Use of Auriculotherapy in Symptom Management of Hemodialysis Patients: A Traditional Review

Öz

End-stage renal disease , the final stage of Chronic Kidney Disease, is a severe condition characterized by irreversible loss of kidney function. At this stage, renal replacement therapies—hemodialysis (HD), peritoneal dialysis, or transplantation are essential for patient survival. In Turkey, HD is the most frequently preferred treatment method. However, while HD provides physiological benefits, it is also associated with significant side effects and symptoms that adversely affect quality of life. Constipation, pruritus, fatigue, sleep disturbances, pain, depression, and anxiety are among the most common symptoms. The prolonged and intense experience of these symptoms negatively impacts treatment adherence and overall well-being. In recent years, patients have increasingly turned to Complementary and Integrative Therapies (CIT) to manage these symptoms. CIT modalities are preferred due to their low risk of side effects, cost-effectiveness, immune system support, and promotion of psychological well-being. Methods such as acupuncture, reflexology, aromatherapy, and meditation are frequently used for symptom management in HD patients. Among these, auriculotherapy stands out as a non-invasive, low-cost, and minimally side-effect-prone option. Auriculotherapy, which involves stimulating reflex points on the auricle to modulate the autonomic nervous system, has demonstrated efficacy in multiple areas, including pain management, anxiety reduction, sleep quality improvement, and alleviation of gastrointestinal symptoms. Research indicates that auriculotherapy is particularly effective in reducing insomnia, pruritus, constipation, thirst, and fistula-related pain in HD patients. Recent studies highlight its potential to enhance quality of life and improve symptom control in this population.

Anahtar Kelimeler

• Hemodialysis
• Auriculotherapy
• Chronic Kidney Disease
• Complementary and Integrative Therapy

Hemodiyaliz Hastalarının Semptom Yönetiminde Aurikuloterapi Kullanımı: Geleneksel Derleme

Öz

Kronik Böbrek Hastalığı’nın son evresi olan son dönem böbrek yetmezliği, böbrek fonksiyonlarının geri dönüşümsüz şekilde kaybedildiği ciddi bir durumdur. Bu evrede, hastaların hayatta kalabilmesi için renal replasman tedavilerinden; Hemodiyaliz (HD), periton diyalizi veya transplantasyon yapılmalıdır. Türkiye’de, HD tedavisi en sık tercih edilen yöntemdir. Ancak, HD tedavisi fizyolojik faydalarının yanı sıra ciddi yan etkiler ve yaşam kalitesini olumsuz etkileyen semptomlarla ilişkilidir. Konstipasyon, kaşıntı, yorgunluk, uyku bozuklukları, ağrı, depresyon ve anksiyete bu semptomların başında gelmektedir. Bu semptomların uzun süreli ve yoğun yaşanması, tedaviye uyum ve genel iyilik halini olumsuz etkiler. Son yıllarda, hastalar bu semptomları yönetebilmek için Tamamlayıcı ve İntegratif Tedavi yöntemlerine yönelmektedir. TİT uygulamaları düşük yan etki riski, düşük maliyet, bağışıklık sistemini destekleme ve ruhsal iyilik hali sağlama gibi avantajlar nedeniyle tercih edilmektedir. Akupunktur, refleksoloji, aromaterapi, meditasyon gibi yöntemler, HD hastalarında semptom yönetiminde sıklıkla tercih edilmektedir. Aurikuloterapi bu yöntemler arasında invaziv olmayan, düşük maliyetli ve yan etkisi minimal bir seçenek olarak öne çıkmaktadır. Kulak kepçesinde bulunan refleks noktaların uyarılması yoluyla otonom sinir sistemini etkileyen aurikuloterapi, ağrı yönetimi, anksiyete azalması, uyku kalitesinin artırılması ve gastrointestinal semptomların iyileştirilmesi gibi birçok alanda etkili bulunmaktadır. Araştırmalar, HD hastalarında aurikuloterapinin özellikle uykusuzluk, kaşıntı, kabızlık, susuzluk ve fistül ağrısı gibi semptomları azaltmada başarılı olduğunu göstermektedir Son yıllarda yapılan çalışmalar, aurikuloterapinin hemodiyaliz hastalarında yaşam kalitesini artırma ve semptom kontrolüne katkı sağlama potansiyeline sahip olduğunu ortaya koymaktadır.

Anahtar Kelimeler

• Hemodiyaliz
• Aurikuloterapi
• Kronik Böbrek Hastalığı
• Tamamlayıcı ve İntegratif Tedavi

Kaynakça

1. 1. Akyol Güner T, ve ark. Kronik böbrek yetmezliği hastalarının bakım vericilerinin yaşam kalitesi. Nefroloji Hemşireliği Dergisi 2018;13(2):91-7.
2. 2. Lukela JR, et al. UMHS chronic kidney disease guidelines: Management of chronic kidney disease [Thesis]. Michigan; 2019.
3. 3. Gupta R, Woo K, Yi JA. Epidemiology of end-stage kidney disease. Semin Vasc Surg 2021;34(1):71-78. doi: 10.1053/j.semvascsurg.2021.02.010.
4. 4. Thurlow JS, et al. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol 2021;52(2):98-107. doi: 10.1159/000514550.
5. 5. T.C. Sağlık Bakanlığı, Türk Nefroloji Derneği. Türkiye’de Nefroloji, Diyaliz ve Transplantasyon 2023. Yayına hazırlayanlar: Kenan Ateş, Nurhan Seyahi, İsmail Koçyiğit. Ankara: T.C. Sağlık Bakanlığı; 2024.
6. 6. Himmelfarb J, Ikizler TA. Hemodialysis. N Engl J Med 2010;363(19):1833-45. doi: 10.1056/NEJMra0902710. 7. Ersoy FF. Hemodiyalizin fiziksel temelleri. In: Akpolat T, Utag C, editörler. Hemodiyaliz Hekimi El Kitabı 3. Samsun: Ceylan Ofset; 2010. s.1-5.
7. 8. Flythe JE, et al. Patient-reported outcome instruments for physical symptoms among patients receiving maintenance dialysis: A systematic review. Am J Kidney Dis 2015;66(6):1033-46. doi: 10.1053/j.ajkd.2015.05.018.
8. 9. Flythe JE, et al. Fostering innovation in symptom management among hemodialysis patients. Clin J Am Soc Nephrol 2019;14(1):150-60. doi: 10.2215/CJN.07950718.

9. 10. Akgöz N, Arslan S. Hemodiyaliz tedavisi alan hastalarda yaşanan semptomların incelenmesi. Nefroloji Hemşireliği Dergisi 2017;12(1):20-8.
10. 11. Varol E, Karaca Sivrikaya S. Kronik böbrek yetmezliğinde yaşam kalitesi ve hemşirelik. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 2018;8(2):89-96.
11. 12. Markell MS, Terebelo S. Complementary medicine use, symptom burden and non-adherence in kidney transplant recipients. Explore (NY) 2018;14(6):414-9. doi: 10.1016/j.explore.2018.04.010.
12. 13. Castelino LR, Nayak-Rao S, Shenoy MP. Prevalence of use of complementary and alternative medicine in chronic kidney disease: A cross-sectional single-center study from South India. Saudi J Kidney Dis Transpl 2019;30(1):185-93.
13. 14. Ovayolu N, et al. Böbrek yetmezliğinde tamamlayıcı tedaviler. Nefroloji Hemşireliği Dergisi 2015;10(1):40-6.
14. 15. Döner A, Taşcı S. Böbrek hastalıklarında tamamlayıcı ve integratif (bütünleşik) uygulamalar. In: Ünsal Avdal E, editör. Nefrolojide Güncel Kanıt Temelli Yaklaşımlar. 1. Baskı. Ankara: Türkiye Klinikleri; 2022. s.81-91.
15. 16. Eroğlu H, Metin ZG. Hemodiyaliz hastalarında semptom yönetiminde tamamlayıcı ve integratif yaklaşımlar: Sistematik bir derleme. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2021;8(3):252-68. doi: 10.17681/hunhemsire.892684.
16. 17. Ceyhan D, Yiğit TT. Güncel tamamlayıcı ve alternatif tıbbi tedavilerin sağlık uygulamalarındaki yeri. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 2016;6(3):178-89.
17. 18. NCCAM. Complementary, alternative, or integrative health: What’s in a name? [Internet]. New York: Association of Cancer Online Resources, Inc.; c2000-01 [updated 2002 May 16; cited 2002 Jul 9]. Available from: http://nccam.nih.gov/health/whatiscam.
18. 19. Jeon HO, Kim BH, Kim O. Illness uncertainty and complementary and alternative medicine use in patients undergoing hemodialysis. Nurs Health Sci 2019;21(3):375-81. doi: 10.1111/nhs.12615.
19. 20. Kligler B, Teets R, Quick M. Complementary/integrative therapies that work: A review of the evidence. Am Fam Physician 2016;94(5):369-74.
20. 21. Delgado R, et al. Assessing the quality, efficacy, and effectiveness of the current evidence base of active self-care complementary and integrative medicine therapies for the management of chronic pain: A rapid evidence assessment of the literature. Pain Med. 2014;15(1):9-20. doi: 10.1111/pme.12381.
21. 22. Dyer NL, Surdam J, Dusek JA. A systematic review of practice-based research of complementary and integrative health therapies as provided for pain management in clinical settings: Recommendations for the future and a call to action. Pain Med (Malden, Mass) 2022;23(1):189–210. doi: 10.1093/pm/pnab151.
22. 23. Ceyhan Ö, et al. The use of complementary and alternative medicine by patients undergoing hemodialysis. Altern Ther Health Med 2017;23(1):40-5.
23. 24. Shahriari A, et al. The effect of foot reflexology massage on pruritus in hemodialysis patients. J Educ Health Promot 2021;10:81. doi: 10.4103/jehp.jehp_1252_20.
24. 25. Jahromi LSM, et al. Efficacy of acupuncture on pain severity and frequency of calf cramps in dialysis patients: A randomized clinical trial. J Acupunct Meridian Stud 2024;17(2):47-54. doi: 10.1016/j.jams.2023.11.002.
25. 26. Soliva MS, et al. The effectiveness of live music in reducing anxiety and depression among patients undergoing haemodialysis: A randomised controlled pilot study. PLoS One 2024;19(8): e0307661. doi: 10.1371/journal.pone.0307661.
26. 27. Komariah A, Rochmawati E. Complementary and integrative interventions for improving fatigue and quality of life in adults receiving hemodialysis: A scoping review. J Nurs Pract 2022;5(3):488-96.
27. 28. Yang G, et al. Auricular acupressure helps alleviate xerostomia in maintenance hemodialysis patients: A pilot study. J Altern Complement Med 2017;23(4):278-84. doi: 10.1089/acm.2016.0283.
28. 29. Wu Y, et al. Auricular acupressure helps improve sleep quality for severe insomnia in maintenance hemodialysis patients: A pilot study. J Altern Complement Med 2014;20(5):356-63. doi: 10.1089/acm.2013.0319.
29. 30. Chang A, Chung Y, Kang M. Effects of the combination of auricular acupressure and a fluid-restriction adherence program on salivary flow rate, xerostomia, fluid control, interdialytic weight gain, and diet-related quality of life in patients undergoing hemodialysis. Int J Environ Res Public Health 2021;18(19):10520. doi: 10.3390/ijerph181910520.
30. 31. Wu Y, et al. Auricular acupressure for insomnia in hemodialysis patients: Study protocol for a randomized controlled trial. Trials 2018;19(1):171. doi: 10.1186/s13063-018-2546-2.
31. 32. Zou C, et al. Auricular acupressure on specific points for hemodialysis patients with insomnia: A pilot randomized controlled trial. PLoS One 2015;10(4): e0122724. doi: 10.1371/journal.pone.0122724.
32. 33. Li AY, Zhang JY. Nursing observation on improving insomnia of patients with hemodialysis by pressing ear points. World Latest Med Inform 2019;19(05):258-60.
33. 34. Pei M, et al. Auricular Acupressure for Insomnia in Patients With Maintenance Hemodialysis: A Systematic Review and Meta-Analysis. Front Psychiatry 2021;12:576050. doi:10.3389/fpsyt.2021.576050.
34. 35. Wu Y, et al. Auricular acupressure for hemodialysis patients with insomnia: A multicenter double-blind randomized sham-controlled trial. J Integr Complement Med 2022;28(4):339-48. doi: 10.1089/jicm.2021.0367.
35. 36. Hou PW, et al. The history, mechanism, and clinical application of auricular therapy in traditional Chinese medicine. Evid Based Complement Alternat Med 2015;2015:495684. doi: 10.1155/2015/495684.
36. 37. Guo K, et al. Multi-level exploration of auricular acupuncture: From traditional Chinese medicine theory to modern medical application. Front Neurosci 2024;18:1426618. doi: 10.3389/fnins.2024.1426618.
37. 38. Kuo SY, et al. Auricular acupressure relieves anxiety and fatigue, and reduces cortisol levels in post-caesarean section women: A single-blind, randomised controlled study. Int J Nurs Stud 2016;53:17-26. doi: 10.1016/j.ijnurstu.2015.10.006.
38. 39. Zhong J, et al. Ear acupressure for allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2021;2021:6699749. doi: 10.1155/2021/6699749.
39. 40. Liu M, et al. Effects of auricular point acupressure on pain relief: A systematic review. Pain Manag Nurs 2021;22(3):268-80. doi: 10.1016/j.pmn.2020.07.007.
40. 41. Hu N, et al. Ear-marking relief: A meta-analysis on the efficacy of auricular acupressure in alleviating anxiety disorders. Complement Med Res 2024;31(3):266-77. doi: 10.1159/000537734.
41. 42. Gao J, et al. The effect of auricular therapy on blood pressure: A systematic review and meta-analysis. Eur J Cardiovasc Nurs 2020;19(1):20-30. doi: 10.1177/1474515119876778.
42. 43. Xin D, et al. Effect of auricular acupressure on sleep quality in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract 2024;57:101876. doi: 10.1016/j.ctcp.2024.101876.
43. 44. Zhang L. Observation on the effectiveness of auricular point attachment in the treatment of insomnia in maintenance hemodialysis patients [master's thesis]. Hubei University of Traditional Chinese Medicine; 2008.
44. 45. Yang G, Chen R, Dai L. The symptoms of 41 dialysis patients with insomnia treated by magnetic bead ear acupuncture. J Clin Acupunct 2016;(07):7-9. doi: 10.19917/j.cnki.1005-0779.2016.07.003.
45. 46. Zhao T. Study on the effect of magnetic bead attachment at auricular points on sleep disorders and comfort conditions in maintenance hemodialysis patients [master's thesis]. Fujian University of Traditional Chinese Medicine; 2011.
46. 47. Saraçoğlu E, Kıymaz D. Çocuklarda akupunktur tedavi uygulamaları ve hemşirelik. Doğu Karadeniz Sağlık Bilimleri Dergisi. 2022;1(3):38-47.
47. 48. Türkiye Cumhuriyeti Sağlık Bakanlığı. Akupunktur uygulama ilkeleri rehberi. Ankara: T.C. Sağlık Bakanlığı Yayınları; 2021.
48. 49. Shen J, Wang X, Zhang Y. Observation on the effect of auricular adhesion in the improvement of constipation in hemodialysis patients. J Nurs 2015;01:62-4.
49. 50. Yan CN, et al. Effect of auricular acupressure on uremic pruritus in patients receiving hemodialysis treatment: A randomized controlled trial. Evid Based Complement Alternat Med 2015;2015:593196. doi: 10.1155/2015/593196.
50. 51. Choi E, Park K. Effects of auricular acupressure on pruritus, dry skin, and depression in hemodialysis patients. J Korean Acad Fundam Nurs 2024;31(1):69-79.
51. 52. Huang Y, Wu A, Mo H. Clinical observation on auricular bean placement in the treatment of hemodialysis care. J Nurs 2017;02:165-6.
52. 53. Li H, Jing P, Zhang Y. Clinical observation of 60 cases of insomnia in hemodialysis patients for care purposes. J Hunan Univ Tradit Chin Med 2012. doi: 10.1155/2015/593196.
53. 54. Lee Y-H, Kim S-Y. Effects of auricular acupressure therapy on insomnia in hemodialysis patients. Korean J Rehabil Nurs 2007;10(1):21-8.
54. 55. Zheng Q, Liu C. The effects of auricular acupuncture point pressure on sleep and quality of life in hemodialysis patients with insomnia. Chin Mod Distance Educ Tradit Chin Med 2014;(20):16-8.
55. 56. Jung ES, Chang AK. Effects of auricular acupressure in patients on hemodialysis. J Nurs Res 2020;28(4): e106. doi: 10.1097/jnr.0000000000000378.
56. 57. Bang YY, Park H. Effects of auricular acupressure on sleep and pruritus in hemodialysis patients. J Korean Acad Fundam Nurs 2020;27(2):141-52.
57. 58. Chun Y, Park S. Effects of auricular acupressure on pruritus and fatigue in hemodialysis patients. Korean J Adult Nurs 2016;28(4):436-46. doi: 10.7475/kjan.2016.28.4.436.
58. 59. Wang S, et al. The use of auricular acupressure to improve quality of life in diabetic patients with chronic kidney disease: A prospective randomized controlled trial. Evid Based Complement Alternat Med 2014;2014:343608. doi: 10.1155/2014/343608.
59. 60. Liu X, et al. Auricular point acupressure combined with compound lidocaine cream to manage arteriovenous fistula puncture pain: A multicenter randomized controlled trial. Evid Based Complement Alternat Med 2021;2021:5573567. doi: 10.1155/2021/5573567.
60. 61. Liu GM, et al. Auricular point sticking for relieving pain in arteriovenous fistula puncture. J Acupunct Tuina Sci 2019;17(6):427-31.