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Chronic Kidney Disease (CKD) has an impact in many aspects of the patients’ lives, among them are the physical, social, economic, occupational, spiritual and emotional aspects. Annually, CKD causes around 2.4 million deaths, besides a remarkable injury in the daily lives of the patients in hemodialysis. On account of the hardships imposed by CKD and hemodialysis therapy, it is fundamental that these patients have an individualized and multidisciplinary approach, based on the precepts of palliative care. This research has the aim to measure the quality of life of CKD patients in stages 3b, 4 and 5, comparing the individuals in conservative care to those in hemodialytic treatment.
Case-control study, being held in the Clínica de Nefrologia Ltda., in the Hospital Regional de Araranguá, Santa Catarina. The IPOS-Renal questionnaire was applied, in which physical, nephrologic, psychologic, and communication characteristics were evaluated. Data analysis were done to the variables of interest, and statistical significance was inferred with P-values ≤ 0.05.
Among the 42 eligible participants of this study, 61% were male, and in the hemodialysis group this number grew up to 66.67%. The group in hemodialysis achieved better results overall. The hemodialysis therapy group reported less dyspnea symptoms than the conservative care group (p=0.025). This could be explained due to the effect of the hemodialysis therapy in the physiopathological mechanism of dyspnea in CKD. The group in hemodialysis had better psychological indicators in the whole subscale (p=0.06), having reported feeling less depressed (p=0.01) and feeling more at peace (p=0.10) than the conservative care group. This difference could be explained by the better understanding that hemodialysis patients have of the CKD health-disease process. Even so, in patients undergoing hemodialysis therapy, depression presents itself at a three to five times higher rate than in the general population. These patients in hemodialysis therapy are routinely exposed to stress factors, like feeling “machine-dependent”, besides the usual exams and medical appointments. In the communication domain, the hemodialysis patients reported they had as much information as they wanted more frequently than the conservative care group (p=0.003). Communication with the healthcare staff is important, as these patients usually feel insecure about their future, and the loss of social function in CKD patients can impact their clinical picture as a whole, highlighting the necessity of palliative care in these patients. Also, the regular appointments with the healthcare staff in the hemodialysis center help the patients in the development of self-knowledge about their clinical picture and its repercussions, upgrading aspects of the quality of life indicators.
Both groups had symptoms that negatively affected their quality of life indicators. The hemodialysis patients had better quality of life results when compared to the conservative group, according to the IPOS-Renal survey, in all physical, psychological and communication subscales. More studies are needed because of the differences between the referred studies and the results found.