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

Öz

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.

Anahtar Kelimeler

• hemodialysis
• bioimpedance
• quality of life
• sleep quality
• depression

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

Öz

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.

Anahtar Kelimeler

• hemodiyaliz
• biyoimpedans
• yaşam kalitesi
• uyku kalitesi
• depresyon

Kaynakça

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