Exploring the Bio-Psychosocial Effects of Renal Replacement Therapy amongst Patients in a State Hospital in South Africa

This article described a qualitative study that investigated the bio-psychosocial effects of renal replacement therapy on patients in a state hospital in South Africa. The study aimed to investigate the level of debility experienced by patients undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) and to explore how this debility affects their bio-psychosocial functioning. Respondents comprised a small sample of HD and CAPD patients. Using an interview schedule as the research tool allowed rich data to be uncovered. Content analysis and reducing data into themes facilitated data analysis. Although the study was not quantitative and thus did not allow for comparative analysis; themes regarding the levels of stress emerged amongst participants. The HD group voiced greater concerns regarding the degree of debility and psychosocial distress than the CAPD group. Governmental support for holistic kidney disease treatment and careful teaming of key role players to reduce the severity and far-reaching bio-psychosocial effects of HD and CAPD treatment are recommended

Psychological Disorders and Quality of Life among Sudanese Dialysis Patients and Renal Transplant Recipients

Introduction: Psychiatric illness is common among patients with chronic disorders; particularly in those with end-stage renal disease on renal replacement therapy (RRT). Patients with a functioning renal allograft have an improved quality of life (QOL) compared to patients on dialysis. Objective: to evaluate the psychological disorders and QOL among dialysis patients and renal transplant recipients. Patients and Methods: This is a prospective cross-sectional study that included 168 patients on RRT. Their psychological health status was assessed through clinical examination and relevant designed questionnaires .The data obtained were fed to the SPSS for analysis. Significance was assumed at P 0.05. Results: Out of 168 ESRD Sudanese patients; 43 (25.6) received renal allograft. The frequency of depression was 90 (72) and nine (25.6) of patients on dialysis; and kidney transplant recipients respectively. Anxiety was reported with significant difference (p 0.001) in the dialyzed patients compared to kidney transplant recipients. Sleep disorders were experienced by 81 (64.8) of dialyzed; and nine (20.9) of kidney transplant recipients (P0.001). Conclusion: Psychological disorders in dialyzed ESRD patients have significant effect on the quality of life and may have a tremendous impact on mortality and morbidity. For this reason; supportive management by psychologist and or psychiatrist is recommended for early detection and alleviation of symptoms of mood and mind disturbances. For most patients with ESRD kidney transplantation offers the greatest potential for restoring healthy productive life

The validity of A new practical quality of life measure in patients on renal replacement therapy.

OBJECTIVE: A new quality of life measure, apart of the National Health and Welfare 2003 survey, is a promising tool for outcome evaluation of clinical practice due to its brevity, validity, reliability, and providing easy interpretation against general population norm-based scores. The measure consisting of 9-items, and so called 9-item Thai Health status Assessment Instrument (9-THAI) was used to assess its validity and reliability in patients on renal replacement therapy (RRT). MATERIAL AND METHOD: Three hundred and two patients on RRT who visited Srinagarind Hospital from March to May 2005 were studied Convergent and divergent validity were assessed using SF-36 as the concurrent measure. Concurrent validity was also assessed using hematocrit level and hospitalization history in the last year as concurrent clinical measures. Test-retest reliability was studied by repeated measure within one 1 month. Responsiveness of 9-THAI was studied in patients who reported health improvement. RESULTS: Results of correlations between 9-THAI and SF-36 domains were as hypothesized 9-THAI scores were significantly correlated with hematocrit level and hospitalization history. The results confirmed the validity of 9-THAI for use as a quality of life measure. Intraclass correlation coefficients of 9-THAI scores in stable patients were satisfactory. Among patients on RRT who reported overall health improvement, 9-THAI scores significantly increased, thus adding further evidence of the responsiveness of 9-THAI. CONCLUSION: The 9-THAI is a valid and reliable generic health status measure that can be used as an ideal core in a battery of quality of life measures in clinical practice for patients on RRT.