Euthanasia of patients with the chronic renal failure.

This study deals with frequency and form of euthanasia in dialysis patients with chronic renal failure (CRF) in Bosnia and Herzegovina (B&H) within the period from 2000 to 2006. Of total number of 2700 patients on dialysis we examined n = 753 of them. Examinees with the Balkan Endemic Nephropathy (BEN) (n = 348) were in the first group, and the Control group was formed of patients with other diseases (n = 405). In this study the following methods were used: adapted Questionnaire from the Renal Registry of B&H, Beck's Anxiety Inventory (BAI), Hamilton's Depression Rating Scale (HDRS) and Mini-Mental Scale of Estimation (MMSE). Age of the BEN group of patients ranged: 64.77 +/- 8.86 and the control one 53.85 +/- 3.60. Multivariate analysis for the BEN group with passive euthanasia was: 0.760 (95%, CI = 0.590-0.710) (p = 0.001) and for the active one was 0.450 (95%, CI = 0.125-0.510 (p = 0.001). Euthanasia is associated with the rural life and renal heredity, and psychological BAI scale-total, HDRS-total and MMSE-total. For the BEN group passive euthanasia is 3.75% as well as active 0.86%. The findings stressed that euthanasia of dialysis patients requires better nephrological-psychiatric control and social care in B&H as well as complete program for the CRF samples protection too.

Anthropological aspect of death in dialyzed patients.

The aim of this article is to compare the incidence of thanatophobia in dialysed patients having Balkan endemic nephropathy (BEN) with a control group (N18) members where some of them have chronic renal failure (CRF), but not (BEN). We examined thanatophobia on a sample of 753 dialysed patients with chronic renal failure (CRF) in Bosnia and Herzegovina (B&H) during the period from 1st January 2000 to 31st December 2006. The first group is a cohort consisted of 348 patients with Balkan endemic nephropathy (BEN), and the control group consisted of 405 randomly selected patients with different diagnoses of CRF (N18). The measurement instruments used were: General data list, Eysenck's Personality Questionnaire (EPQ), Beck's Anxiety Inventory (BAI), Hamilton's Depression Rating Scale (HDRS), and Mini-Mental State Examination (MMSE). Univariante and multivariante statistical analyses were carried out. From the multivariante analysis, the highest correlations with thanatophobia were found in these variables: avoidance of dialysis in BEN group: R=0.985, OR=0.358, CI=0.483-0.728 (95%), and in control group: R=0.550, OR=0.935, CI=0.615-0.830 (95%), age, years on dialysis, education, pervasive fear with statistical significance P=0.001. BEN group differentiates from control group: BAI-total (R=1.110, OR=0.578 (95%), CI=0.770-0.890, P=0.001), HDRS-total (R=0.995, OR=1.290 (95%), CI=1.180-1.920 P=0.001. BEN group have lower scores than the control group in MMSE-total: (R=0.430, OR=0.023 (95%), CI=0.034-2.850, P=0.001) which represents the organic part of anxiety. Thanatophobia is present in both groups, but it is more frequent in the BEN (11.70%) than in control group (7.50%). We found that thanatophobia occurs before dialysis, and that it is structured as a pervasive fear of death and is associated with endemia, years spent on dialysis, and avoidance of dialysis.