Organ Failure and Quality of Life: A Study among Patients undergoing Maintenance Hemodialysis
2. PHQ-9: This tool is widely used for diagnosing depression among the Kidney Patients undergoing
maintenance hemodialysis. The tool is developed by Kroen et al (2001). The nine items of the PHQ- 9 are based on the nine diagnostic criteria for major depressive disorder in the DSM-IV.
ReSultS
Table 1: Socio-demographic Profile
Sex frequency Age group frequency
Male 46 (71.9) 20- 40 Years 8 (12.5)
Female 18 (28.1) 41 to 60 years 30 (46.9)
Above 60 26 (40.6)
Marital Status frequency Education frequency
Married 48 (75) Illiterate 2 (3.1)
Unmarried 6 (9.4) Primary 5 (7.8)
Widow 5 (7.8) Secondary 20 (31.3)
Widower 5 (7.8) Higher Secondary and above 37 (57.8)
Education frequency Income frequency
Unemployed 26 (40.6) Below Rs. 10000 20 (31.3)
Farming 4 (6.25) Rs.10001 to Rs.30000 26 (40.6)
Government service 9 (14) Above Rs.30000 18 (28.1)
Private Sector 8 (12.5)
Retired 17 (26.5)
(N = 64)
Men constitute the majority of participants with 72 percent. This was a real reflection of the patients admitted to the hospital for dialysis as men account larger in number.
Nearly Half (46.9%) of the respondents belongs to the age group of 41 to 60 years, almost same percent (40.6%) come under the age category of above 60 years. As a positive
indication, respondents in the youthhood (below 40 years) constitute a minority of respondents (12.5%).
A majority of the participants in the study were married (75%) while almost 10 percent of the respondents are still unmarried. A major portion of the respondents had a Higher secondary or above qualification while 31 percent of the respondents had secondary education.
Only three percent of the participants were illiterate.
The employment status of the respondents indicates that
around 41 percent of them were unemployed, a major portion of them was jobless due to illness and others were housewives. Around 27 percent of the respondents reported that they are retired from service and 14 percent are government employees. It was evident that 41 percent of the respondent are earning below Rs.
10000 per month while less than one-third (31.3%) of the respondents are earning between Rs. 10001 to Rs.
30000. Around 28 percent of the respondents are earning more than Rs. 30000 per month.
Table 2: Disease related information
Duration of illness frequency Frequency of Dialysis frequency
Up to 2 years 20 (31.3) Once in a week 1 (1.6)
3 to 7 years 27 (42.2) Twice in a week 16 (25)
Above 8 years 17 (26.6) Thrice in a week 47 (73.4)
care giver frequency Usage of Wheel Chair frequency
Family Member 60 (93.8) N o 31 (48.4)
Others 4 (6.3) Yes 33 (51.6)
Causes of Disease frequency Insurance frequency
Don’t know 7 (10.9) No insurance 28 (43.8)
Hypertension 21 (32.8) Mediclaim 21 (32.8)
Diabetes 19 (29.7) Reimbursement 4 (6.3)
Other 17 (26.5) Other 11 (17.2)
(N = 64)
Patient participated in this study reported that 42.2% of them are victims of the illness between 3 to 7 years while 31 percent become within 2 years of time period. Around 27 percent of the patients have started their treatment before eight years. When asked about the dialysis frequency, 73.4 percent of the respondents reported that they are undergoing maintenance hemodialysis thrice a week whereas 25 percent reported that twice in a week. It is evident that majority of the patients are in need of availing dialysis very regularly.
Showcasing the scenario of Indian caring system, around 94 percent of the participants are reported that they are being cared by one of their family members while 6 percent reported that caregiving was provided by someone else. In most of the cases, when probed, it was a nurse. It is evident that a majority (51.6%) of the patients undergoing maintenance hemodialysis are using a wheelchair. The researcher tried to explore the probable reasons for the Kidney disease. It is reported by 32.8%
of the respondent that Hypertension is the cause of their
Kidney Disease whereas 29.7 percent reported Diabetes as a cause of their Kidney Disease. Around 27 percent of the respondents stated that they are not aware of the cause of the kidney failure. Diabetes and hypertension remained the crucial reason for kidney disease among the samples of this study too.
Table 3: Level of Depression
Level of Depression frequency Percent
No Depression 4 6.3
Minimal Depression 32 50
Mild Depression 11 17.2
Moderate Depression 3 4.7
Severe Depression 6 9.3
(N = 64)
The impact of being a kidney patient and undergoing dialysis has evident from the results of the study. It is
reported that half of the respondents (50.0%) are having Minimal Depression while 17 percent of respondents are having Mild. Around 10 percent of the respondents are identified with Severe Depression. The state of being subjected to dialysis has made many of them feel
helpless and hopeless. This further leads to depression and other mental health problems.
The same negative trend has also evident in the case of Quality of life. A majority of the respondents are identified with the poor quality of life.
Table 4: Gender, depression and different dimensions of quality of life
Gender n Mean Std. Deviation t P
Depression Male 46 5.33 5.420 1.974 .053*
Female 18 8.33 5.636
Symptom Male 46 79.1667 12.35253 2.242 .029*
Female 18 70.7176 16.31792
Quality of Social
Interaction Male 46 76.5217 24.89441 .073 .942 (NS)
Female 18 77.0370 26.98072
(*Significant, = p<0.05) (NS: Not Significant) It is evident from the present study that there are significant differences among male and female participants in some variables. Depression was seen to be more in Female when compared to Males. The t ratio for Depression is significant (t=1.974, p=0.05) which indicates that there is a significant difference in depression among Males and Females. Symptoms are another variable that shows a significant difference in the grounds of gender. Remaining sub-dimensions in the quality of life have shown no significant difference.
The present study indicates that frequency of dialysis doesn’t have any influence on the different sub- dimensions of the quality of life and depression. Patients in different categories of frequency have shown an almost same level of quality of life and depression, a statistically relevant difference was not traced. In the same manner, age group also doesn’t make much difference in the case quality of life among the respondents. The case of income and quality of life also remains same as lower or higher income doesn’t make a significant difference in the quality of life of the patients.
Table 5: Duration of dialysis, depression and other variables in quality of life
Duration of Dialysis n Mean Std. Deviation f P
Depression
Up to 2 Years 20 5.70 5.507
4.308 .018*
3 to 7 Years 27 6.33 6.403
Above 8 Years 17 6.47 4.543
Total 64 6.17 5.605
Effect of Kidney Disease
Upto 2 Years 20 66.7188 18.92123
3.190 .048*
3 to 7 Years 27 72.6852 19.83239
Above 8 Years 17 68.5662 18.06937
Total 64 69.7266 18.97905
Burden of Kidney Disease
Upto 2 Years 20 44.3750 37.10870
4.118 .021*
3 to 7 Years 27 43.2870 35.56405
Above 8 Years 17 51.1029 36.59289
Total 64 45.7031 35.89272
Cognitive Function
Upto 2 Years 20 80.3333 22.63103
5.859 .005*
3 to 7 Years 27 72.0988 25.28721
Above 8 years 17 85.0980 17.40521
Total 64 78.1250 22.92442
Contd…
Quality of Social Interaction
Up to 2 years 20 75.0000 22.77528
4.954 .010*
3 to 7 Years 27 78.2716 27.46202
Above 8 years 17 76.0784 25.82622
Total 17 86.2729 23.00134
Social Support
Up to 2 years 20 81.6648 22.23037
5.689 .005*
3 to 7 years 27 85.8007 16.47701
Above 8 years 17 86.2729 23.00134
total 17 84.6337 19.98893
dIScuSSIOn
It is evident from the study that duration of dialysis has an impact on the other variables. The respondents’ group which is on dialysis more than 8 years is having a Mean (M= 6.47), higher depression in comparison to two other groups. The same trend is visible in the case of ‘effects of kidney diseases’ too. The respondent receiving dialysis since 3 to 7 years are having a Mean = 72.68, which depicts that they have much bothered with the effects of kidney disease in comparison to two other groups.
Duration of dialysis made a significant impact on the patient’s perception on the ‘Burden of kidney diseases’. The respondent receiving dialysis since more than 8 years have a Mean= 51.10 which results that they are having the maximum burden of Kidney Disease.
Further, the respondent group undergoing dialysis up to 2 years, having Mean= 44.37 which shows that they are feeling less burden of kidney disease while comparing to other groups. Cognitive functioning is another variable that shows significant variation among the respondents according to the duration of illness.
This study underlines the physiological and psychological problems are very commonly identified with the patients undergoing maintenance hemodialysis.
Care and Caregiving become a complicated issue among the patients undergoing hemodialysis. Activity limitation is common among the patients and half of them are using a wheelchair. Showcasing the poor health insurance system in India, it is evident from the study that more than 40 percent of the patients do not have any insurance.
This creates a significant financial burden on the patient, especially when a proportionate of them is unemployed.
Psychological variables in the study also manifest the negative implications of the organ failure. A considerable number of patients are identified with severe and mild
depression. A large number of them have the feeling of helplessness and hopelessness while facing with the complexities of organ failure and frequent dialyzes. The level of depression has shown a significant relationship with other variables. As like much previous literature, the present study also indicates higher depression among females while compared to males. The duration of dialysis and depression is also established a strong connection. Patients with higher duration had a high level of depression while comparing to the patients with lower duration.
A considerable percentage of patients who are undergoing maintenance hemodialysis reported a lower level of quality of life. Variations also found in connection with the different sociodemographic and illness-related variables. The severity of symptoms is high among females than males. Other gender-related variables don’t show much difference. Duration of dialysis is a variable that has a significant connection with the overall quality of life and its dimensions. Patient with higher dialysis duration reported higher effects and burden of kidney diseases. It is evident that Cognitive functions also decreases when the duration of dialysis increases.
The same trend is visible in the case of quality social interactions. Patient with fresh dialysis history reported higher social interaction while comparing to a patient with long history of dialysis. Patient’s felt higher social support in the initial years of dialysis while comparing to other categories.
cOncluSIOn
Replicating the previous researchers, this study also reveals that end-stage renal disease patients receiving dialysis treatment have a lower quality of life than people in general population. The patients receiving longer years of dialysis are shown a much better quality of life
than patients with a new history. This is an indication which highlights the patient’s ability to cope-up with the life realities rationally. Further investigations could focus on the factors contributed to the higher quality of life among patient with long history of dialysis.
Like many other studies, this study also underlines the presence of depression among the patients. Psychosocial intervention programmes for the patients and their families have to be mandated for professionals and institutions. This would help in minimizing disease and treatment related psychosocial complexities.
Conflict of Interest: The author declares that there is no conflict of interest.
Source of Funding: No funding was received for writing this study.
ethical clearance: The study was approved by Institutional Ethic Committee of Muljibhai Patel Urological Hospital, Gujarat, India.
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