Quality of life related to the health of chronic renal failure patients on dialysis/Qualidade de vida relacionada à saúde de pacientes renais crônicos em diálise

Abstract

This study aims to assess the quality of life related to the health of chronic renal failure patients on dialysis. Cross-sectional study with 101 chronic renal failure patients who had been under dialysis treatment for three months. The instruments used for research were: Instrument of Characterization of Subjects and the Kidney Disease Quality of Life-Short Form. A descriptive analysis was performed and the standard deviation was found; Cronbach's alpha was used to assess the reliability of alpha values equal to or greater than 0.60. The quality of life was proven to be compromised in the following aspects: Physical Function (30.20), Work Situation (37.13) and Physical Functioning. The best perceptions were: Cognitive Function (89.31), Social Support (88.61) and Sexual Function (84.58). Quality of life related to the health of chronic renal failure patients on dialysis was more compromised in physical aspects.

Headnote

Keywords

Renal dialysis; Nursing assessment; Chronic renal failure; Quality of life

Descritores

Diálise renal; Avaliação em enfermagem; Qualidade de vida; Insuficiência renal crônica

Submitted

December 19, 2013

Accepted

May 5, 2014

Abstract

Objective: To assess the quality of life related to the health of chronic renal failure patients on dialysis.

Methods: Cross-sectional study with 101 chronic renal failure patients who had been under dialysis treatment for three months. The instruments used for research were: Instrument of Characterization of Subjects and the Kidney Disease Quality of Life-Short Form. A descriptive analysis was performed and the standard deviation was found; Cronbach's alpha was used to assess the reliability of alpha values equal to or greater than 0.60.

Results: The quality of life was proven to be compromised in the following aspects: "Physical Function (30.20), Work Situation (37.13) and Physical Functioning". The best perceptions were: "Cognitive Function (89.31), Social Support (88.61) and Sexual Function (84.58)".

Conclusion: Quality of life related to the health of chronic renal failure patients on dialysis was more compromised in physical aspects.

Resumo

Objetivo: Avaliar a qualidade de vida relacionada a saúde de pacientes renais crônicos em diálise.

Métodos: Estudo transversal com a inclusão de 101 pacientes renais crônicos com três meses de tratamento dialítico. Os instrumentos de pesquisa foram: Instrumento de Caracterização dos Sujeitos e do Kidney Disease Quality of Life- Short Form. Foi realizada análise descritiva e desvio padrão; coeficiente Alfa de Cronbach para verificar a confiabilidade para valores de alfa iguais ou superiores a 0,60.

Resultados: A qualidade de vida mostrou-se comprometida nos domínios: "Função Física (30,20), Situação de Trabalho (37,13) e Funcionamento Físico". As melhores percepções ocorreram: "Função Cognitiva (89,31), Suporte Social (88,61) e Função Sexual (84,58)".

Conclusão: A qualidade de vida relacionada a saúde de pacientes renais crônicos em diálise apresentou maior comprometimento nos domínios físicos.

Introduction

Chronic renal failure is considered to be a public health issue, and it consists of the slow, gradual and irreversible loss of renal function, resulting in failure of the kidneys to perform their basic functions.(1,2)

The number of patients undergoing dialy- sis treatment has been growing over the years, from 42,695 cases in 2000 to 91,314 in 2011, hemodialysis being the most common form of treatment.(3)

During the treatment stage, chronic renal fail- ure patients may have their quality of life altered, as there is anxiety prior to and during treatment, loss of autonomy, difficulty of dealing with an ir- reversible and incurable disease, difficulty of going to a hospital daily or weekly, decrease in vitality levels, limitations in performing everyday activi- ties, and frequent lack of support from relatives and friends, all of which damage the patient's physical and mental health.(4)

As renal failure develops, patients can show symptoms that affect their daily life. In more ad- vanced stages, the impact on the functional state and quality of life becomes very clear. Renal re- placement therapies, such as hemodialysis, partially rectify the symptoms experienced by patients and result in additional changes to their lifestyle, which can affect quality of life.(5)

The objective of this study is to assess the quality of life related to the health of chronic renal failure patients on dialysis.

Methods

This is a cross-sectional study carried out in a spe- cialized public health service located in the State of São Paulo, in the southeastern area of Brazil.

The sample was composed of 101 chronic renal failure patients on hemodialysis, the in- clusion criteria being: 1) Aged 18 or over; 2) Diagnosed with chronic renal failure diagnosis; 3) Being in hemodialysis treatment for at least 3 months.

The research instruments were the Instru- ment of Characterization of Subjects and the Kidney Disease Quality of Life-Short Form (KD- QOL-SF). The Instrument of Characterization of Subjects is composed of questions related to identification, sociodemographic data and clini- cal conditions. The KDQOL-SF was developed by the Working Group in 1997 (version 1.3) and validated in Brazil in 2003. The KDQOL-SF is applicable to patients under hemodialysis, aim- ing to measure the QVRS, in order to meet two essential properties: the assessment of the aspects that are important to the health condition and the integration of the information that came from specific and general domains, allowing for a thorough analysis. The score procedure is done through the KDQOL-SF measurement, and therefore is analyzed separately. Thus, there is not a unique value that results from the general assessment of quality of life related to health, but rather average scores for each aspect. This analy- sis enables identification of the actual problems related to patient health and which have an im- pact on quality of life.(6,7)

The final score of each aspect varies within a range of 0 to 100, where the higher score reflects better quality of life.(6)

Data from the KDQOL-SF were transferred to a review program produced and made available by the Working Group. The program also has Mi- crosoft Excel® sheets, which automatically recode all of the data of the items with reverse scores and calculates the scores by item of each aspect.

Data collected were transferred to a Mic- rosoft Excel® sheet and the analyses were per- formed with the help of a statistics program: a) descriptive: frequency tables, with position fig- ures (mean, median, minimum and maximum) and standard deviation; Cronbach's alpha: evalu- ates the internal consistency of the KDQOL-SF. Reliability is considered good for alpha values equal to or greater than 0.60.(7)

The development of the study complied with national and international rules of ethics in hu- man research.

Results

The sociodemographic features found in this study are described in table 1. Out of 101 sub- jects participating in the study, 69 were male and 32 were female. Their age varied from 24 to 88 years; the age group with the greatest percent- age of participants was 50 to 59, at 27%. Ac- cording to the division by age group, 57 were adults and 44 were elderly. The prevalent ethnic group was white (n=50). Regarding marital status, the majority was married (n=56). As for schooling, most subjects had completed primary school (n=28).

Table 1 shows that most subjects had wag- es ranging from 1.1 to 2 times minimum wage (30.8%) and were Catholics. We see that the most prevalent basic disease was systemic hypertension (59.4%). Regarding the use of medicine, 100% of individuals made use of it.

In table 2, it is observed that the average age of the studied subjects was 56.4 (±14.44) years. As for the clinical variables, the aver- age hemodialysis treatment period was 43.15 (±43.24) months. Concerning the laboratory tests, the average hematocrit and albumin lev- els were 32.78 (±15.03%) and 3.78 (±0.47g/dl) respectively.

In table 3, the average scores of quality of life related to health are described. It was observed that the aspects that obtained lower scores were: "Physical Function (30.20), Work Situation (37.13) and Physical Functioning" (46.68). On the other hand, the aspects that obtained high- er scores were: "Cognitive Function" (89.31), "Social Support" (88.61) and "Sexual Function" (84.58).

Regarding the internal consistency of KD- QOL-SF, most aspects obtained satisfactory Cron- banch's alpha scores (≥ 0,60).

Discussion

The limitations of the results of this study are as- sociated with the cross-sectional pattern, which does not allow for the establishment of cause and effect relationships.

Patients with chronic renal failure under hemo- dialysis treatment live with an incurable disease that needs long-term treatment. Besides, the evolution of the disease and its complications lead to limitations and changes in their quality of life and that of their relatives and friends. Out of the 101 studied subjects, the majority of was male (68%). The Brazilian So- ciety of Nephrology confirmed in the 2011 Census that approximately 57% of chronic renal failure pa- tients were male, whereas 42% were female.(3)

Observational studies have pointed out the prev- alence of the disease in male subjects.(8-11) In other studies, the prevalence was in female subjects.(12-14) Regarding the age groups, despite the high percent- age of elderly people (42%), the most prevalent age group was 50 to 59. This finding was also observed in another study, where the prevalent age group was 40 to 60.(14) As for the color of skin, white was prevalent, similar to other studies.(8,10) Concerning marital status, it was observed that most subjects were married (55.5%). Similar results were found in several studies.(8-10,15,16) Regarding religious belief, most individuals declared themselves as Catholics (67,0%). This finding conforms to other studies which reported that the subjects were Catholic in 57% and 85% of cases.(17,18) As for schooling, it was observed that the prevalence was of subjects who had completed primary school (27.7%), similar to other studies in which 63.2% and 56.4% of indi- viduals had the same education level.(6,19)

Concerning income, most subjects had up to two times the minimum wage (30.8%). In other studies found in the literature, results were consis- tent with the present one, as 34% and 46% had a minimum wage or less.(15,17)

As for clinical features, the prevalence of sys- temic hypertension was observed (59.4%) as a basic disease, followed by diabetes mellitus (26.7%). This finding conforms to the results of another study that observed that their subjects had diabetes melli- tus and hypertension as a basic renal disease in more than 71% of the total cases.(10)

In this study, the average hemodialysis treatment time was approximately 43 months (which corre- sponds to 3.6 years). Similar results were found in the literature, where the average treatment period was 40 months.(11)

Regarding albumin, the average score of partic- ipants was 3.78 (±0.47) g/dl. Albumin is the most common marker used to evaluate the nutritional status of hemodialysis patients. The recommended value for albumin is above 3.5 mg/dl, therefore we can consider the results of this study within the normal range.(3,20)

There are publications that found albumin lev- els above the average (4.11mg/dl and 4.2g/dl, re- spectively).(11,12) Another clinical variable that was analyzed was the laboratory test result of hemato- crit, used as an anemia marker, which has a refer- ence value of 33%(21) It is worth mentioning that many studies indicate that anemia affects the quali- ty of life related to the health of chronic renal failure patients. There is also evidence in the literature that indicates that hemodialysis patients show signif- icant improvement in their survival when normal hematocrit is reached.(22)

In our study, the average value of hematocrit obtained was (32.78%), which is close to the min- imum expected value. A research study carried out in two Spanish hospitals with 53 patients under- going peritoneal dialysis found an average value of 33.46%.(13) As for the drugs, all participants made use of them. Another study found an average of 4.1 drugs per day for each hemodialysis patient.(16)

In the assessment of quality of life related to health, high average scores were obtained in the aspects "Cognitive Function" (89.31), "Social Support" (88.61), "Sexual Function" (84.58) and "Quality of Social Interaction" (82.97). The highest average score was for "Cognitive Function" (89.31). Despite having obtained this result, it is worth mentioning that chronic renal failure patients are a group at risk for cognitive decline. In that sense, even with good performance in this aspect, periodic evaluation of cognitive function is necessary, as there are many risk factors for cognitive impairment.(23) The second aspect with the high performance was "Social Support" (88.61). The importance of social support to the individual is considerable, as the par- ticipation of family in care is an essential resource for improving better acceptance of the disease and treatment by patients. Other works also show high average scores of 79.1, 88.2 and 81.1.(6,13,15) Anoth- er aspect that presented high average scores in our study was "Sexual Function" (84.58), and there are other studies with similar results.(6,15)

However, a decrease in the levels of quality of life was observed due to erectile dysfunction, which is a prevalent condition in chronic renal failure pa- tients. Therefore, the results in this aspect must be analyzed cautiously, as the sample of patients who had sexual intercourse up to three weeks before the test was composed of 30 individuals, which is con- sidered low.(24)

The lowest average scores of quality of life related to health were: "Physical Function (30.20), Work Sit- uation (37.13) and Physical Functioning" (46.68).

In this context, the results suggest that the set of symptoms of the diseases, along with the patients' everyday life factors, have a negative impact on hemodialysis patients. Worthy of note is that the "Physical Aspect" may be the most affected in the perception of these patients.(15)

In our study, the second most affected aspect was "Work Situation." Work is a basic condition for human emancipation and is part of each per- son's identity; therefore, it becomes one of the most precious values of human beings. As a re- sult of the disease and treatment, patients often need to stop working, and this has an impact on quality of life. To stop working or to reduce the workload is an aspect that is opposed to the life- style the individual had before, so it has a nega- tive impact on quality of life.(14)

The third aspect with a lower average score was "Physical Functioning," showing that there is a decrease in the ability to perform everyday activities or work. Some studies have suggested the implementation of a program of regular exercise for this group.(25)

Conclusion

Quality of life related to the health of chronic renal failure patients on dialysis showed a better percep- tion of the aspects "Cognitive Function," "Social Support," "Sexual Function" and "Quality of Social Interaction"; and lower scores in "Physical Func- tion," "Work Situation," "Physical Functioning" and "General State of Health".

Acknowledgments

Research done with the support of the Research Sup- port Foundation of São Paulo (FAPESP, as per its acro- nym in Portuguese), process number 2012/19453-2.

Collaborations

Lopes JM and Fukushima RLM contributed in the execution of the research, planning, analysis and interpretation of data, writing of the arti- cle, and final approval of the published version. Inouye K and Pavarini SCI contributed in the analysis and interpretation of data, writing of the article and final approval of the published version. Orlandi FS participated in the concep- tion of the project, planning, analysis and inter- pretation of data, writing of the article, critical review of the content and final approval of the published version.

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