The Relationship of Patients Receiving Hemodialysis with Depression, Anxiety, Stress Conditions and Dialysis Symptoms/

Abstract

Objective: This study was carried out to determine anxiety, depression, and stress levels in patients receiving chronic hemodialysis treatment and to evaluate their relationship with dialysis symptoms. Material and Methods: The data of this descriptive and correlational study were collected in a private dialysis center in stanbul between June and July 2021. 128 patients were
included in the study. Research data were collected using the Patient Description Form, Depression-Anxiety-Stress Scale-21 and Dialysis Symptom Index. Results: The mean age of the patients included in the study was 60.4815.01 years, and the mean duration of hemodialysis treatment was 4.594.32 years. While 45.3% of the patients had very severe anxiety and 18% had very severe depression, more than half of them (59.4%) had normal stress levels. It was determined that the average total score of the Dialysis Symptom Index was 37.3218.12. A positive statistical significance was found between the age of the patients receiving hemodialysis treatment and the Dialysis Symptom Index and anxiety level (p<0.05). A positive statistical significance was determined
between the duration of hemodialysis treatment and Dialysis Symptom Index and depression level (p<0.05). A statistically significant positive correlation was found between the dialysisrelated symptoms of the patients and their anxiety levels and depression levels (p<0.05). Conclusion: As a result, it was determined that the patients receiving hemodialysis treatment had high anxiety levels,
moderate depression levels, and low-stress levels. Patients were experienced moderate dialysis-related symptoms and these symptoms affected patients’ anxiety and depression levels.

Keywords

• Hemodialysis
• symptom
• depression
• anxiety
• stress

Hemodiyaliz Tedavisi Alan Hastaların Depresyon, Anksiyete, Stres Durumları ve Diyaliz Semptomlarıyla İlişkisi/The Relationship of Patients Receiving Hemodialysis with Depression, Anxiety, Stress Conditions and Dialysis Symptoms

Abstract

Amaç: Bu araştırma, kronik hemodiyaliz tedavisi alan hastalarda anksiyete, depresyon, stres durumlarının belirlenmesi ve diyaliz semptomlarıyla ilişkisinin incelenmesi amacıyla yapılmıştır.
Gereç ve Yöntemler: Tanımlayıcı ve ilişki arayıcı tipte olan bu araştırmanın verileri İstanbul ilinde bulunan özel bir diyaliz merkezinde Haziran ve Temmuz 2021 tarihleri arasında toplandı. Araştırmaya 128 hasta dahil edildi. Araştırma verileri Hasta Tanıtım Formu, Depresyon-Anksiyete-Stres Ölçeği-21 ve Diyaliz Semptom İndeksi kullanılarak toplandı. Bulgular: Araştırmaya dahil edilen hastaların yaş ortalaması 60,4815,01 yıl, hemodiyaliz tedavi süresi ortalaması 4,594,32 yıldır. Hastaların %45,3’ünün çok ileri derecede anksiyetesi ve %18’nin çok ileri düzeyde depresyonu bulunurken yarısından fazlasının (%59,4) stres düzeyi normaldir. Diyaliz Semptom İndeksi toplam puan ortalamasının 37,3218,12 olduğu belirlenmiştir. Hemodiyaliz tedavisi alan hastaların yaşı ile Diyaliz Semptom İndeksi ve anksiyete düzeyi arasında pozitif yönde istatistiksel anlamlılık olduğu saptanmıştır (p<0,05). Hemodiyaliz tedavisi süresi ile Diyaliz Semptom İndeksi ve depresyon düzeyi arasında pozitif yönde istatistiksel anlamlılık belirlenmiştir (p<0,05). Hastaların diyalize ilişkin semptomları ile anksiyete düzeyleri ve depresyon düzeyleri arasında pozitif yönde istatistiksel olarak anlamlı düzeyde ilişki saptanmıştır (p<0,05). Sonuç: Sonuç olarak, hemodiyaliz tedavisi alan hastaların anksiyete düzeylerinin yüksek, depresyon düzeylerinin orta ve stres düzeylerinin düşük olduğu belirlendi. Hastalar orta düzeyde diyalize ilişkin semptomlar yaşamakta ve bu semptomlar hastaların anksiyete ve depresyon düzeylerini etkilemektedir.

Keywords

• Hemodiyaliz
• semptom
• depresyon
• anksiyete
• stres

References

1. 1. Senmar M, Razaghpoor A, Mousavi AS, Zarrinkolah F, Esmaeili F, Rafiei H. Psychological Symptoms in Patients on Dialysis and Their Relationship with Spiritual Well-Being. Florence Nightingale Journal of Nursing. 2020;28(3):243–9. doi:10.5152/FNJN.2020.19061
2. 2. Süleymanlar G, Ateş K, Seyahi N. Türkiye’de Nefroloji, Diyaliz ve Transplantasyon Registry-2019. Ankara: BAYT Bilimsel Arş. Basın Yayın Tanıtım Ltd. Şti.; 2020.
3. 3. Fleishman TT, Dreiher J, Shvartzman P. Patient-reported outcomes in maintenance hemodialysis: a cross-sectional, multicenter study. Quality of Life Research. 2020;29(9):2345–54. doi:10.1007/s11136-020-02508-3
4. 4. Davison SN. Integrating palliative care for patients with advanced chronic kidney disease: recent advances, remaining challenges. Journal of Palliative Care. 2011;27(1):53–61. doi:10.1177/082585971102700109
5. 5. O’Sullivan D, McCarthy G. Exploring the symptom of fatigue in patients with end stage renal disease. Nephrology Nursing Journal. 2009;36(1).
6. 6. Wikström B. Itchy skin-a clinical problem for haemodialysis patients. Nephrology Dialysis Transplantation. 2007;22:3–7. doi:10.1093/ndt/gfm292
7. 7. Fleishman TT, Dreiher J, Shvartzman P. Pain in maintenance hemodialysis patients: a multicenter study. Journal of Pain and Symptom Management. 2018;56(2):178–84. doi:10.1016/j.jpainsymman.2018.05.008
8. 8. Murtagh FEM, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Advances in Chronic Kidney Disease. 2007; 14(1): 82–99. doi:10.1053/j.ackd.2006.10.001

9. 9. Anjomshoa F, Esmaeli Abdar M, Rafiei H, Arjmand Kermani M, Hassanarabi F, Hasani A, et al. Depression among hemodialysis patients: a cross-sectional study in southeast of Iran. International Journal of Epidemiologic Research. 2014;1(1):24–8.
10. 10. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet. 2007; 370(9590): 859–77. doi:10.1016/S0140-6736(07)61238-0
11. 11. Roy-Byrne PP, Davidson KW, Kessler RC, Asmundson GJG, Goodwin RD, Kubzansky L, et al. Anxiety disorders and comorbid medical illness. General Hospital Psychiatry. 2008; 30(3): 208–25. doi: 10.1016/j.genhosppsych.2007.12.006
12. 12. Akman B, Özdemir FN, Sezer S, Miçozkadioǧlu H, Haberal M. Depression levels before and after renal transplantation. Transplantation proceedings. 2004; 36(1): 111-3. doi:10.1016/j.transproceed.2003.11.021
13. 13. Cukor D, Coplan J, Brown C, Friedman S, Newville H, Safier M, et al. Anxiety disorders in adults treated by hemodialysis: a single-center study. American Journal of Kidney Diseases. 2008;52(1):128–36. doi:10.1053/j.ajkd.2008.02.300
14. 14. Kimmel PL. Psychosocial factors in dialysis patients. Kidney Int. 2001;59(4):1599–613. doi: 10.1046/j.1523- 1755.2001.0590041599.x
15. 15. Akgöz N, Arslan S. Hemodiyaliz tedavisi alan hastalarda yaşanan semptomların incelenmesi. Nefroloji Hemşireliği Dergisi. 2017;12(1):20–8.
16. 16. Dikmen RD, Aslan H. The effects of the symptoms experienced by patients undergoing hemodialysis treatment on their comfort levels. Journal of Clinical Nephrology and Renal Care. 2020;6:60. doi: 10.23937/2572-3286/1510060
17. 17. Hoang VL, Green T, Bonner A. Examining social support, psychological status and health‐related quality of life in people receiving haemodialysis. Journal of Renal Care. 2021;1–10. doi: 10.1111/jorc.12380
18. 18. Çetinkaya S, Nur N, Ayvaz A, Özdemir D. Bir üniversite hastanesinde hemodiyaliz ve sürekli ayaktan periton diyalizi hastalarında depresyon, anksiyete düzeyleri ve stresle bafla çıkma tutumları. Nöropsikiyatri Arşivi. 2008;45:78–84.
19. 19. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995;33(3):335–43. doi:10.1016/0005-7967(94)00075-u
20. 20. Sarıçam H. The Psychometric properties of Turkish Version of Depression Anxiety Stress Scale-21 (DASS-21) in community and clinical samples. Journal of Cognitive Psychotherapy. Res. 2018; 7(1): 19-30. doi: 10.5455/JCBPR.274847
21. 21. Weisbord SD, Fried LF, Arnold RM, Rotondi AJ, Fine MJ, Levenson DJ, et al. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index. Journal of Pain and Symptom Management. 2004;27(3):226–40. doi:10.1016/j.jpainsymman.2003.07.004
22. 22. Onsoz HB, Usta Yesilbalkan O. Reliability and validity of the Turkish Version of the Dialysis Symptom Index in chronic hemodialysis patients. Turkish Nephrology, Dialysis and Transplantation Journal. 2013;22(01):60–7. doi: 10.5262/tndt. 2013.1001.08
23. 23. El Nahas AM, Bello AK. Chronic kidney disease: the global challenge. Lancet. 2005;365(9456):331–40. doi:10.1016/S0140- 6736(05)17789-7
24. 24. Hou Y, Li X, Yang L, Liu C, Wu H, Xu Y, et al. Factors associated with depression and anxiety in patients with end-stage renal disease receiving maintenance hemodialysis. International Urology and Nephrology. 2014;46(8):1645–9. doi:10.1007/s11255- 014-0685-2
25. 25. Cukor D, Ver Halen N, Fruchter Y. Anxiety and quality of life in ESRD. Seminars in Dialysis. 2013;26(3):265-8. doi:10.1111/sdi.12065
26. 26. Turkistani I, Nuqali A, Badawi M, Taibah O, Alserihy O, Morad M, et al. The prevalence of anxiety and depression among end-stage renal disease patients on hemodialysis in Saudi Arabia. Renal Failure. 2014;36(10):1510–5. doi: 10.3109/0886022X.2014.949761
27. 27. Mosleh H, Alenezi M, Al johani S, Alsani A, Fairaq G, Bedaiwi R. Prevalence and factors of anxiety and depression in chronic kidney disease patients undergoing hemodialysis: a cross-sectional single-center study in Saudi Arabia. Cureus. 2020;12(1): e6668. doi:10.7759/cureus.6668
28. 28. Demirbilek H, Ciğerli Ö, Yakupoğlu Ü, Turhan F, Erman AM, KÖSE A, et al. Hemodiyaliz hastalarında anksiyete ve depresyona psikososyal bakış açısı. Göztepe Tıp Derg. 2010;25(4):177–81. doi:10.5222/J.GOZTEPETRH.2010.177
29. 29. Cukor D, Coplan J, Brown C, Peterson RA, Kimmel PL. Course of depression and anxiety diagnosis in patients treated with hemodialysis: a 16-month follow-up. Clinical Journal of the American Society of Nephrology. 2008;3(6):1752–8. doi:10.2215/CJN.01120308
30. 30. Ćwiek A, Czok M, Kurczab B, Kramarczyk K, Drzyzga K, Kucia K. Association between depression and hemodialysis in patients with chronic kidney disease. Psychiatria Danubina. 2017;29(3):499–503.
31. 31. Flythe JE, Hilliard T, Castillo G, Ikeler K, Orazi J, Abdel-Rahman E, et al. Symptom prioritization among adults receiving incenter hemodialysis. Clinical Journal of the American Society of Nephrology. 2018;13(5):735–45. doi:10.2215/CJN.10850917