•  
  •  
 

Abstract

Background: End-stage renal disease (ESRD) puts tremendous burdens upon affected patients and their support persons in Nepal. The health-related quality of life (HRQoL) among Nepalese persons with hemodialysis-dependent ESRD is not well understood. This study aimed to examine HRQoL and its predicting factors among persons undergoing hemodialysis in Nepal.

Methods: A purposive sampling was applied to recruit 106 persons with ESRD receiving hemodialysis at a tertiary hospital in Nepal between October and December 2021. The structured questionnaires included personal information, the World Health Organization Quality of Life instruments (WHOQOL-BREF), the fatigue assessment scale (FAS), the Hamilton depression rating scale (HDRS), and the social support scale (SSS). Data was collected through interviews. Descriptive statistics and multiple regression analysis were used to analyze data.

Results: The mean age of participants was 47.3 years, and 52.8% were female. The mean score of overall HRQoL was 59.8. Predictors of overall HRQoL included depression, medical payment, marital status, age, social support, and hemodialysis complications (p < 0.05) with an explained variance of 43.2%. Predictors of physical health included age, medical payment, and depression. Significant predictors of psychological health included depression, hematocrit level, age, marital status, social support, and hemodialysis complications. Social relationships were predicted by depression, marital status, hemodialysis complications, and diabetes mellitus. Environment domain was significantly predicted by depression.

Conclusions: Nurses should focus on assessing HRQoL and its significant factors in ESRD persons receiving hemodialysis. An early diagnosis of depression and proper management could improve quality of life of persons undergoing hemodialysis.

Keywords: Health- related quality of life, End-stage renal disease, Hemodialysis, Nepal

References

[1] Intiso D. The rehabilitation role in chronic kidney and end stage renal disease. Kidney Blood Press Res. 2014;39(2-3):180-8. https://doi.org/10.1159/000355795.

[2] Wetmore JB, Collins AJ. Global challenges posed by the growth of end-stage renal disease. Ren Replace Ther. 2016;2(1):15. https://doi.org/10.1186/s41100-016-0021-7.

[3] Karki KB, Maskey J, Giri M, Pandey AR, Makai P, Subedi R, et al. Assessment of chronic kidney disease support program of government of Nepal, 2016. Kathmandu Nepal Health Research Council. 2017;88(5):950-7.

[4] Ghimire M, Vaidya S, Upadhyay HP. Prevalence of newly diagnosed end-stage renal disease patients in a tertiary hospital of central Nepal, Chitwan: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021;59(233):61-4. https://doi.org/10.31729/jnma.4971.

[5] Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975-82. https://doi.org/10.1016/S0140-6736(14)61601-9.

[6] Anand S, Khanam MA, Finkelstein FO. Global perspective of kidney disease. In: Byham-Gray LD, Burrowes JD, Chertow GM, editors. Nutrition in kidney disease. Totowa, NJ: Humana Press; 2014. p. 11-23. https://doi.org/10.1007/978-1-62703-685-6_2.

[7] Mcgee J, Pandey B, Maskey A, Frazer T, Mackinney T. Free dialysis in Nepal: logistical challenges explored. Hemodial Int. 2018;22(3):283-9. https://doi.org/10.1111/hdi.12629.

[8] Kuipers J, Verboom LM, Ipema KJR, Paans W, Krijnen WP, Gaillard CAJM, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with meta-analysis. Am J of Nephrol. 2019;49:497-506. https://doi.org/10.1159/000500877.

[9] Ju A, Unruh ML, Davison SN, Dapueto J, Dew MA, Fluck R, et al. Patient-reported outcome measures for fatigue in patients on hemodialysis: a systematic review. Am J Kidney Dis. 2018;71(3):327-43. https://doi.org/10.1053/j.ajkd.2017.08.019.

[10] Abdel-Kader K, Unruh ML, Weisbord SD. Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol. 2009;4(6):1057-64. https://doi.org/10.2215/CJN.00430109.

[11] Beder J. Evaluation research on the effectiveness of social work intervention on dialysis patients. Social Work in Health Care. 2000;30(1):15-30. https://doi.org/10.1300/J010v30n01_02.

[12] Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al. Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int. 1998;54(1):245-54. https://doi.org/10.1046/j.1523-1755.1998.00989.x.

[13] Jablonski A. The illness trajectory of end-stage renal disease dialysis patients. Res Theory Nurs Pract. 2004;18(1):51-72. https://doi.org/10.1891/rtnp.18.1.51.28053.

[14] Moore C, Carter L-A, Mitra S, Skevington S, Wearden A. Quality of life improved for patients after starting dialysis but is impaired, initially, for their partners: a multi-centre, longitudinal study. BMC Nephrology. 2020;21(1):185. https://doi.org/10.1186/s12882-020-01819-4.

[15] Anu VK, Pushpa P, Kumar SS. Quality of life of patients undergong haemodialysis at B.P. Koirala Institute of Health Sciences. J Manmohan Mem Inst Health Sci. 2014;1(2):19-25. https://doi.org/10.3126/jmmihs.v1i2.9904.

[16] Mahato SKS, Apidechkul T, Sriwongpan P, Hada R, Sharma GN, Nayak SK, et al. Factors associated with quality of life among chronic kidney disease patients in Nepal: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):207. https://doi.org/10.1186/s12955-020-01458-1.

[17] Joshi U, Subedi R, Poudel P, Ghimire PR, Panta S, Sigdel MR. Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study. Int J Nephrol Renovasc Dis. 2017;10:195-203. https://doi.org/10.2147/IJNRD.S136522.

[18] Musavian AS, Soleimani A, Masoudi Alavi N, Baseri A, Savari F. Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life. Nurs Midwifery Stud. 2015;4(1):e25922. https://doi.org/10.17795/nmsjournal25922.

[19] Sousa H, Ribeiro O, Paúl C, Costa E, Miranda V, Ribeiro F, et al. Social support and treatment adherence in patients with end-stage renal disease: a systematic review. Semin Dial. 2019;32(6):562-74. https://doi.org/10.1111/sdi.12831.

[20] Untas A, Thumma J, Rascle N, Rayner H, Mapes D, Lopes AA, et al. The associations of social support and other psychosocial factors with mortality and quality of life in the dialysis outcomes and practice patterns study. Clin J Am Soc Nephrol. 2011;6(1):142-152. https://doi.org/10.2215/CJN.02340310.

[21] Ranabhat K, Khanal P, Mishra SR, Khanal A, Tripathi S, Sigdel MR. Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF. BMC Nephrol. 2020;21(1):433. https://doi.org/10.1186/s12882-020-02085-0.

[22] Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60. https://doi.org/10.3758/BRM.41.4.1149.

[23] Pereira CV, Leite ICG. Health-related quality of life of patients receiving hemodialysis therapy. Acta Paul de Enferm. 2019;32:267-74. https://doi.org/10.1590/1982-0194201900037.

[24] Adhikari GP. Calculating the sample size in quantitative studies. Scholars' J. 2021;4(1):14-29. https://doi.org/10.3126/scholars.v4i1.42458.

[25] World Health Organization. Division of Mental H. WHOQOL-BREF : introduction, administration, scoring and generic version of the assessment : field trial version, December 1996. Geneva: World Health Organization; 1996. https://apps.who.int/iris/handle/10665/63529.

[26] Michielsen HJ, De Vries J, Van Heck GL. Psychometric qualities of a brief self-rated fatigue measure: The Fatigue Assessment Scale. J Psychosom Res. 2003;54(4):345-52. https://doi.org/10.1016/s0022-3999(02)00392-6.

[27] Jugjali R. Predictive factors of spiritual well-being in Nepalese patients with end stage renal disease receiving hemodialysis. Prince of Songkla University: Prince of Songkla University; 2017. http://kb.psu.ac.th/psukb/handle/2016/11610.

[28] Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56-62. https://doi.org/10.1136/jnnp.23.1.56.

[29] Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord. 2013;150(2):384-8. https://doi.org/10.1016/j.jad.2013.04.028.

[30] Toljamo M, Hentinen M. Adherence to self-care and social support. J Clin Nurs. 2001;10(5):618-27. https://doi.org/10.1046/j.1365-2702.2001.00520.x.

[31] Maharjan R, Leelacharas S, Prapaipanich W. Illness perception, personal characteristics, social support, and lifestyle behavior in patients with hypertension, attending a cardiac out-patient department, Nepal. Rama Med J. 2018;41(4):37-47. https://doi.org/10.14456/rmj.2018.42.

[32] Jesus NM, Souza GF, Mendes-Rodrigues C, Almeida Neto OP, Rodrigues DDM, Cunha CM. Quality of life of individuals with chronic kidney disease on dialysis. J Bras Nefrol. 2019;41(3):364-74. https://doi.org/10.1590/2175-8239-JBN-2018-0152.

[33] Hayhurst WS, Ahmed A. Assessment of physical activity in patients with chronic kidney disease and renal replacement therapy. Springerplus. 2015;4(1):536. https://doi.org/10.1186/s40064-015-1338-3.

[34] Maung S, Sara AE, Cohen D, Chapman C, Saggi S, Cukor D. Sleep disturbance and depressive affect in patients treated with haemodialysis. J Ren Care. 2017;43(1):60-6. https://doi.org/10.1111/jorc.12188.

[35] Jankowska-Polańska B, Uchmanowicz I, Wysocka A, Uchmanowicz B, Lomper K, Fal AM. Factors affecting the quality of Eur J Public Health. 2017;27(2):262-7. https://doi.org/10.1093/eurpub/ckw193.

[36] Zhou X, Xue F, Wang H, Qiao Y, Liu G, Huang L, et al. The quality of life and associated factors in patients on maintenance hemodialysis - a multicenter study in Shanxi province. Ren Fail. 2017;39(1):707-11. https://doi.org/10.1080/0886022X.2017.1398095.

[37] Zyoud SH, Daraghmeh DN, Mezyed DO, et al. Factors affecting quality of life in patients on haemodialysis: a cross-sectional study from Palestine. BMC Nephrol. 2016;17(1):44. https://doi.org/10.1186/s12882-016-0257-z.

[38] Laudański K, Nowak Z, Niemczyk S. Age-related differences in the quality of life in end-stage renal disease in patients enrolled in hemodialysis or continuous peritoneal dialysis. Med Sci Monit. 2013;19:378-85. https://doi.org/10.12659/MSM.883916.

[39] van Sandwijk MS, Al Arashi D, van de Hare FM, van der Torren JMR, Kersten MJ, Bijlsma JA, et al. Fatigue, anxiety, depression and quality of life in kidney transplant recipients, haemodialysis patients, patients with a haematological malignancy and healthy controls. Nephrol Dial Transplant. 2019;34(5):833-8. https://doi.org/10.1093/ndt/gfy103.

[40] Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in chronic kidney disease and end-stage renal disease: similarities and differences in diagnosis, epidemiology, and management. Kidney Int Rep. 2017;2(1):94-107. https://doi.org/10.1016/j.ekir.2016.09.005.

[41] Mitema D, Jaar BG. How can we improve the quality of life of dialysis patients?. Semin Dial. 2016;29(2):93-102. https://doi.org/10.1111/sdi.12467.

[42] Bautovich A, Katz I, Smith M, Loo CK, Harvey SB. Depression and chronic kidney disease: review for clinicians. Aust N Z J Psychiatry. 2014;48(6):530-41. https://doi.org/10.1177/0004867414528589.

[43] Manandhar NR, Shakya R, Pandey B, Wagley P. Depression among patients undergoing maintenance hemodialysis at a tertiary care center in Kathmandu, Nepal. J Patan Acad Health Sci. 2018;5(2):4-11. https://doi.org/10.3126/jpahs.v5i2.23982.

[44] Marcus M, Yasamy MT, van Ommeren Mv, Chisholm D, Saxena S. Depression: a global public health concern. 2012. https://doi.org/10.1037/e517532013-004.

[45] Farhood LF, Fares S, Sabbagh R, Hamady C. PTSD and depression construct: prevalence and predictors of co-occurrence in a South Lebanese civilian sample. Eur J Psychotraumatol. 2016;7:31509. https://doi.org/10.3402/ejpt.v7.31509.

[46] Ganu VJ, Boima V, Adjei DN, Yendork JS, Dey ID, Yorke E, et al. Depression and quality of life in patients on long term hemodialysis at a nationalhospital in Ghana: a cross-sectional study. Ghana Med J. 2018;52(1):22-8. https://doi.org/10.4314/gmj.v52i1.5.

[47] Shokrpour N, Sheidaie S, Amirkhani M, Bazrafkan L, Modreki A. Effect of positive thinking training on stress, anxiety, depression, and quality of life among hemodialysis patients: a randomized controlled clinical trial. J Educ Health Promot. 2021;10:225. https://doi.org/10.4103/jehp.jehp_1120_20.

[48] Alshraifeen A, Al-Rawashdeh S, Alnuaimi K, Alzoubi F, Tanash M, Ashour A, et al. Social support predicted quality of life in people receiving haemodialysis treatment: A cross-sectional survey. Nurs Open. 2020;7(5):1517-25. https://doi.org/10.1002/nop2.533.

Download

Share

COinS