen
| | - J Casper Swarte
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Frank Klont
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen; Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
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Zhang P, Liu XL, Li X, Yang JH, Zhang RM. Association Between the Fatigue and Sleep Quality of Kidney Transplant Recipients: The Mediating Role of Rumination. J Nerv Ment Dis 2023; 211:23-28. [PMID: 35926188 DOI: 10.1097/nmd.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT Sleep disorders persist in renal transplant patients. Previous studies have showed that fatigue and rumination are an important determinant of sleep quality. However, very few studies have explored the mediating role of rumination in the relationship between fatigue and sleep quality in kidney transplant recipients. A descriptive cross-sectional research design was implemented, and 192 kidney transplant patients completed the short questionnaire about their recent experiences of fatigue, rumination, and sleep quality. The prevalence of sleep disorders among kidney transplant recipients was 19.3%. With rumination as a partial mediator, fatigue indirectly affected the patients' sleep quality. This indirect effect was 0.10 (95% confidence interval, 0.154-0.419). Our results indicate that the incidence of sleep disorders after renal transplantation was high, and the more tired kidney transplant recipients become, the more likely they are to ruminate, which leads to a decline in sleep quality.
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Affiliation(s)
- Ping Zhang
- Department of Transplantation, Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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9
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Knobbe TJ, Kremer D, Abma FI, Annema C, Berger SP, Navis GJ, van der Mei SF, Bültmann U, Visser A, Bakker SJ. Employment Status and Work Functioning among Kidney Transplant Recipients. Clin J Am Soc Nephrol 2022; 17:1506-1514. [PMID: 36162849 PMCID: PMC9528259 DOI: 10.2215/cjn.05560522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/18/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES To date, employment figures of kidney transplant recipients in Europe are inconsistent. Additionally, little is known about work functioning of employed kidney transplant recipients and work functioning trajectories before and after transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the ongoing TransplantLines Biobank and Cohort study and from community-dwelling employed adults were used. Health-related work functioning of kidney transplant recipients was assessed with the Work Role Functioning Questionnaire 2.0 and compared with potential kidney donors and community-dwelling employed adults. RESULTS We included 668 kidney transplant recipients of working age (59% men, age 51±11 years) at median 3 (interquartile range, 2-10) years after transplantation, 246 potential kidney donors of working age (43% men, age 53±9 years), and 553 community-dwelling employed adults (70% men, age 45±11 years). The proportion of employed kidney transplant recipients was lower compared with potential kidney donors (56% versus 79%). If employed, the work functioning score of kidney transplant recipients was slightly lower compared with employed potential kidney donors yet higher compared with community-dwelling employed adults (medians 91 [interquartile range, 76-98], 94 [interquartile range, 85-99], and 88 [interquartile range, 79-95], respectively). Backward linear regression analyses revealed that lower educational level, having a kidney from a deceased donor, presence of tingling or numbness of hands or feet, presence of concentration/memory problems, presence of anxiety, and presence of severe fatigue were independently associated with lower work functioning among kidney transplant recipients. Additional subgroup analyses showed that work functioning scores were lower before transplantation than at 12 months after transplantation (83 [interquartile range, 66-93] versus 92 [interquartile range, 88-98], respectively; P=0.002). CONCLUSIONS Stable employed kidney transplant recipients report to function well at work. In addition, this study shows that self-reported work functioning is higher after successful kidney transplantation compared with before transplantation. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER TransplantLines Biobank and Cohort study, NCT03272841 PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_09_26_CJN05560522.mp3.
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Affiliation(s)
- Tim J. Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Femke I. Abma
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J. Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijrike F. van der Mei
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annemieke Visser
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- University Medical Center Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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10
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Han Y, Kong Y, Peng S, Wang X. Effect of attribution training on early postoperative depression of kidney transplant recipients. Curr Psychol 2022. [DOI: 10.1007/s12144-020-00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Gomes-Neto AW, Douwes RM, Gan CT, Corpeleijn E, Annema C, Navis G, Berger SP, Bakker SJ. Airflow Limitation, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2021; 16:1686-1694. [PMID: 34750161 PMCID: PMC8729428 DOI: 10.2215/cjn.06600521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Many kidney transplant recipients suffer from fatigue and poor health-related quality of life. Airflow limitation may be an underappreciated comorbidity among kidney transplant recipients, which could contribute to fatigue and lower health-related quality of life in this population. In this study, we compared the prevalence of airflow limitation between kidney transplant recipients and healthy controls and investigated associations of airflow limitation with fatigue and health-related quality of life in kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the ongoing TransplantLines Biobank and Cohort study were used. Airflow limitation was defined as forced exhaled volume in 1 second less than the fifth percentile of the general population. Fatigue and health-related quality of life were assessed using checklist individual strength 20 revised (CIS20-R) and Short Form-36 (SF-36) questionnaires. RESULTS A total of 539 kidney transplant recipients (58% men; mean age 56±13 years) and 244 healthy controls (45% men; mean age 57±10 years) were included. Prevalence of airflow limitation was higher in kidney transplant recipients than in healthy controls (133 [25%] versus 25 [10%]). In multinomial regression models, airflow limitation was independently associated with fatigue severity (odds ratio moderate fatigue, 1.68; 95% confidence interval, 0.92 to 3.09 and odds ratio severe fatigue, 2.51; 95% confidence interval, 1.39 to 4.55; P=0.007) and lower physical health-related quality of life (-0.11 SDs; 95% confidence interval, -0.19 to -0.02; P=0.01) in kidney transplant recipients. In exploratory mediation analyses, fatigue accounted for 79% of the association of airflow limitation with physical health-related quality of life. CONCLUSIONS Airflow limitation is common among kidney transplant recipients. Its occurrence is associated with more than two times higher risk of severe fatigue, and it is associated with lower physical health-related quality of life. Mediation analyses suggest that airflow limitation causes fatigue, which in turn, decreases physical health-related quality of life. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER TransplantLines: The Transplantation Biobank, NCT03272841 PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN06600521.mp3.
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Affiliation(s)
- Tim J. Knobbe
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F. Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - António W. Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rianne M. Douwes
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C. Tji Gan
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Ponticelli C, Favi E. Physical Inactivity: A Modifiable Risk Factor for Morbidity and Mortality in Kidney Transplantation. J Pers Med 2021; 11:927. [PMID: 34575704 PMCID: PMC8470604 DOI: 10.3390/jpm11090927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
In patients with chronic kidney disease, sedentary behavior is widely recognized as a significant risk factor for cardiovascular disease, diabetes, obesity, osteoporosis, cancer, and depression. Nevertheless, the real impact of physical inactivity on the health of kidney transplant (KT) recipients remains uncertain. Over the last decade, there has been a renewed interest in exploring the effects of regular physical exercise on transplant-related outcomes. There is now mounting evidence that physical activity may reduce the burden of cardiovascular risk factors, preserve allograft function, minimize immunosuppression requirement, and ameliorate the quality of life of KT recipients. Many positive feedbacks can be detected in the early stages of the interventions and with a minimal exercise load. Despite these encouraging results, the perceived role of physical activity in the management of KT candidates and recipients is often underrated. The majority of trials on exercise training are small, relatively short, and focused on surrogate outcomes. While waiting for larger studies with longer follow-up, these statistical limitations should not discourage patients and doctors from initiating exercise and progressively increasing intensity and duration. This narrative review summarizes current knowledge about the deleterious effects of physical inactivity after KT. The benefits of regular physical exercise are also outlined.
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Affiliation(s)
| | - Evaldo Favi
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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13
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Shahabeddin Parizi A, Vermeulen KM, Gomes-Neto AW, van der Bij W, Blokzijl H, Buskens E, Bakker SJ, Krabbe PF. Using a novel concept to measure outcomes in solid organ recipients provided promising results. J Clin Epidemiol 2021; 139:96-106. [PMID: 34273526 DOI: 10.1016/j.jclinepi.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/18/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Efforts to evaluate the health of solid organ transplant recipients are hampered by the lack of adequate patient-reported outcome measures (PROMs) targeting this group. We developed the Transplant ePROM (TXP), which is based on a novel measurement model and administered through a mobile application to fill this gap. The main objective of this article is to elucidate how we derived the weights for different items, and to report initial empirical results. STUDY DESIGN AND SETTING The nine health items in the TXP were fatigue, skin, worry, self-reliance, activities, weight, sexuality, stooling, and memory. Via an online survey solid organ recipient participating in the TransplantLines Biobank and Cohort study (NCT03272841) were asked to describe and then compare their own health state with six other health states. Coefficients for item levels were obtained using a conditional logit model. RESULTS A total of 232 solid organ transplant recipients (mean age: 54 years) participated. The majority (106) were kidney recipients, followed by lung, liver, and heart recipients. Fatigue was the most frequent complaint (54%). The strongest negative coefficients were found for activities and worry, followed by self-reliance and memory. CONCLUSION A set of coefficients and values were developed for TXP. The TXP score approximated an optimal health state for the majority of respondents and recipients of different organs reported comparable health states.
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14
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Bossola M, Arena M, Urciuolo F, Antocicco M, Pepe G, Calabrò GE, Cianfrocca C, Stasio ED. Fatigue in Kidney Transplantation: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:833. [PMID: 34063041 DOI: 10.3390/diagnostics11050833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
Fatigue is still present in up to 40–50% of kidney transplant recipients (KTR), the results of studies comparing the prevalence among patients on hemodialysis (HD) and KTR led to conflicting results. Fatigue correlates include inflammation, symptoms of depression, sleep disorders and obesity. Fatigue in KTR leads to significant functional impairment, it is common among KTR poorly adherent to immunosuppressive therapy and is associated with a serious deterioration of quality of life. The following databases were searched for relevant studies up to November 2020: Medline, PubMed, Web of Science and the Cochrane Library. Several studies have compared the prevalence and severity of fatigue between KTR and hemodialysis or healthy patients. They have shown that fatigue determines a significant functional deterioration with less chance of having a paid job and a significant change in quality of life. The aim of the review is to report methods to assess fatigue and its prevalence in KTR patients, compared to HD subjects and define the effects of fatigue on health status and daily life. There is no evidence of studies on the treatment of this symptom in KTR. Efforts to identify and treat fatigue should be a priority to improve the quality of life of KTR.
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15
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Liu M, Sun Q, Cui L, Liu J, Liu L, Wu X, Wang Z, Zhou X, Xie J, Cheng AS. Fear of Movement and Physical Self-Efficacy Partially Mediate the Association Between Fatigue and Physical Activity Among Kidney Transplant Recipients. Clin Nurs Res 2021; 30:950-959. [PMID: 33511857 DOI: 10.1177/1054773821990263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is one of the most distressing symptoms in renal transplant patients, causing functional impairment and worsening their quality of life. However, the mechanism by which fatigue affects physical activity is unclear. A cross-sectional study using a convenient sampling approach was utilized to investigate 665 kidney transplant recipients recruited from the transplantation centers of six general hospitals from July and September 2019. Structural equation modeling was used to examine the interaction among fatigue, fear of movement, physical self-efficacy, and physical activity. Our study found fatigue was directly negatively associated with physical activity and had an indirect impact on physical activity through the mediating effects of physical self-efficacy and fear of movement. These variables accounted for 44.4% of the variation in physical activity. Our findings alert healthcare providers for the importance of fatigue management for physical activity and focused attention on fear of movement and physical self-efficacy in renal transplant recipients.
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Affiliation(s)
- Min Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qian Sun
- Xiangya Nursing School, Central South University, Changsha, China
| | - Lina Cui
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jia Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lifang Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxia Wu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhimin Wang
- Nursing Department of the Second Affiliated Hospital, Nanhua University, Hengyang, China
| | - Xin Zhou
- Transplantation Center of Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jianfei Xie
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, China
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16
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Senthil Kumar TG, Soundararajan P, Maiya AG, Ravi A. Effects of graded exercise training on functional capacity, muscle strength, and fatigue after renal transplantation: a randomized controlled trial. Saudi J Kidney Dis Transpl 2021; 31:100-108. [PMID: 32129202 DOI: 10.4103/1319-2442.279929] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Successful renal transplantation (RT) recipients suffer residual muscle weakness, fatigue, and low functional capacity. A safe, feasible, structured, early graded exercise training to improve functional capacity, muscle strength, and fatigue is the need of the hour. The aim of the study is to assess the effectiveness of graded exercise training on the functional capacity, muscle strength, and fatigue after RT. It is a randomized controlled trial conducted at a tertiary care hospital from January 2012 to December 2016. This trial included 104 consented, stable renal transplant recipients without cardiopulmonary/neuromuscular impairment. They received either routine care (51) or graded exercise training (53) for 12 weeks after randomization. The functional capacity, isometric quadriceps muscle strength, and fatigue score were measured at baseline, six, and 12 weeks later to induction. The outcomes of the study and control groups were analyzed using the /-test, Wilcoxon signed-rank test, ANOVA, and Pearson's correlation. For all analyses, P <0.05 was fixed acceptable. The functional capacity improved by 147 and 255 m, the muscle strength by 6.35 and 9.27 kg, and fatigue score by 0.784 and 1.781 in the control and the study group (SG), respectively, significantly more in the SG. Functional capacity had a positive and negative correlation with muscle strength and fatigue, respectively (P <0.05). The graded exercise training significantly improved the functional capacity, fatigue levels, and muscle strength after RT.
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Affiliation(s)
- Thillai Govindarajan Senthil Kumar
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | | | - Arun G Maiya
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Annamalai Ravi
- Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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17
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Neto AWG, Boslooper-Meulenbelt K, Geelink M, van Vliet IMY, Post A, Joustra ML, Knoop H, Berger SP, Navis GJ, Bakker SJL. Protein Intake, Fatigue and Quality of Life in Stable Outpatient Kidney Transplant Recipients. Nutrients 2020; 12:E2451. [PMID: 32824065 DOI: 10.3390/nu12082451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
Fatigue is a frequent complaint in kidney transplant recipients (KTR), often accompanied by poor quality of life (QoL). The role of nutrition as determinant of fatigue in KTR is largely unexplored. The aims of this study are to examine the association of protein intake with fatigue and QoL in KTR and to identify other determinants of fatigue. This cross-sectional study is part of the TransplantLines Cohort and Biobank Study (NCT03272841). Protein intake was calculated from urinary urea nitrogen (UUN) in 24-h urine samples. Fatigue was assessed by the Checklist Individual Strength (CIS) questionnaire; moderate and severe fatigue were defined as a CIS score of 20–34 and ≥ 35, respectively. QoL was assessed with the RAND-36-Item Health Survey (RAND-36). Associations of protein intake with fatigue and QoL were analyzed using multinomial logistic and linear regression analyses. We included 730 stable outpatient KTR (median age 58 year [IQR 48–65], 57% male) with a mean protein intake of 82.2 ± 21.3 g/d. Moderate and severe fatigue were present in 254 (35%) and 245 (34%) of KTR. Higher protein intake was significantly associated with lower risk of moderate fatigue (OR 0.89 per 10 g/d; 95%CI 0.83–0.98, p = 0.01), severe fatigue (OR 0.85; 95%CI 0.78–0.92, p < 0.001) and was associated with higher physical component summary score of QoL (β 0.74 per 10 g/d; 95%CI 0.39–1.09, p < 0.001). Higher BMI, a history of dialysis, glomerulonephritis as primary kidney disease and a history of combined organ transplantation were also associated with severe fatigue. In conclusion, amongst the potential modifiable factors of fatigue, higher protein intake is independently associated with lower risk of moderate and severe fatigue and with better QoL in KTR. These findings underline the need to incorporate nutritional assessment in the diagnostic work-up of fatigue. Intervention studies are needed to assess the benefits and safety of higher protein intake in KTR.
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18
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Samarehfekri A, Dehghan M, Arab M, Ebadzadeh MR. Effect of Foot Reflexology on Pain, Fatigue, and Quality of Sleep after Kidney Transplantation Surgery: A Parallel Randomized Controlled Trial. Evid Based Complement Alternat Med 2020; 2020:5095071. [PMID: 32831868 DOI: 10.1155/2020/5095071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/12/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
Materials and Methods The study was a parallel randomized controlled trial. Patients admitted to the transplantation ward participated in the study. Fifty-three eligible patients were allocated into the foot reflexology group (n = 26) and the control group (n = 27) by using the stratified randomization method. Finally, 25 participants in each group finished the study. The intervention group received foot reflexology for 30 minutes once a day for three consecutive days, and no reflexology was applied in the control group. The intervention started on the second day after surgery. Pain, fatigue, and quality of sleep were measured on the first, second (before intervention), third, fourth, and eleventh days after surgery. Data were collected using visual analogue scale for measuring pain and fatigue and Verran and Snyder-Halpern sleep scale for measuring quality of sleep. Results In each group, 25 patients finished the study. The mean pain score in the foot reflexology and control groups decreased from 9.44 ± 0.96 and 9.36 ± 0.91 on the day of surgery to 1.32 ± 0.94 and 4.32 ± 1.68 on the eleventh day after surgery, respectively. The mean fatigue score in the reflexology and control groups decreased from 8.76 ± 1.27 and 8.6 ± 1.26 on the day of surgery to 1.24 ± 1.2 and 3.92 ± 1.63 on the eleventh day after surgery, respectively. The mean sleep score in the foot reflexology and control groups increased from 33.38 ± 11.22 and 39.59 ± 12.8 on the day of surgery to 69.43 ± 12.8 and 56.27 ± 8.03 on the eleventh day after surgery, respectively. While pain, fatigue, and sleep quality scores improved in both groups, those in the intervention group showed significantly greater improvement compared with the control group (P < 0.001). No significant difference was found between the two groups in the use of acetaminophen on the first, second, third, fourth, and eleventh days after surgery (P > 0.05). Conclusion Foot reflexology may reduce pain and fatigue and improve sleep quality of patients after kidney transplantation.
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19
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Peipert JD, Caicedo JC, Friedewald JJ, Abecassis MMI, Cella D, Ladner DP, Butt Z. Trends and predictors of multidimensional health-related quality of life after living donor kidney transplantation. Qual Life Res 2020; 29:2355-2374. [PMID: 32285345 DOI: 10.1007/s11136-020-02498-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Living donor kidney transplant (LDKT) imparts the best graft and patient survival for most end-stage kidney disease (ESKD) patients. Yet, there remains variation in post-LDKT health-related quality of life (HRQOL). Improved understanding of post-LDKT HRQOL can help identify patients for interventions to maximize the benefit of LDKT. METHODS For 477 LDKT recipients transplanted between 11/2007 and 08/2016, we assessed physical, mental, social, and kidney-targeted HRQOL pre-LDKT, as well as 3 and 12 months post-operatively using the SF-36, Kidney Disease Quality of Life-Short Form (KDQOL-SF), and the Functional Assessment of Cancer Therapy-Kidney Symptom Index 19 item version (FKSI-19). We then examined trajectories of each HRQOL domain using latent growth curve models (LGCMs). We also examined associations between decline in HRQOL from 3 months to 12 months post-LDKT and death censored graft failure (DCGF) using Cox regression. RESULTS Large magnitude effects (d > 0.80) were observed from pre- to post-LDKT change on the SF-36 Vitality scale (d = 0.81) and the KDQOL-SF Burden of Kidney Disease (d = 1.05). Older age and smaller pre- to post-LDKT decreases in serum creatinine were associated with smaller improvements on many HRQOL scales across all domains in LGCMs. Higher DCGF rates were associated with worse physical [e.g., SF-36 PCSoblique hazard ratio (HR) 1.18; 95% CI 1.01-1.38], mental (KDQOL-SF Cognitive Function HR 1.27; 95% CI 1.00-1.62), and kidney-targeted (FKSI-19 HR: 1.18; 95% CI 1.00-1.38) HRQOL domains. CONCLUSION Clinical HRQOL monitoring may help identify patients who are most likely to have failing grafts and who would benefit from post-LDKT intervention.
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Affiliation(s)
- John D Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA. .,Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA.
| | - Juan Carlos Caicedo
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - John J Friedewald
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Michael M I Abecassis
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA.,Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela P Ladner
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA.,Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Zeeshan Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA.,Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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van Sandwijk MS, Al Arashi D, van de Hare FM, van der Torren JMR, Kersten MJ, Bijlsma JA, Ten Berge IJM, Bemelman FJ. Fatigue, anxiety, depression and quality of life in kidney transplant recipients, haemodialysis patients, patients with a haematological malignancy and healthy controls. Nephrol Dial Transplant 2020; 34:833-838. [PMID: 29726909 DOI: 10.1093/ndt/gfy103] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of haemodialysis (HD) and kidney transplantation on quality of life (QoL) is often underestimated due to a lack of comparative studies with other patient groups. METHODS We conducted a cross-sectional cohort study in 168 patients including HD patients, kidney transplant recipients (KTR), patients with a haematological malignancy either receiving chemotherapy or in remission and healthy controls. All participants completed the 36-item short form survey of health-related quality of life, the Checklist Individual Strength and the Hospital Anxiety and Depression Scale questionnaire. RESULTS HD patients and haematological patients undergoing chemotherapy were more frequently severely fatigued (53.3% and 50% of cases) compared with KTR (33.3%), haematological patients in remission (23.3%) and healthy controls (12.1%, P < 0.001). There were no significant differences in anxiety rates. HD patients and haematological patients undergoing chemotherapy were most likely to be depressed (33.3% and 25%), compared with 16.7% of KTR, 20% of haematological patients in remission and 8.6% of healthy controls (P = 0.066). KTR reported the largest positive health change (+27%, P < 0.001), but still had a lower overall QoL than healthy controls, comparable to haematological patients in remission. HD and chemotherapy patients reported the lowest QoL scores. CONCLUSIONS Fatigue and depression are common in HD patients, resulting in a low QoL, comparable to haematological patients receiving chemotherapy. KTR do better, with scores similar to patients with a haematological malignancy in remission, but still have a lower QoL than healthy controls.
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Affiliation(s)
- Marit S van Sandwijk
- Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.,Dianet Dialysis Center, Amsterdam, The Netherlands
| | - Doaa Al Arashi
- Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands
| | - Fons M van de Hare
- Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Marie-José Kersten
- Department of Haematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joost A Bijlsma
- Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.,Dianet Dialysis Center, Amsterdam, The Netherlands
| | - Ineke J M Ten Berge
- Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands
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21
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De Pasquale C, Pistorio ML, Veroux M, Indelicato L, Biffa G, Bennardi N, Zoncheddu P, Martinelli V, Giaquinta A, Veroux P. Psychological and Psychopathological Aspects of Kidney Transplantation: A Systematic Review. Front Psychiatry 2020; 11:106. [PMID: 32194453 PMCID: PMC7066324 DOI: 10.3389/fpsyt.2020.00106] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Kidney transplantation is a serious event that involves profound psychological, relational and social changes both for the patient and his family context. Assessment of personality profile, awareness of disease, family and social support of the patient candidate for kidney transplantation are necessary because factors not adequately considered, can influence the success of the transplant and alter the psychological stability of the patient. The present study aims to provide a systematic review of the literature of the last twelve years (2006-2018), focusing in particular on patient's readiness level and illness management and on possible psychopathology. Sixty-two studies were examined. Based on the Downs and Black checklist, most studies (n = 32) were of high quality; 15 of which related to lifestyle, health education, and therapeutic adherence in post-renal transplantation, 17 studies concerned the possible existence of psychopathology and cognitive impairment of renal deceased transplanted subjects. The literature used has shown that the population of kidney transplant patients is exposed to a high risk of psychiatric disorders with repercussions on the quality of life and the risk of rejection. Therefore, an adequate pre-transplant psychosocial assessment is necessary, which allows a more in-depth knowledge of the candidate to plan coping strategies and possible post-transplant psychotherapy.
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Affiliation(s)
- Concetta De Pasquale
- Department of Educational Sciences, University of Catania, Catania, Italy.,Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy
| | - Maria Luisa Pistorio
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Luisa Indelicato
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Gabriella Biffa
- SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,Clinical Psychology and Psychotherapy Unit, San Martino Hospital-Genoa, Genoa, Italy
| | - Nunzialinda Bennardi
- SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,University Hospital, City of Health and Science, Turin, Italy
| | - Pietro Zoncheddu
- SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,Department of Mental Health, Bergamo Local Health Authority, Bergamo, Italy
| | | | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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22
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Abstract
The aim of this study was to investigate the prevalence of fatigue among lung recipients 1–5 years after transplantation (LuTx) and to explore its relationship to distressing symptoms such as dyspnea, sleep problems, pain, and decreased appetite, as well as psychological and transplant specific wellbeing. A cross-sectional, multicenter cohort study was conducted. A total of 117 lung recipients with a mean age of 54 years ( SD 13 years) who were due for their annual follow-up were included at 1 year ( n = 35), 2 years ( n = 28), 3 years ( n = 23), 4 years ( n = 20), and 5 years ( n = 11) after lung transplantation. Several instruments were used: the Multidimensional Fatigue Inventory, the Organ Transplant and Symptom Well-being Instrument (OTSWI), the Pain-O-Meter, and the Psychological General Well-Being Index. Overall 56% reported high or severe fatigue. The Psychological General Well-Being sum score makes the strongest contribution ( p < .0001) to explaining the variance in general fatigue (Beta –.628). The results of the study indicate that efforts both to identify fatigue and to test interventions are needed after LuTx.
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Affiliation(s)
- Anna Forsberg
- Institute of Health Sciences, Lund University, Sweden
- Department of Thoracic Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
| | - Annette Lennerling
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Kisch
- Institute of Health Sciences, Lund University, Sweden
- Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
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23
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Nap-van der Vlist MM, Burghard M, Hulzebos HJ, Doeleman WR, Heijerman HGM, van der Ent CK, Nijhof SL. Prevalence of severe fatigue among adults with cystic fibrosis: A single center study. J Cyst Fibros 2018; 17:368-74. [PMID: 29606526 DOI: 10.1016/j.jcf.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/13/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND With life expectancy increasing among patients with cystic fibrosis (CF), the prevalence of complications such as fatigue is also expected to increase. Our aim was to investigate the prevalence of severe fatigue among adults with CF and to identify factors associated with fatigue. METHODS Adult patients with CF receiving treatment at a single center were invited to complete three questionnaires. We then studied the associations between fatigue and clinically measured parameters and between fatigue and patient-reported outcomes. RESULTS A total of 77 patients (age 19-54years; 56% males; mean FEV1: 63%) completed the questionnaires (43% response rate). The prevalence of severe fatigue among these patients was 26%. The variance in fatigue was explained partially by clinically measured parameters. However, patient-reported outcomes were stronger independently associated with fatigue and included the patients' reported respiratory symptoms, emotional functioning, and social functioning. CONCLUSIONS Fatigue is a clinically important and highly prevalent issue among adults with CF and is associated with a significant reduction in health-related quality of life and participation in society. In addition, fatigue is associated more strongly with the patient's perception of symptoms and well-being than with clinically measured parameters.
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24
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Abstract
Low serum levels of vitamin D have been associated with fatigue in both healthy and clinical populations. Our aim was to evaluate the effect of vitamin D supplementation on fatigue in kidney transplant recipients (KTRs). In total, 137 patients after kidney transplant and 119 age- and sex-matched healthy volunteers were recruited. Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured by competitive protein-binding assay. Fatigue was assessed using the subscale fatigue of the Checklist Individual Strength (CIS). Of all KTRs, 60 patients without initial vitamin D3 supplementation were started on vitamin D3 supplementation (cholecalciferol) 800 IU/d, with a follow-up examination after 3.0 to 9.0 months (mean, 6 months). Fatigue was found in 40.1% of KTRs. Serum 25(OH)D levels were inversely and independently associated with CIS scores in KTRs (P = .002). In the 60 patients who received vitamin D3 supplementation, 25(OH)D was overall increased at follow-up with 18.5% (P = .004) and CIS scores improved with 10.0% (P = .007). As vitamin D has beneficial effects on fatigue scores in KTRs, we suggest monitoring this parameter in KTRs and supplementation with vitamin D3 when vitamin D levels are low.
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Affiliation(s)
- Bin Han
- Department of Nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing
| | - Xiao Wu
- Department of Gastrointestinal Surgery, People's Hospital of Yueqing
| | - Yong Guo
- Department of Nephrology and Transplantation, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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25
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Abrahams H, Smits L, Lugt MD, Roos WD, Kamm Y, Heins M, Verhagen C, Gielissen M, Knoop H. Severe fatigue after treatment of ductal carcinoma in situ: A comparison with age-matched breast cancer survivors and healthy controls. Breast 2017; 31:76-81. [DOI: 10.1016/j.breast.2016.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 12/13/2022] Open
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26
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Picariello F, Moss-Morris R, Macdougall IC, Chilcot AJ. The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review. Clin Kidney J 2016. [PMID: 28638608 PMCID: PMC5469558 DOI: 10.1093/ckj/sfw113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a common and debilitating symptom, affecting 42-89% of end-stage kidney disease patients, persisting even in pre-dialysis care and stable kidney transplantation, with huge repercussions on functioning, quality of life and patient outcomes. This paper presents a critical review of current evidence for the role of psychological factors in renal fatigue. To date, research has concentrated primarily on the contribution of depression, anxiety and subjective sleep quality to the experience of fatigue. These factors display consistent and strong associations with fatigue, above and beyond the role of demographic and clinical factors. Considerably less research is available on other psychological factors, such as social support, stress, self-efficacy, illness and fatigue-specific beliefs and behaviours, and among transplant recipients and patients in pre-dialysis care. Promising evidence is available on the contribution of illness beliefs and behaviours to the experience of fatigue and there is some indication that these factors may vary according to treatment modality, reflecting the differential burdens and coping necessities associated with each treatment modality. However, the use of generic fatigue scales casts doubt on what specifically is being measured among dialysis patients, illness-related fatigue or post-dialysis-specific fatigue. Therefore, it is important to corroborate the available evidence and further explore, qualitatively and quantitatively, the differences in fatigues and fatigue-specific beliefs and behaviours according to renal replacement therapy, to ensure that any model and subsequent intervention is relevant and grounded in the experiences of patients.
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Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | | | - And Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
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27
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Service; Department of Surgery; Catholic University of the Sacred Heart; Rome Italy
| | - Gilda Pepe
- Department of Emergency; Catholic University of the Sacred Heart; Rome Italy
| | - Carlo Vulpio
- Hemodialysis Service; Department of Surgery; Catholic University of the Sacred Heart; Rome Italy
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28
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Schipper K, van der Borg WE, de Jong-Camerik J, Abma TA. Living with moderate to severe renal failure from the perspective of patients. BMC Nephrol 2016; 17:48. [PMID: 27184894 PMCID: PMC4867508 DOI: 10.1186/s12882-016-0263-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/10/2016] [Indexed: 01/20/2023] Open
Abstract
Background Within healthcare, almost no attention is given to patients with moderate-to- severe chronic kidney disease, having a with GFR between 20 and 45 while the presumption exists that these patients already experience several problems in their lives during the course of their illness. Methods A team of academic researchers and a renal patient participated in a qualitative study. Individual interviews (n = 31) and focus groups (10 participants in total) with patients having moderate-to-severe chronic kidney disease were conducted to gain insight into their everyday problems. Results Participants mentioned several experiences that can be divided into physical, social, societal and psychological aspects as well as aspects related to healthcare. The most important findings, following under each of these categories are: 1) the experience of fatigue (physical aspects) 2) the search for acknowledgment of complaints/not enough attention given to complaints leading to overcompensation and secrecy (societal aspects) 3) work problems (societal aspects) and 4) the wish to control the disease but not receiving enough support for this (healthcare). Patients feel in general that healthcare professionals do not take them seriously in their complaints and problems. Conclusions This study offers important new insights into an expanding group of patients having moderate-to-severe chronic kidney disease. Healthcare professionals should acknowledge their problems instead of ignoring or rejecting them and they should support patients in finding a way to deal with them. The assumptions of Personalised Care Planning could be used to support patients.
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Affiliation(s)
- K Schipper
- Department of Medical Humanities/EMGO+, VU University Medical Center, Post box 7057, 1081 BT, Amsterdam, The Netherlands.
| | - W E van der Borg
- Department of Medical Humanities/EMGO+, VU University Medical Center, Post box 7057, 1081 BT, Amsterdam, The Netherlands
| | - J de Jong-Camerik
- Department of Medical Humanities/EMGO+, VU University Medical Center, Post box 7057, 1081 BT, Amsterdam, The Netherlands
| | - T A Abma
- Department of Medical Humanities/EMGO+, VU University Medical Center, Post box 7057, 1081 BT, Amsterdam, The Netherlands
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29
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Amro A, Waldum-Grevbo B, von der Lippe N, Brekke FB, Miaskowski C, Os I. Symptom Clusters From Dialysis to Renal Transplantation: A Five-Year Longitudinal Study. J Pain Symptom Manage 2016; 51:512-9. [PMID: 26550937 DOI: 10.1016/j.jpainsymman.2015.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 12/16/2022]
Abstract
CONTEXT Patients on dialysis experience multiple concurrent and often related symptoms defined as symptom clusters. Renal transplantation (RTX) is thought to reduce symptom experience and improve health-related quality of life. No longitudinal study has assessed symptoms and symptom clusters in patients in the transition from dialysis to RTX. OBJECTIVES We aimed to assess changes in symptom prevalence, identify symptom clusters after RTX, and evaluate the effect of the treatment conversion on predefined symptom clusters. METHODS A cohort of patients on chronic dialysis (n = 110) was followed prospectively with measurements of health-related quality of life using the Kidney Disease and Quality of Life-Short Form (KDQOL-SF) during dialysis (baseline) and after subsequent RTX. Predefined symptom clusters based on 11 symptoms listed in KDQOL-SF were previously generated using principal component analysis with varimax rotation, that is, uremic (nausea, lack of appetite, dizziness, feeling squeezed out, shortness of breath, and chest pain), neuromuscular (numbness, sore muscle, and cramps), and skin (itching and dry skin) clusters. Stratified analyses were undertaken to identify characteristics associated with change in the symptom clusters after RTX. Cohen's d was used as effect size. RESULTS Of the 110 patients, mean age was 51.3 ± 14.4 years, and 66% were males. After RTX, the estimated glomerular filtration rate was 54 (interquartile range [IQR] 45-72) mL/minute/1.73 m2. Median follow-up time from assessments during dialysis was 55 (IQR 50-59) months, and follow-up time after RTX was 41 (IQR 34-51) months. The total symptom score improved (73 ± 16 vs. 82 ± 15, P = 0.001, and Cohen's d = 0.6), and the number of symptoms was reduced (6.5 ± 2.6 vs. 4.7 ± 3.0, P = 0.001). Seven symptoms improved statistically after RTX, but only two with Cohen's d > 0.5 (itching and cramps). The scores of the predefined symptom clusters improved after RTX: uremic (82 ± 16 vs. 85 ± 17, P = 0.008, and Cohen's d = 0.2), neuromuscular (66 ± 24 vs. 79 ± 18, P = 0.001, and Cohen's d = 0.6), and skin cluster (62 ± 27 vs. 78 ± 22, P = 0.001, and Cohen's d = 0.6). Symptom clusters could not be generated after RTX. CONCLUSION Although symptoms and symptom clusters were reduced after RTX, the clinical relevance of the reductions was ambiguous. Symptom clusters could not be generated after RTX, suggesting that use of the KDQOL-SF may not be optimal to assess symptoms in RTX patients.
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Affiliation(s)
- Amin Amro
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Bård Waldum-Grevbo
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway
| | - Nanna von der Lippe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fredrik Barth Brekke
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Ingrid Os
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway
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30
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Zelle DM, Corpeleijn E, Klaassen G, Schutte E, Navis G, Bakker SJL. Fear of Movement and Low Self-Efficacy Are Important Barriers in Physical Activity after Renal Transplantation. PLoS One 2016; 11:e0147609. [PMID: 26844883 PMCID: PMC4742485 DOI: 10.1371/journal.pone.0147609] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical activity (PA) and exercise are commonly used as preventive measures for cardiovascular disease in the general population, and could be effective in the management of post-transplantation cardiovascular risk. PA levels are low after renal transplantation and very few renal transplant recipients (RTR) meet the PA guidelines. Identification of barriers to regular PA is important to identify targets for intervention to improve PA levels after renal transplantation. We investigated fear of movement and physical self-efficacy as barriers to PA in RTR. METHODS RTR were investigated between 2001-2003. The Tampa Score of Kinesiophobia-Dutch Version (TSK-11) was used to assess fear of movement. Physical self-efficacy was measured with the LIVAS-scale. PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire). RESULTS A total of 487 RTR (age 51±12 years, 55% men) were studied. Median score [interquartile range] on TSK-11 was 22 [17-26]. Low physical self-efficacy (Exp B:0.41[0.31-0.54], p<0.001) and history of myocardial infarction, transient ischemic attack and cerebrovascular accident (Exp B:1.30[1.03-1.63],p = 0.03) were independent determinants for fear of movement. Fear of movement was associated with lower daily PA, occupational, sports and leisure time PA. Mediation-analysis showed that a large part (73%) of the effect of fear of movement on PA was explained by low physical self-efficacy. CONCLUSIONS This study was the first to examine fear of movement and self-efficacy in relation to PA in RTR. Fear of movement was associated with a low PA level, and the larger part of this relation was mediated by low physical self-efficacy. Both fear of movement and physical self-efficacy level are important targets for intervention during rehabilitation after renal transplantation.
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Affiliation(s)
- Dorien M. Zelle
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerald Klaassen
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise Schutte
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J. L. Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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31
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Chan W, Jones D, Bosch JA, McPhee J, Crabtree N, McTernan PG, Kaur O, Inston N, Moore S, McClean A, Harper L, Phillips AC, Borrows R. Cardiovascular, muscular and perceptual contributions to physical fatigue in prevalent kidney transplant recipients. Transpl Int 2016; 29:338-51. [DOI: 10.1111/tri.12727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/18/2015] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Winnie Chan
- Department of Nephrology & Kidney Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
- School of Sport, Exercise and Rehabilitation Sciences; University of Birmingham; Birmingham UK
- Department of Nutrition & Dietetics; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - David Jones
- School of Healthcare Science; Manchester Metropolitan University; Manchester UK
| | - Jos A. Bosch
- School of Sport, Exercise and Rehabilitation Sciences; University of Birmingham; Birmingham UK
- Department of Clinical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | - Jamie McPhee
- School of Healthcare Science; Manchester Metropolitan University; Manchester UK
| | - Nicola Crabtree
- Department of Nuclear Medicine; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Philip G. McTernan
- Division of Metabolic and Vascular Health; Clinical Sciences Research Institute; Warwick Medical School; University of Warwick; Coventry UK
| | - Okdeep Kaur
- Department of Nephrology & Kidney Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Nicholas Inston
- Department of Nephrology & Kidney Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Sue Moore
- Department of Nephrology & Kidney Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Andrew McClean
- Department of Nephrology & Kidney Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Lorraine Harper
- Department of Nephrology & Kidney Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Anna C. Phillips
- School of Sport, Exercise and Rehabilitation Sciences; University of Birmingham; Birmingham UK
| | - Richard Borrows
- Department of Nephrology & Kidney Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
- Translational Inflammation Research; University of Birmingham; Birmingham UK
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