Quran recitation therapy reduces the depression levels of hemodialysis patients

Background: Depression is one of the serious neuropsychiatric complications in CKD patients because of its high prevalence, leading to decline in the quality of life, and the potential to increase the risk of death. The psycho spiritual therapy that potential to be developed for provide support and decrease depression level is Quran recitation therapy. But studies on the effectiveness of Quran recitation therapy are still limited. The aim of this study was to reveal the effect of Quran recitation therapy on depression level of CKD patients undergoing hemodialysis in Hemodialysis Unit of dr. Soepraoen Hospital, Malang, Indonesia.Methods: This study was a quasy-experimental that compared the decrease of depression score level between treatment (n=14) and control group (n=14) before and after Quran recitation therapy. The subjects were CKD patients with hemodialysis who had moderate and severe depression based on screening results using BDI (Beck's Depression Inventory). Treatment group got Quran recitation therapy twice with one week interval. Data was analyzed using independent t-test.Results: The depression score in the treatment group showed a significantly higher reduction than the control group. Decrease level of depression in the treatment group was 17.43±9.00, while in the control group 7±7.19 (p=0.002, p<0.05).Conclusions: This results show that Quran recitation therapy is an effective non-pharmacological therapy to overcome depression in CKD patients undergoing hemodialysis. This study adds the evidence based practice of Quran recitation therapy as Islamic psychotherapy in the clinical setting.

A Prospective Study on Nutritional Status and Nutrient Intake of Hemodialysis Patients Based on Coexistence of Diabetes

It is well known that malnutrition is a predictor of mortality in hemodialysis patients. The number of diabetic nephropathy patients is increasing rapidly. This study aimed to investigate nutritional status and nutrient intake according to the presence of diabetes among hemodialysis patients. The nutritional intake and general characteristics of outpatients at Ajou University Hospital (24 with diabetes and 30 without diabetes) were investigated between July and September 2015. Patients' general data were collected, and nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA) was evaluated. Nutrient intakes were assessed according to 3-day food records. There was no significant difference regarding body weight between the two groups. However, the non-diabetic group showed a better nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA) (5.2±4.4 vs. 8.0±4.3 score, non-diabetics vs. diabetics, P<0.05). There was no difference in daily calorie intake (1,473.9±370.5 vs. 1,503.8±397.5 kcal) and protein intake (60.3±19.7 vs. 65.6±20.5 g) in those with diabetes. Intakes of vegetables protein, sodium, potassium, vitamin C, folic acid and fiber were significantly higher in the diabetic group compared to those of the non-diabetic group. There was no difference in daily nutrient intake between the hemodialysis weekday and weekend groups. The non-diabetic group had higher calorie and sodium intakes per meal in the hemodialysis weekday group, but the difference was not significant. Based on these results, intervention should be performed to improve nutritional status in consideration of diabetes and dietary patterns.

Inflammation and Endothelial Dysfunction in the Initiation and Propagation of Cardiovascular Disease in Patients with Chronic Kidney Disease.

Background: There are many different theories on atherosclerosis pathophysiology. The dominant one is endothelial function disorder resulting from the existence of risk factors such as dyslipidemia, diabetes, smoking, and high blood pressure and hyperhomocysteinemia bacterial and viral infections. The inflammation is an important parameter for CKD appearance and evolution too. In this review we will summarize the most recent evidence that inflammation and endothelial dysfunction are implicated in the enhanced cardiovascular risk experienced by individuals with CKD, we will not discuss the role of dialysis or transplantation in the propagation of cardiovascular risk. Literature Review: Electronic medical databases were searched using as key - words the terms: “atherosclerosis”, “hemodialysis patient”, “end stage renal disease”, “Chronic Inflammation”, “Endothelial Dysfunction”. The search was conducted in English language. All studies referred to the correlation of the key terms were included and highlight the Inflammation and Endothelial Dysfunction in the Initiation and Propagation of Cardiovascular Disease in patients with Chronic Kidney Disease. Conclusions: The presence of enhanced CV risk in patients with CKD is well known but the mechanisms by which it occurs are less clear. The endothelium is a complex, multifunctional organ with a variety of vascular homeostatic functions and ED has been shown to result in the initiation and propagation of atherosclerosis. Causes of ED are numerous but inflammation and oxidative stress are clearly highly implicated; albuminuria (even at levels thought to be well below previous definitions of abnormal) may contribute to the inflammatory process, as might dyslipidemia (though a combination of traditional and no-traditional pathways).

The Effects of Nutrition Education and Regular Exercise on Nutritional Status, Quality of Life and Fatigue in Hemodialysis Patients

The purpose of this study was to investigate the effects of a nutrition education and exercise on nutritional status in hemodialysis patients, with regard to quality of life (QoL), and fatigue. The subjects were divided into two groups : an educated (E) group (11 men and 9 women) and a non-educated (NE) group (7 men and 22 women). The educated group received a nutrition education and a regular exercise program for 3 months. Data on anthropometric indices and biochemical parameters were obtained from medical records. Dietary habits and nutrient intake were assessed through questionnaires and three-day food records. QoL (through the SF-36 questionnaire) and fatigue (measured by a visual analogue scale questionnaire) were assessed before and after the interventions. Dietary habit scores regarding food variety and fluid intake control significantly increased (P<0.05) after the nutrition education. Furthermore, the intake of total energy, carbohydrates, Fe, and vitamin A significantly increased (P<0.05). Vitamin C intake also significantly increased (P<0.01). Hb levels decreased whereas TG levels increased in the NE group. BUN levels decreased in the E group. After the nutrition education, QoL aspects, such as feelings of pain and general health, and the total score significantly increased (P<0.05) and the level of fatigue score decreased (P<0.01). The results of this study indicate that nutrition education and exercise for hemodialysis patients provides changes in dietary habit, daily nutrient intake, biochemical parameters, QoL, and the level of fatigue. Therefore, nutrition education and exercise help improve nutritional status and QoL.

Effects of Nutrition Education on Nutritional Status of Hemodialysis Patients

Malnutrition is a common problem in patients undergoing maintenance hemodialysis (HD) and compromised food intake is an important cause. Malnutrition is one of the important factors influencing mortality in these patients. This study was conducted to evaluate the effectiveness of nutrition education at improving nutritional status of 23 Korean HD patients (mean : 48.6 +/- 10.4 years, men : 8, women : 15). Anthropometric indices, nutrient intakes, and biochemical blood indices were measured before and after a 6-month nutrition education intervention. Anthropometric indices such as percent ideal body weight [PIBW (%)], body fat, body mass index (BMI), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), and calculated arm muscle area (CAMA) of subjects were within the normal range and not changed by nutrition education. Subjective global assessment (SGA) was significantly increased (p<0.05) after nutrition education. Intake of total energy, carbohydrate, lipid, Ca, and vitamin B1 was increased significantly (p<0.05) but intake of phosphorus, potassium, and sodium was decreased (p<0.05). The serum concentrations of albumin, total protein, and Ca were significantly increased (p<0.05), but levels of P and K were decreased (p<0.05) after the intervention. These findings suggest that nutrition education for HD patients can be effective for positively changing nutrient intakes, leading to improvements in blood indices and nutritional status.

Bleeding from a Tuberculous Gastric Ulcer in a Hemodialysis Patient / 대한신장학회잡지

The incidence of Tuberculosis among the patients with end-stage renal disease(ESRD) has increased up to 16 times of that in the general population. The impairment of the cellular immunity in the ESRD patients may have a role in the pathogenesis. Extrapulmonary tuberculous manifestations such as lymph node, peritoneum, and pleura involvement are more frequent in the ESRD patients than in the general population. However, there has been no case of upper gastrointestinal(UGI) bleeding as a result of a gastric tuberculosis in the ESRD patient on hemodialysis. Here we report an unusual case of a hemodialysis patient with UGI bleeding secondary to a tuberculous gastric ulcer. A 31-year-old female on hemodialysis was admitted with melena. Endoscopy revealed a benign gastric ulcer with a visible bleeding vessel at the base, located in the anterior wall of the antrum. An exploratory laparotomy showed multiple, round, small and yellow nodules on the visceral peritoneum as well as a 1-cm sized gastric ulcer. After gastric resection, a histological examination including peritoneal nodules demonstrated chronic granulomatous inflamation with caseous necrosis and giant cells. The patient has been on antituberculosis medication and followed up in the outpatient department without any event for 8 months.

The Clinical Effect of Jyuzen-Taiho-to for Malaises in Hemodialysis Patients / 日本東洋医学雑誌

In hemodialysis patients, malaise is a common compliant. We tried to use Juzen-taiho-to as a treatment for malaise. Seventeen patients took 5g of Juzen-taiho-to twice a day for 8 weeks, and then responded to questionaires regarding their condition. Twelve patients experienced a decreased feeling of malaise, but 4 patients dropped out of the study, and 1 patient was ineffective. Hemodialysis patients usually feel cold and their skin is dry; these are symptoms of weak Ki (elemental energy) and anemia. Juzen-taiho-to is a medicine for Ki and blood deficiency. Juzen-taiho-to is a useful drug for treatment of malaise in hemodialysis patients.

Evaluation of Nutritional Deficit Status in Hemodialysis Patients Based on Usual Dietary Intake, Anthropometric and Biochemical Parameters / 기본간호학회지

Long-term hemodialysis(HD) patients manifest various signs of protein and caloric malnutrition due to poor intake of nutrients and other causes. Poor nutritional status increases the mortality and morbidity rates in HD patients. Thus, mataintnance of adequate nutritional status has been a major task in taking care of patients receiving HD. This study was to evaluate the nutritional status of HD patients and to clarify the degree of nutritional deficit based on usual dietary intake, anthropometric and biochemical indicators. Sixty HD patients comprised a HD group, while the control group consisted of 60 healthy adults whose age and sex matched those of the HD group. Nutritional status was evaluated by dietary intake using instant nutritional scale, anthropometric measures, serum protein concentrations and the number of lymphocytes. The data were analyzed by using Chi-square test and unpaired t-test. The results are as follows. 1. Regarding usual dietary intake of HD group : 1) Estimated caloric intake was significantly lower than the recommended daily allowance(RDA) and among them, 35% were taking calories less than 85% of the RDA. 2) Estimated protein intake was significantly higher than the RDA and among them 40% were taking protein more than 115% of the RDA. 3) Estimated fat intake was lower than the RDA. 4) Vitamin A, B, B1, B2, C and niacin in take was lower than the RDA respectively. 5) Estimated ferrous intake was within the normal limit the RDA while estimated calcium intake was higher than the RDA. 6) Both caloric and protein intake were higher for the 10 patients who had been under continuous ambulatory peritoneal dialysis than for the patients under HD from the beginning. 2. Regarding anthropometric measures : 1) Body mass index(BMI), midarm circumference(MAC), and triceps skinfolds thickness(TSF) were lower in the HD group than in the control group. 2) Among HD group, 47.1% were within the normal limit of BMI, while 86.7% were within the same limit in the control group. 3) Among HD group, 35.0% were within the normal limit of MAC, while 83.3% were within the same limit I the control group. 4) Among HD group, only 8.3% were normal, 30.3% were mild deficit status of FSF, while 50% were normal and 48.3% were mild deficit status in the control group. 3. Regarding biochemical laboratory tests 1) Albumin, transferring concentrations and the number of lymphocytes were lower in HD group than in the control group. 2) Among HD group, 98.3% were within the normal limit of albumin concentration and all were within the same limit in the control group. 3) Among HD group, only 11.7% were within the normal limit of transferring concentration, while 81.7% were within the same limit in the control group. 4) Among HD group, 25% were within the normal limit, while 93.3% were within the same limit in the control group. The above findings suggest that HD patients were in nutritional deficit status. Adequate diet therapy and periodical evaluation of the nutritional status in HD patients ar needed. Accordingly, it turned out that anthropometric measures were very reliable parameters and easy to use to evaluate nutritional status. So nurses are encouraged to adopt anthropometric measures to examine nutritional deficit status of HD patients.

Modeling Hemodialysis Patient`s Quality of Life / 기본간호학회지

The purpose of this study is to develop and test a nursing model which can be applied to prediction of the quality of life for the patient receiving hemodialysis. A hypothetical model was constructed on Johns & Meleis's empowerment model framework which has 3 constructs (stress, resource, empowerment). 6 Factor(perceived stress, self-esteem as personal resource, perceived social support as social resource, perceived fertigue, perceived health status & self efficacy as empowerment) were selected to predict the quality of life of receiving hemodialysis patients. 4 Factors(self-esteem, perceived social support, perceived health status & self efficacy) had direct effects on the quality of life significantly. Self-esteem had indirect effect on the quality of life via perceived health status significantly. Perceived social support had indirect effect on the quality of life via self-efficacy significantly. Perceived stress ha no direct and indirect effect on the quality of life significantly. Revised model from hypothetical model showed better fit to the data by eliminating unsignificant path. From results of this study we suggest that to improve quality of life of hemodialysis patient nurses provide nursing interventions which improve self-esteem, perceived social support, self-efficacy & perceived health status.