Araştırma Makalesi
BibTex RIS Kaynak Göster

Hemodiyaliz Hastalarında Kırılganlığın Günlük Yaşam Aktiviteleri ve Tedaviye Uyum Düzeyine Etkisi/The Effect of Frailty on Daily Living Activities and Treatment Adherence in Hemodialysis Patients

Yıl 2026, Cilt: 21 Sayı: 1, 36 - 47, 31.01.2026
https://doi.org/10.47565/ndthdt.2026.122

Öz

Amaç: Bu çalışmanın amacı, hemodiyaliz hastalarında kırılganlığın günlük yaşam aktiviteleri ve tedaviye uyum üzerindeki etkisini ayrıntılı olarak incelemektir.
Gereç ve Yöntem: Araştırma, Temmuz-Eylül 2023 tarihleri arasında Türkiye’nin doğusunda yer alan bir üniversite hastanesi ve özel hastanenin hemodiyaliz ünitelerinde yürütülmüş olup, kesitsel desende tanımlayıcı bir çalışmadır. Araştırmaya, hemodiyaliz tedavisi gören toplam 135 hasta dahil edilmiştir. Veriler, Hasta Bilgi Formu, Kırılganlık Ölçeği, Katz Günlük Yaşam Aktiviteleri Ölçeği ve Morisky İlaç Uyumu Ölçeği kullanılarak toplanmıştır.
Bulgular: Hastaların Kırılganlık Ölçeği, Katz Günlük Yaşam Aktiviteleri Ölçeği ve Morisky İlaç Uyumu Ölçeği ortalama puanları sırasıyla 2,19±1,58; 16,18±2,76 ve 2,58±1,27 olarak belirlenmiştir. Yaş, hem kırılganlık hem de günlük yaşam aktiviteleri üzerinde anlamlı bir etkiye sahip bulunurken, eğitim düzeyi yalnızca günlük yaşam aktiviteleri üzerinde anlamlı bir etkiye sahiptir (p<0,05). Kırılganlık ile günlük yaşam aktiviteleri arasında orta düzeyde negatif bir ilişki (r=-0,489), kırılganlık ile ilaç uyumu arasında orta düzeyde pozitif bir ilişki (r=0,302) saptanmıştır (p<0,001). Bulgular, hastaların kırılganlık düzeyleri azaldıkça günlük yaşam aktiviteleri puanlarının arttığını ve ilaç uyumlarının iyileştiğini göstermektedir.
Sonuç: Araştırma, hemodiyaliz hastalarının önemli ölçüde kırılgan olduğunu ve kırılganlığın hem günlük yaşam aktiviteleri hem de ilaç tedavisine uyum üzerinde anlamlı bir etkisi bulunduğunu ortaya koymaktadır. Bu bulgular, kırılganlığın klinik olarak değerlendirilmesi gerektiğini, hastaların günlük yaşam aktivitelerine ve tedaviye uyumunun artırılmasına yönelik çalışmalar yapılması gerektiğini vurgulamaktadır.

Etik Beyan

Etik Kurul Onayı: Etik onay bir üniversitenin Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu'ndan (Tarih: 24/01/2023, karar no: 2023/4349) alınmıştır. Araştırma protokolü Helsinki Bildirgesi'ne (Dünya Tabipler Birliği 2013) uygun olarak planlanmıştır. Çalışmaya katılan hastalardan aydınlatılmış onam alınmıştır. Tüm katılımcılara verilerin gizliliği konusunda bilgi verilmiştir.

Destekleyen Kurum

Bu araştırmada herhangi bir fon desteği bulunmamaktadır.

Teşekkür

Bu çalışmaya katılan tüm hemodiyaliz hastalarına teşekkür ederiz.

Kaynakça

  • 1. Karabulutlu EY, Yılmaz M. Level of concordance with fluid restriction in individuals receiving hemodialysis. Acıbadem Universty Journal of Health Sciences. 2019;(3):390-8. https://doi.org/10.31067/0.2018.97
  • 2. Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930. doi:10.1053/j.ajkd.2015.07.015 https://doi.org/10.1053/j.ajkd.2015.07.015
  • 3. Türk Nefroloji Derneği. Hemodiyaliz kılavuzu. Utaş C, Akpolat T, editörler. Ankara: Türk Nefroloji Derneği; 2020; 69-78. [Internet] 2020 [cited: 22.01.2026] Available from: https://nefroloji.org.tr/en/kilavuz-ve-kitaplar
  • 4. Turgay G, Tutal E, Sezer S. Evaluation of hemodialysis patients in terms of activities of daily living, disability, depression and comorbidity. Turk J Nephrol Dial Transplant. 2017;26(3):311-6. http://doi.org/10.5262/tndt.2017.1003.11
  • 5. Taşkın Yılmaz F, Sert H, Karakoç Kumsar A, Aygin D, Sipahi S, Genç AB. Evaluation of hope, symptom control, and medication compliance/adherence in hemodialysis patients. Acibadem Univ Health Sci J. 2018;11(1):35-43. https://doi.org/10.31067/0.2019.197
  • 6. Çelebi K, Erdoğmuş Ş, Turgut D. Determination of frailty and risk factors in elderly hemodialysis patients. Ankara University Faculty of Medicine Journal 2020;73(1):26-30. http://doi.org/10.4274/atfm.galenos.2020.14622
  • 7. Tsuruya K. Frailty and cognitive impairment in chronic kidney disease. In: Recent advances of sarcopenia and frailty in CKD. 2020:197-222. http://doi.org/10.1007/978-981-15-2365-6
  • 8. Bilgiç BD, Kızıltan G. Hemodiyaliz hastalarında frailite ile malnütrisyon arasındaki ilişkinin değerlendirilmesi. Başkent Üniv SağlıBilim Fak Derg. 2023;8(2):115-29. [Internet] 2023 [cited. 30.01.2026] Available from: http://hdl.handle.net/11727/10150
  • 9. Erken E, Güzel, F. B., Akkuş, G., Güngör, Ö., Altinören, O. The relationshp between frailty and cognitive impairment in young adult hemodialysis patients. Journal of Istanbul Faculty of Medicine. 2019;82(2):81-8. http://doi.org/10.26650/2018.0037
  • 10. Özkan ZK, Ünver S, Çetin B, Ecder T. Determining of compliance of patients receiving hemodialysis for fluid control. NefroHemDergi. 2019;14(1):10-6. [Internet] 2019 [cited: 28.01.2026] Available from:https://dergipark.org.tr/tr/pub/hemsire/article/494658
  • 11. Mechta Nielsen T, Marott, T., Hornum, M., Feldt-Rasmussen, B., Kallemose, T., Thomsen, T. Non-adherence, medication beliefs and symptom burden among patients receiving hemodialysis-a cross-sectional study. BMC Nephrol. 2023;24(1):321. https://doi.org/10.1186/s12882-023-03371-3
  • 12. Hymabaccus M. BAB. Turkish validity and reliability study of the FRAIL scale to measure frailty in the elderly. Ankara. Hacettepe University.;2017.
  • 13. Özkan Pehlivanoğlu EFÖ, Özkan MU, Balcıoğlu H, Bilge U, Ünlüoğlu İ. Adjustment and reliability of Katz daily life activity measures for elderly in Turkish. Ankara Med J. 2018;18(2):219-23. https://doi.org/10.17098/amj.435264
  • 14. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74. https://10.1097/00005650-198601000-0000
  • 15. Hornik B, Duława J. Frailty, quality of life, anxiety, and other factors affecting adherence to physical activity recommendations by hemodialysis patients. Int J Environ Res Public Health. 2019;16(10):1827. https://doi.org/10.3390/ ijerph16101827
  • 16. Álvarez López Á, Cancho Castellano B, Lopez Arnaldo C, Diaz Campillejo RM, Garcia de Vinuesa P, Elena Aragon Lara R, et al. Body composition evaluated by bioimpedance in frail patients on hemodialysis. Nephrology Dialysis Transplantation. 2021;36:102.0014. http://doi.org/10.1093/ndt/gfab102.0014
  • 17. Kutner NG, Zhang R, Huang Y, McClellan WM, Lea J, Soltow QA. Risk factors for frailty in a large prevalent cohort of hemodialysis patients. The American Journal of the Medical Sciences. 2014;348(4):277-82. https://doi.org/10.1097/MAJ.0000000000000250
  • 18. Chen G, Zhang H, Du X, Yin L, Zhang H, Zhou Q. Comparison of the prevalence and associated factors of cognitive frailty between elderly and middle-young patients receiving maintenance hemodialysis. International Urology and Nephrology. 2022;54(10):2703-11. https://doi.org/10.1007/s11255-022-03188-3
  • 19. Datlı Yakaryılmaz F, Pembegül İ. The relationship between hopelessness and daily living activities in hemodialysis patients. Fırat University Health Sciences Medical Journal. 2022;36(2):97-100. [Internet] 2022 [cited: 28.01.2026] Available from: http:// www.fusabil.org/
  • 20. Rani D, Kalia R. Activities of daily living (ADL) and fatigue among patients undergoing hemodialysis. Nursing and Midwifery Research Journal. 2022;18(2):88-96. https://doi.org/10.1177/0974150X221085747
  • 21. Kamitani T, Fukuma S, Shimizu S, Akizawa T, Fukuhara S. Length of hospital stay is associated with a decline in activities of daily living in hemodialysis patients: a prospective cohort study. BMC Nephrol. 2020;21(1):9. doi:10.1186/s12882-019-1674-6.
  • 22. Jiménez MDA, García MN, Reina ES, Álvarez Ude F. Disability in instrumental activities of daily living in hemodialysis patients: Influence on quality of life related to health. Nefrol (Engl Ed). 2019;39(5):531-8. https://doi.org/10.1016/j.nefroe.2019.10.007
  • 23. Bülbül E, Demiroğlu S. The relationship between health literacy and adherence to treatment in patients receiving hemodialysis treatment. Karya Journal of Health Science. 2023;4(1):1-5. https://doi.org/10.52831/kjhs.1166286
  • 24. Rahdar Z, Haghighi MJ, Mansouri A, Siasary A, Alahyari J, Jahantigh F. Probing the relationship between treatment regimen compliance and the quality of life in hemodialysis patients: A descriptive-analytic study. Medical-Surgical Nursing Journal. 2019;8(2):e95599. http://doi.org/%2010.5812/msnj.95599
  • 25. Gowda H, Shastry A, Narula R, Srinivasan R. A study on assessment of medication adherence in hemodialysis patients. The Pharma Innovation Journal. 2020;9(6):253-8. http://www.thepharmajournal.com/
  • 26. Gesualdo G, Duarte JG, Zazzetta MS, Kusumota LO, Fabiana de Souza. Frailty and associated risk factors in patients with chronic kidney disease on dialysis. Ciência Saúde Coletiva. 2020;25:4631-7. https://doi.org/10.1590/1413-812320202511.03482019
  • 27. Darvall JN, Fanzca M, Loth J, Bose T, Braat S, Loth J. Accuracy of the clinical frailty scale for perioperative frailty screening: A prospective observational study. Canadian Journal of Anesthesia. 2020;67:694-705. http://doi.org/10.1007/s12630-020-01610
  • 28. Ying J, Cai G, Pan M, Sun X, Shao B, Xiang S, Yu W, Chen J, Yuan J. Effect of frailty phenotype on activities of daily living in maintenance hemodialysis patients. Chinese Journal of Nephrology. 2021;37:639-46. http://doi.org/10.3760/cma.j.cn441217-20201221-00095
  • 29. Kimura H, Kalantar-Zadeh K, Rhee CM, Streja E, Sy J. Polypharmacy and frailty among hemodialysis patients. Nephron. 2021;145(6):624-632. https://doi.org/10.1159/000516532
  • 30. Kimura H, Kalantar-Zadeh K, Rhee CM, Streja E, Sy J. Geriatric syndromes are potential determinants of the medication adherence status in prevalent dialysis patients. PeerJ. 2016;4:e2122. http://dx.doi.org/10.7717/peerj.2122
  • 31. Zhu L, Liu Y, Yang F, Yu S, Fu P, Yuan H. Prevalence, associated factors and clinical implications of medication literacy linked to frailty in hemodialysis patients in China: A cross-sectional study. BMC Nephrology. 2023;24(1):307. https://doi.org/10.1186/s12882-023-03346-4.

The Effect of Frailty on Daily Living Activities and Treatment Adherence in Hemodialysis Patients/Hemodiyaliz Hastalarında Kırılganlığın Günlük Yaşam Aktiviteleri ve Tedaviye Uyum Düzeyine Etkisi

Yıl 2026, Cilt: 21 Sayı: 1, 36 - 47, 31.01.2026
https://doi.org/10.47565/ndthdt.2026.122

Öz

Aim: This study aimed to examine in detail the impact of frailty on activities of daily living and treatment adherence among hemodialysis patients.
Materials and Methods: The study was conducted between July and September 2023 in the hemodialysis units of a university hospital and a private hospital located in eastern Türkiye, using a cross-sectional descriptive design. A total of 135 patients receiving hemodialysis treatment were included in the study. Data were collected using the Patient Information Form, Frailty Assessment Scale, Katz Index of Activities of Daily Living, and the Morisky Medication Adherence Scale.
Results: The mean scores of the Frailty Assessment Scale, Katz Index of Activities of Daily Living, and Morisky Medication Adherence Scale were 2.19±1.58, 16.18±2.76, and 2.58±1.27, respectively. Age was found to significantly affect both frailty and activities of daily living, whereas educational level had a significant effect only on activities of daily living (p<0.05). A moderate negative correlation was observed between frailty and activities of daily living (r=-0.489), and a moderate positive correlation was observed between frailty and medication adherence (r=0.302) (p<0.001). The findings indicate that as patients’ frailty levels decreased, their activities of daily living scores increased, while their medication adherence improved.
Conclusion: The study revealed that hemodialysis patients are significantly frail and that frailty has a considerable impact on both activities of daily living and adherence to treatment. These findings underscore the need for clinical assessment of frailty and the implementation of interventions aimed at improving daily functioning and treatment adherence in this patient population.

Etik Beyan

Ethıcs Commıttee Approval: Ethical approval was obtained from the Non-Interventional Clinical Research Ethics Committee of a University (Date: 24/01/2023, decision no: 2023/4349). The research protocol was planned in accordance with the Declaration of Helsinki (World Medical Association 2013). Informed consent was obtained from the patients participating in the study. All participants were informed about the confidentiality of the data.

Destekleyen Kurum

There is no funding support in this research.

Teşekkür

We thank all hemodialysis patients who participated in this study.

Kaynakça

  • 1. Karabulutlu EY, Yılmaz M. Level of concordance with fluid restriction in individuals receiving hemodialysis. Acıbadem Universty Journal of Health Sciences. 2019;(3):390-8. https://doi.org/10.31067/0.2018.97
  • 2. Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930. doi:10.1053/j.ajkd.2015.07.015 https://doi.org/10.1053/j.ajkd.2015.07.015
  • 3. Türk Nefroloji Derneği. Hemodiyaliz kılavuzu. Utaş C, Akpolat T, editörler. Ankara: Türk Nefroloji Derneği; 2020; 69-78. [Internet] 2020 [cited: 22.01.2026] Available from: https://nefroloji.org.tr/en/kilavuz-ve-kitaplar
  • 4. Turgay G, Tutal E, Sezer S. Evaluation of hemodialysis patients in terms of activities of daily living, disability, depression and comorbidity. Turk J Nephrol Dial Transplant. 2017;26(3):311-6. http://doi.org/10.5262/tndt.2017.1003.11
  • 5. Taşkın Yılmaz F, Sert H, Karakoç Kumsar A, Aygin D, Sipahi S, Genç AB. Evaluation of hope, symptom control, and medication compliance/adherence in hemodialysis patients. Acibadem Univ Health Sci J. 2018;11(1):35-43. https://doi.org/10.31067/0.2019.197
  • 6. Çelebi K, Erdoğmuş Ş, Turgut D. Determination of frailty and risk factors in elderly hemodialysis patients. Ankara University Faculty of Medicine Journal 2020;73(1):26-30. http://doi.org/10.4274/atfm.galenos.2020.14622
  • 7. Tsuruya K. Frailty and cognitive impairment in chronic kidney disease. In: Recent advances of sarcopenia and frailty in CKD. 2020:197-222. http://doi.org/10.1007/978-981-15-2365-6
  • 8. Bilgiç BD, Kızıltan G. Hemodiyaliz hastalarında frailite ile malnütrisyon arasındaki ilişkinin değerlendirilmesi. Başkent Üniv SağlıBilim Fak Derg. 2023;8(2):115-29. [Internet] 2023 [cited. 30.01.2026] Available from: http://hdl.handle.net/11727/10150
  • 9. Erken E, Güzel, F. B., Akkuş, G., Güngör, Ö., Altinören, O. The relationshp between frailty and cognitive impairment in young adult hemodialysis patients. Journal of Istanbul Faculty of Medicine. 2019;82(2):81-8. http://doi.org/10.26650/2018.0037
  • 10. Özkan ZK, Ünver S, Çetin B, Ecder T. Determining of compliance of patients receiving hemodialysis for fluid control. NefroHemDergi. 2019;14(1):10-6. [Internet] 2019 [cited: 28.01.2026] Available from:https://dergipark.org.tr/tr/pub/hemsire/article/494658
  • 11. Mechta Nielsen T, Marott, T., Hornum, M., Feldt-Rasmussen, B., Kallemose, T., Thomsen, T. Non-adherence, medication beliefs and symptom burden among patients receiving hemodialysis-a cross-sectional study. BMC Nephrol. 2023;24(1):321. https://doi.org/10.1186/s12882-023-03371-3
  • 12. Hymabaccus M. BAB. Turkish validity and reliability study of the FRAIL scale to measure frailty in the elderly. Ankara. Hacettepe University.;2017.
  • 13. Özkan Pehlivanoğlu EFÖ, Özkan MU, Balcıoğlu H, Bilge U, Ünlüoğlu İ. Adjustment and reliability of Katz daily life activity measures for elderly in Turkish. Ankara Med J. 2018;18(2):219-23. https://doi.org/10.17098/amj.435264
  • 14. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74. https://10.1097/00005650-198601000-0000
  • 15. Hornik B, Duława J. Frailty, quality of life, anxiety, and other factors affecting adherence to physical activity recommendations by hemodialysis patients. Int J Environ Res Public Health. 2019;16(10):1827. https://doi.org/10.3390/ ijerph16101827
  • 16. Álvarez López Á, Cancho Castellano B, Lopez Arnaldo C, Diaz Campillejo RM, Garcia de Vinuesa P, Elena Aragon Lara R, et al. Body composition evaluated by bioimpedance in frail patients on hemodialysis. Nephrology Dialysis Transplantation. 2021;36:102.0014. http://doi.org/10.1093/ndt/gfab102.0014
  • 17. Kutner NG, Zhang R, Huang Y, McClellan WM, Lea J, Soltow QA. Risk factors for frailty in a large prevalent cohort of hemodialysis patients. The American Journal of the Medical Sciences. 2014;348(4):277-82. https://doi.org/10.1097/MAJ.0000000000000250
  • 18. Chen G, Zhang H, Du X, Yin L, Zhang H, Zhou Q. Comparison of the prevalence and associated factors of cognitive frailty between elderly and middle-young patients receiving maintenance hemodialysis. International Urology and Nephrology. 2022;54(10):2703-11. https://doi.org/10.1007/s11255-022-03188-3
  • 19. Datlı Yakaryılmaz F, Pembegül İ. The relationship between hopelessness and daily living activities in hemodialysis patients. Fırat University Health Sciences Medical Journal. 2022;36(2):97-100. [Internet] 2022 [cited: 28.01.2026] Available from: http:// www.fusabil.org/
  • 20. Rani D, Kalia R. Activities of daily living (ADL) and fatigue among patients undergoing hemodialysis. Nursing and Midwifery Research Journal. 2022;18(2):88-96. https://doi.org/10.1177/0974150X221085747
  • 21. Kamitani T, Fukuma S, Shimizu S, Akizawa T, Fukuhara S. Length of hospital stay is associated with a decline in activities of daily living in hemodialysis patients: a prospective cohort study. BMC Nephrol. 2020;21(1):9. doi:10.1186/s12882-019-1674-6.
  • 22. Jiménez MDA, García MN, Reina ES, Álvarez Ude F. Disability in instrumental activities of daily living in hemodialysis patients: Influence on quality of life related to health. Nefrol (Engl Ed). 2019;39(5):531-8. https://doi.org/10.1016/j.nefroe.2019.10.007
  • 23. Bülbül E, Demiroğlu S. The relationship between health literacy and adherence to treatment in patients receiving hemodialysis treatment. Karya Journal of Health Science. 2023;4(1):1-5. https://doi.org/10.52831/kjhs.1166286
  • 24. Rahdar Z, Haghighi MJ, Mansouri A, Siasary A, Alahyari J, Jahantigh F. Probing the relationship between treatment regimen compliance and the quality of life in hemodialysis patients: A descriptive-analytic study. Medical-Surgical Nursing Journal. 2019;8(2):e95599. http://doi.org/%2010.5812/msnj.95599
  • 25. Gowda H, Shastry A, Narula R, Srinivasan R. A study on assessment of medication adherence in hemodialysis patients. The Pharma Innovation Journal. 2020;9(6):253-8. http://www.thepharmajournal.com/
  • 26. Gesualdo G, Duarte JG, Zazzetta MS, Kusumota LO, Fabiana de Souza. Frailty and associated risk factors in patients with chronic kidney disease on dialysis. Ciência Saúde Coletiva. 2020;25:4631-7. https://doi.org/10.1590/1413-812320202511.03482019
  • 27. Darvall JN, Fanzca M, Loth J, Bose T, Braat S, Loth J. Accuracy of the clinical frailty scale for perioperative frailty screening: A prospective observational study. Canadian Journal of Anesthesia. 2020;67:694-705. http://doi.org/10.1007/s12630-020-01610
  • 28. Ying J, Cai G, Pan M, Sun X, Shao B, Xiang S, Yu W, Chen J, Yuan J. Effect of frailty phenotype on activities of daily living in maintenance hemodialysis patients. Chinese Journal of Nephrology. 2021;37:639-46. http://doi.org/10.3760/cma.j.cn441217-20201221-00095
  • 29. Kimura H, Kalantar-Zadeh K, Rhee CM, Streja E, Sy J. Polypharmacy and frailty among hemodialysis patients. Nephron. 2021;145(6):624-632. https://doi.org/10.1159/000516532
  • 30. Kimura H, Kalantar-Zadeh K, Rhee CM, Streja E, Sy J. Geriatric syndromes are potential determinants of the medication adherence status in prevalent dialysis patients. PeerJ. 2016;4:e2122. http://dx.doi.org/10.7717/peerj.2122
  • 31. Zhu L, Liu Y, Yang F, Yu S, Fu P, Yuan H. Prevalence, associated factors and clinical implications of medication literacy linked to frailty in hemodialysis patients in China: A cross-sectional study. BMC Nephrology. 2023;24(1):307. https://doi.org/10.1186/s12882-023-03346-4.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Nefroloji Hemşireliği
Bölüm Araştırma Makalesi
Yazarlar

Hatice Oltuluoğlu 0000-0003-0141-8567

Sema Kömürkara 0000-0002-4965-8650

Gönderilme Tarihi 22 Kasım 2025
Kabul Tarihi 26 Ocak 2026
Yayımlanma Tarihi 31 Ocak 2026
Yayımlandığı Sayı Yıl 2026 Cilt: 21 Sayı: 1

Kaynak Göster

Vancouver 1.Oltuluoğlu H, Kömürkara S. The Effect of Frailty on Daily Living Activities and Treatment Adherence in Hemodialysis Patients/Hemodiyaliz Hastalarında Kırılganlığın Günlük Yaşam Aktiviteleri ve Tedaviye Uyum Düzeyine Etkisi. NefroHemDergi [Internet]. 01 Ocak 2026;21(1):36-47. Erişim adresi: https://izlik.org/JA57LR27RY

Nefroloji Hemşireliği Dergisi/ Journal of Nephrology Nursing Creative Commons Lisansı Creative Commons Atıf-GayriTicari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.