HEMODİYALİZ HASTALARINDA VOLÜM DURUMUNUN YAŞAM KALİTESİ, ANKSİYETE, DEPRESYON VE UYKU KALİTESİ ÜZERİNE ETKİSİ

Year 2024, , 71 - 79, 18.03.2024

Selma Özlem Çelikdelen

https://doi.org/10.17343/sdutfd.1401138

Abstract

Amaç
Çalışmada hemodiyalize girmekte olan hastaların biyoimpedans
yöntemi ile volüm durumlarının belirlenmesi
ve volüm durumunun hastaların yaşam kalitesi,
anksiyete, depresyon ve uyku kalitesi ile ilişkisinin
araştırılması amaçlandı.
Gereç ve Yöntem
Kesitsel olarak planlanan çalışmaya 2016 Yılı Mart
Ayı’nda Hemodiyaliz Ünitesinde hemodiyalize girmekte
olan toplam 100 hasta alındı. Hastaların volüm
durumunu belirlemek için, hafta ortası hemodiyaliz
seansları öncesinde vücut kompozisyon monitörü ile
biyoelektriksel impedans analizi (BİA) yapıldı. Hastaların
yaşam kaliteleri SF-36 yaşam kalitesi ölçeği ile,
uyku kalitesi Pittsburg Uyku Kalitesi İndeksi (PUKİ)
kullanılarak, depresyon taramaları Beck Depresyon
Ölçeği (BDÖ), anksiyete taramaları Beck Anksiyete
Ölçeği ile değerlendirildi. Hastalar BİA parametrelerinden
hücre dışı sıvı/ total vücut sıvısı (HDS/TVS)
oranlarına göre üç gruba ayrıldı. Grup1; <25 persentil
(HDS/TVS<0,426 Lt, n=24), grup 2; 25-50 persentil
(HDS/TVS: 0,426-0,438 Lt, n=37), grup 3; 50-75 persentil
(HDS/TVS: 0,438-0,481 Lt, n=39). İstatiksel
analizler üç grup üzerinden yapıldı.
Bulgular
Kadın cinsiyette, yalnız yaşayan ve eğitim seviyesi
düşük olan hastalarda HDS/TVS oranları yüksek bulundu.
HDS/TVS oranı arttıkça, yaşam kalitesi komponentlerinden;
fiziksel komponent (p=0,01) ve mental
komponentte (p=0,02) bozulma olduğu; fiziksel komponent
bileşenlerinden; fiziksel fonksiyon (p<0,001),
fiziksel rol güçlüğü (p=0,03), genel sağlık algısında
(p=0,03) azalma, mental komponent bileşenlerinden;
mental sağlık (p=0,01), sosyal fonksiyon (p<0,001) ve
vitalite (p=0,01) alanlarında bozulma olduğu görüldü.
Tüm hastalarda depresyon oranı %40, gruplar kendi
içinde değerlendirildiğinde depresyon oranı grup 1’de
%25, grup 2’de %43 ve grup 3’de %45 olarak tespit
edildi. HDS/TVS oranı arttıkça, depresyon skorlarında
istatiksel anlamlı olmayan bir artış izlendi. Çalışmaya
alınan hastaların tamamında PUKİ total skoru 5’in üstünde
saptandı.
Sonuç
Çalışma sonucunda, HD hastalarında HDS/TVS oranı
arttıkça, yaşam kalitesinin azaldığı, depresyon ve anksiyete bulgularının arttığı, uyku kalitesinin bozulduğu,
uyku veriminin azaldığı ve uyku süresinin kısaldığını
saptadık. Tüm bu faktörlerin, hastaların morbidite ve
sağkalımına etkisi göz önüne alındığında, HD hastalarında
volüm kontrolü ve kuru ağırlık tespiti önemlidir.

Keywords

hemodiyaliz, biyoimpedans, yaşam kalitesi, uyku kalitesi, depresyon

THE EFFECT OF VOLUME STATUS ON QUALITY OF LIFE, ANXIETY, DEPRESSION AND SLEEP QUALITY IN HEMODIALYSIS PATIENTS

Abstract

Objectives
To determine the volume status of patients undergoing
hemodialysis using the bioimpedance method and to
investigate the relationship of volume status with the
patients’ quality of life, anxiety, depression, and sleep
quality.
Material and Method
This cross-sectional study included a total of 100
patients undergoing hemodialysis at the Hemodialysis
Unit in March 2016. The volume status of the patients
was determined using bioelectrical impedance
analysis (BIA) performed with a body composition
monitor before their mid-week hemodialysis sessions.
The quality of life was evaluated using the 36-item
Short Form Survey, sleep quality was assessed using
the Pittsburg Sleep Quality Index (PSQI), depression
screening was performed with the Beck Depression
Inventory, and anxiety screening was undertaken with
the Beck Anxiety Inventory. The patients were divided
into three groups according to the extracellular fluid/
total body fluid (ECF/TBF) ratio, which is one of the
BIA parameters: Group 1, <25th percentile (ECF/
TBF<0.426 L, n=24); Group 2, 25-50th percentile
(ECF/TBF: 0.426-0.438 L, n=37); and Group 3, 50-
75th percentile (ECF/TBF: 0.438-0.481 L, n=39).
Statistical analyses were performed for the three
groups.
Results
The ECF/TBF ratio was found to be higher in female
patients, individuals who lived alone, and those
with a low educational level. As the ECF/TBF ratio
increased, there was a deterioration in the physical
and mental components of quality of life, including
physical functioning (p<0.001), physical role difficulties
(p=0.03), general health perceptions (p=0.03), mental
component (p=0.02), mental health (p=0.01), social
functioning (p<0.001), and vitality (p=0.01). The rate
of depression was 40% in all patients, 25% in Group 1,
43% in Group 2, and 45% in Group 3. As the ECF/TBF
ratio increased, a statistically non-significant increase
was observed in depression scores. The PSQI total
score was found to be above 5 in all patients included
in the study.
Conclusion
It was determined that as the ECF/TBF ratio increased
in hemodialysis patients, the quality of life decreased,
depression and anxiety symptoms increased, sleep
quality deteriorated, sleep efficiency decreased, and
sleep duration was shortened. Considering the impact
of all these factors on patients’ morbidity and survival,
it is important to determine volume status and dry
weight in patients undergoing hemodialysis.

Keywords

hemodialysis, bioimpedance, quality of life, sleep quality, depression

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