Helplessness and depression in end-stage renal disease

Mansoura Nursing Journal (Print), 2019

Background and aim of the Work : End-Stage Renal Disease (ESRD) patients on Hemodialysis (HD) are vulnerable to many psychological disorders. This study aim was to assess the psychological problems among patients with ESRD undergoing hemodialysis. Subjects and Methods:This descriptive cross-sectional study was conducted in the hemodialysis unit in Ibrahimia Central Hospital, at Ibrahimia City, Sharkia Governorate. A purposive sample of 82 adult patients on regular HD in the study settings during the time of the study.The study lasted from the beginning of October2016to the end of December 2016. Results : Four tools were used for collection of data. An interview questionnaire sheet was used in data collection. It included a section for patient's socio-demographic characteristics and second section was for patient's medical history. Taylor Manifest Anxiety Scale, Rosenberg Self-Esteem Scale and Beck Suicidal Ideation Scale. the patients' characteristics had a significant influence on this score. Concerning the suicidal ideation score, patients' anxiety score was the only statistically significant independent positive predictor. Conversely, the years of hemodialysis was a negative predictor. The model explains 34% of the variation in the suicidal ideation score. None of the patients' characteristics had a significant influence on this score. Conclusion : In conclusion, ESRD patients on regular HD in the study settings suffer high levels of anxiety and suicidal ideation, and low self-esteem. The level of anxiety decreases their self-esteem and eventually increases their suicidal ideation. The study recommends periodic regular psychological evaluation all ESRD patients on HD for early detection of any deviations from normal. The nephrology and the psychiatric nurse should be trained in the use of simple scales to screen these patients for such disorders, and should hold related educational sessions. Further research is proposed to test the effectiveness of nursing interventions in alleviating ESRD patient's anxiety and suicidal ideation, and improving their self-esteem.

Background: Illness perception is useful in understanding the impact of hopelessness on ESRD patients. This perception has been found to be an important determinant of behavior and has been associated with a number of important outcomes such as treatment adherence and functional recovery and quality of life.

Indian Journal of Nephrology, 2011

End-stage kidney disease (ESKD) is associated with depression and anxiety disorders. [3,4] Causes and effects of depression in ESKD patients with or without dialytic support have been addressed [5-7] but anxiety somehow has not received that much attention. Anxiety is a physiological and psychological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine together to create the painful feeling that is typically recognized as uneasiness, apprehension, or worry. Anxiety is a normal reaction to stress but extreme anxiety is a problem in itself as it leads to mental health problems and reduced quality of life and subjective wellbeing. Among ESKD patients undergoing hemodialysis, besides the disease itself, accompanying modifications in the occupational, marital, familial, societal, and personal life provide a sufficient base to give rise to anxiety. The effects of illness, dietary constraints, time restrictions, financial burdens, feeling of handicap, psychological strain of awareness of impending death, and many such factors impede the normal life and normal ways

ASAIO Journal, 2001

H3GlY6, Canada administration of genetically engineered cells can lower urea, uric acid, and creatinine in uremic rats. The present study is to see whether this can lower K+, P, el-, and P in uremic rats. B) Methods used: Genetically engineered E. coli DH5 cells are encapsulated in artificial cells. The efficacy for the removal of electrolytes was analyzed in-vitro in batch bioreactors and in-vivo in daily oral administration to partially nephrectomized male Wistar rats. C) Results summary: In-vitro: Significant lowering of plasma K' , P, Na' , and CI-occurs in in-vitro experiments in batch bioreactors. In-vivo experiments in uremic rats show that oral administration also resulted in lowering of plasma electrolytes levels. For example, plasma K+ decreases from 5.66 +I. 15 (mmol/L) to 4.23 0.90 (mmol/L), plasma P from 2.44 2 0.56 (mmol/L) to 1.54 5 0.59 (mmoVL), plasmaNa+ 1462 6.30 (mmol/L) to 13 1.20+ 8.60 (mmol/L), plasma Cf from 206.00 5 49.70 (mmol/L) to 101.00 5 15.00 (mmol/L), and alkaline phosphatase from 212.33 5 63.21 (dl) to 87.66 24.54 (dl). On discontinuation of the therapy, electrolyte levels increased again. Ref.: www.artcell.mcgill.ca A) Purpose of study: We have shown earlier that oral Mean Arterial Blood Pressures during Extended Daily Dialysis (EDD) vs. Intermittent Hemodialysis in Intensive Care Unit (ICU) Patients.

International journal of advance research in nursing, 2023

Chronic kidney disease is an irreversible decline in renal function, which can be fatal in the absence of dialysis and transplantation. Hemodialysis causing many physical and psychological problems, such as depression, anxiety, stress and inefficiency in patient, which should be considered in health promotion intervention. Objectives: To assess the level of depression, anxiety, stress among patients undergoing hemodialysis. To assess coping strategies among patients undergoing hemodialysis. To assess correlation between depression, anxiety, stress and coping strategies among patients undergoing hemodialysis. To find the association between the depression, anxiety, stress among patients undergoing hemodialysis with selected demographic variables and clinical variables. To find the association between coping strategies among patients undergoing hemodialysis with selected demographic variables and clinical variables.

Progress in Hemodialysis - From Emergent Biotechnology to Clinical Practice, 2011

The incidence rates of End-stage renal disease (ESRD) have increased steadily internationally since 1989. The United States has the highest incident rate of ESRD, followed by Japan; Japan has the highest prevalence per million population, with the United States second (1). Of the 490,000 patients with ESRD in the United States, more than 380,000 are currently on hemodialysis (HD) (2). ESRD on HD disproportionately affects minority populations. Whites represent the majority of the HD population (59.8%), while African Americans (33.2%), Asians (3.6%), and Native Americans (1.6%) comprise the rest of the ESRD population. However, the incidence rate of ESRD among African Americans is 4-fold higher and Native Americans 2-fold higher than that for whites. ESRD is slightly more prevalent in men than in women (male-to-female ratio, 1.2:1) and more prevalent in older adults (3). 2. Morbidity/mortality Chronic renal failure is associated with a very high morbidity and hospitalization rate, likely due to existing comorbid conditions, such as hypertension, coronary artery disease, and peripheral vascular disease. The first-year age-adjusted mortality rate of patients on dialysis is 9.4%, the two-year mortality rate is 32.3%, and the 5-year mortality rate is 60.8% (3). ESRD patients with diabetes have a first-year mortality rate of 23% (3). In patients with ESRD, cardiovascular disease is the primary cause of death, followed by sepsis and cerebrovascular disease. The dialysis population in the United States has a 10-to 20-fold higher risk of death due to cardiovascular complications than the general population after adjusting for age, race, and sex. The relative risk with respect to the general population is much higher in younger patients, with cardiovascular event rates in ESRD patients in their 20s equivalent to the event rates in the general population in their 80s (3). Increased understanding of the disease process, new insights into pathogenic mechanisms, and new therapeutic options are emerging that may improve survival rates and quality of life for patients with ESRD. 3. The need for dialysis Given the poor outcomes for patients on HD, every effort should be undertaken to preserve residual renal function, which is associated with improved survival (4). Early nephrology referrals, patient education, and consideration of transplant options may be helpful in decreasing the progression to ESRD. Preparation for dialysis therapy is critical for the www.intechopen.com Progress in Hemodialysis-From Emergent Biotechnology to Clinical Practice 228 smooth transition from CKD care to ESRD. Poor planning for initiation of dialysis is a major cause of increased morbidity and mortality. The use of temporary or tunneled dialysis catheters contributes to dialysis mortality by increasing the incidence of sepsis, acting as a stimulus for chronic inflammation, and damaging the central veins, thereby preventing or shortening the survival of more permanent vascular access once created. The chapter will discuss in detail regarding type of dialysis access.

ABSTRACT... Objective: To determine the nature and frequency of psychosocial stressors faced by the patients on hemodialysis admitted in Renal Dialysis Unit of Nishtar Hospital, Multan. Study design: A descriptive study. Place & duration of study: The study was conducted in the Renal Dialysis Unit of Nishtar Hospital, Multan, from 1st May, 2014 to 31st May, 2014. Subjects & methods: The sample consisted of 170 (112 Male, 58 Females) consecutive inpatients on Hemodialysis Treatment. They were interviewed and Hemodialysis Stressors Scale (HSS) was administrated to know the frequency of Hemodialysis Stressors. Results: Results showed that all the patients reported Physiological and Psychosocial stressors. Most frequent physical stressors included feeling tired (92%) and stiffening of joints (91%). In psychosocial stressors restriction of fluid (100%), dependence on dialysis machine and/ or equipment (95%), limitation of physical activity (93%), changes in family responsibilities (93%), dependency on nurses and technicians (93%), length of treatment (92%), dependency on physicians (91%), sleep disturbance (90%) and limitation of food (93%) were the most frequently reported. Conclusions: We concluded that both physiological and psychosocial stressors were present in significant majority of patients. Key words: Hemodialysis, Stressors,

Journal of Advanced Nursing, 1998