A Descriptive Study to Assess the Quality of Life in ESRD (End Stage Renal Disease) Patients Undergoing Hemodialysis in Selected Hospital of Mohali, Punjab

 

Monika¹, Dr. Mrs. Kiran Batra², Mrs.  Shaveta Sharma³

¹MSc Nursing Student, Silver Oaks College of Nursing, Mohali, Punjab.

²Principal, Silver Oaks College of Nursing, Mohali, Punjab.

³Assistant Professor, Silver Oaks College of Nursing, Mohali, Punjab.

 

ABSTRACT:

ESRD is one of the chronic diseases causing high level of disability in different domains of the patient’s life. The experience of multiple losses, including kidney functions, family role, work role, sexual function, time and mobility impact significantly on the lives of these patients. So the present study was conducted to assess the quality of life in the end stage renal disease patients undergoing hemodialysis. Quality of life determines the effectiveness and outcome of different treatment method. According to the WHO, quality of life is define as the general perception of individual toward different aspects of life including the dominant culture, value system, goal and achievements, expectations, standards and priorities. The objectives of the present study were to (i) assess the quality of life in ESRD patients undergoing hemodialysis with references to their physical, psychological, social and environmental health dimensions and (ii) associate the quality of life in ESRD patients undergoing hemodialysis with selected socio-demographic variables. The study was conducted at Silver Oaks Hospital phase 9 Mohali. 50 ESRD patients were recruited for the study using convenient sampling technique. Quantitative research approach and non-experimental descriptive design was used. Pretested and validated modified WHO BREFF questionnaire was used to collect the data. The findings of the study revealed that majority (60%) of research participants had poor quality of life followed by (40%) who had very poor quality of life. It also concluded that quality of life in ESRD patients undergoing hemodialysis had no statistically significant association with any of the socio demographic variables.

 

 

INTRODUCTION:

The kidneys are two bean shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.

 

The urine flows from the kidney to bladder through two thin tubes of muscle called ureter, one on each side of bladder. The bladder stores urine.¹

 

Kidneys are the significant organs that contribute to overall well-being. But when kidneys function at only below 10 to 15 percent of their normal capacity, they cannot effectively do their job, such as remove waste or excess fluid from blood. End stage renal disease (ESRD) is the last stage (stage five) of chronic kidney disease (CKD). When CKD, polycystic kidney disease (PKD) or other kidney diseases develop into ESRD, dialysis or a kidney transplant is necessary to live. Regular dialysis treatment, along with renal diet and taking prescribed medications can go a long way in managing ESRD.²

 

Chronic kidney disease is an emerging disease caused by diabetes and hypertension. Diabetes and hypertension are responsible for nearly one third and one fifth of chronic kidney disease, respectively. Apart from diabetes and hypertension, obesity, smoking and aging are important precursor of CKD. CKD is associated with increased incidence of cardiovascular mortality and loss of disability adjusted quality of life (QOL) years.³

 

End stage renal disease (ESRD) is a chronic and life threatening illness. It implies that the kidneys are permanently damaged and the person can no longer survive without renal replacement therapy. Individual undergoing long term hemodialysis have been found to be subjected to multiple physiological and psychosocial stressors and experience personal losses and lifestyle changes.⁴

 

In India, majority of the CKD patients belong to the younger population when compared with other countries. According to WHO global burden of disease project, diseases of the kidney and urinary tract contribute to approximately 850,000 deaths every year of which CKD is the 12th leading cause of the death and 17th leading cause of disability in the world. Approximate total burden of CKD is 800 per million populations. It has been reported that diabetes mellitus as the cause of CKD was found in 31.2 to 41.0% of patients in India.³

 

In India, the rising incidence of CKD is likely to pose major problems for both healthcare and the economy in future years. Indeed, it has been recently estimated that the age-adjusted incidence rate of ESRD in India to be 229 per million population (pmp), and >100,000 new patients enter renal replacement programs annually in India. On the other hand, because of scarce resources, only 10% of the Indian ESRD patients receive any renal replacement therapy (RRT). The lack of community-based screening programs has led to patients being detected with CKD at an advanced stage. It is possible that early detection of kidney disease through community based screening programs might have an impact on this problem through earlier intervention.⁵

 

According to the Indian chronic kidney disease registry 2010, the mean age of the patient with chronic kidney disease is about 50 years. There are about 7.85 million chronic renal failure patients in India. The number of patients with chronic renal failure is increasing steadily with its associated poor quality of life and high economic burden. CRF has become one of the most expensive diseases to treat in present time this is particularly true in the developing world where the resources are limited.⁶

 

The prevalence of ESRD in India has increased in the last two decades. It has become a global threat with significant morbidity and mortality. ESRD also decreased the overall quality of life among the affected patients.⁷ ESRD is one such chronic disease causing a high level of disability in different domains of the patient’s life, leading to impaired quality of life and it has a significant impact upon the lives of sufferers. The experience of multiple losses, including kidney functions, family role, work role, sexual function, time and mobility impact significantly on the lives of patients.³

 

The use of renal replacement therapy becomes necessary when the kidneys can no longer remove waste, maintain electrolytes and regulate fluid balance.⁸

 

Dialysis treatments (both hemodialysis and peritoneal dialysis) are not cures for ESRD, but will help to feel better and live longer. Hemodialysis can be performed at home or in a dialysis center or hospital by trained health care professionals. A special type of access, called an arterio venous (AV) fistula, is placed surgically, usually in the arm. This involves joining an artery and a vein together. An external, central, intravenous (IV) catheter may also be inserted, but is less common for long-term dialysis. After access has been established, client will be connected to hemodialysis machine that drains the blood, bathes it in a special dialysate solution which removes waste substances and fluid, then returns it to the patients’ bloodstream. ⁹

 

Quality of life is an important indicator of health and well-being, it determines the effectiveness of treatment, decides the priority for resources distribution, and help in policy developments. Since chronic disease is not curable, the aim is to improve the well being of patients and prolongs life without symptoms, thus QOL is used to evaluate the outcome of treatment given. In addition, QOL gives information about other that are equally or more important to patients perspective and establishes information about the range of problem that affects the patients.¹⁰

 

Majority of Indian population is suffering from chronic disease such as diabetes or hypertension. Because of negligence or unawareness or due to the poor control of these disease conditions, complications such as renal failure may occur. Without proper care or management, this renal failure may progress to a condition where the glomerular filtration rate (GFR) is less than 15 ml/min.¹¹

Chronic kidney disease is a very tense condition which causes a wide variety of complication. In addition, its treatment causes significant changes in the daily lives of patients, and affects their QOL. Impaired QOL can be related to CKD itself and its treatment. Hemodialysis is not a cure for CKD but helps to prolong and improve patients QOL. Moreover, the development of knowledge on renal physiology and the treatment of various kidney disease have prolonged the life and improved patients QOL. ¹⁰

 

Sathvik BS (2008) conducted a study to assess the quality of life in hemodialysis patient using WHO quality of life – BREF questionnaire. Patients were recruited from dialysis centers of J.S.S medical College hospital and Basappa, memorial hospital Mysore. The sample size was 90. The results showed that quality of life of hemodialysis patient is considerably impaired compared to that of healthy subject, especially with respect to the physical, psychological and social relationship domain.

 

RekhaRaju, Latha S. (2012) conducted a study to describe the QOL and coping strategy among dialysis patients in selected hospital. 60 dialysis patients were selected by purposive sampling technique. Rating scale was used to measure the QOL and coping strategy used by them. The findings of the study showed that majority of the dialysis patients 41(68.3%) had average QOL and highest percentage 49(81.7%) had satisfactory coping. 19 (31.7%) of dialysis patients were in the age group of 61-70 yrs. 60% of dialysis patients had an income less than 5000 rupees/ month, 83.3% of the subjects were Hindus, 57% were undergoing dialysis for a duration of 0-12 months. The correlation coefficient value of QOL and coping strategy was p<0.05 and hence there is positive correlation between QOL and coping strategy. The study showed that there is significant association between the QOL and religion.

 

While working in clinical area researcher observed and managed the ESRD patients who were on hemodialysis and found that these patients are facing many problems in their day to day life which is expensive, time consuming and poses a lot of physical and psychosocial stress. So the researcher felt the need to assess the quality of life of these patients to obtain an in-depth understanding of the problems in all four domains i.e. physical, psychological, social and spiritual domains.

 

STATEMENT OF THE PROBLEM:

A descriptive study to assess the quality of life in ESRD (end stage renal disease) patients undergoing hemodialysis in selected hospital of Mohali, Punjab.

 

OBJECTIVES:

●To assess the quality of life in ESRD patients undergoing hemodialysis with references to their physical, psychological, social and environmental health dimensions.

●To associate the quality of life of ESRD patients undergoing hemodialysis with selected socio demographic variables.

ASSUMPTION:

End Stage Renal Disease patients require long term and expensive treatment therapies including hemodialysis which affect the quality of life of these patients in one or the other way.

 

DELIMITATIONS:

The study was delimited only to the patients with ESRD who were:-

1. Undergoing hemodialysis in the selected hospital.

2. Willing to participate in the study

3. able to communicate and understand English, Hindi and Punjabi

 

MATERIALS AND METHOD:

Quantitative research approach was adopted to assess the quality of life of ESRD patients undergoing hemodialysis. Non experimental descriptive research design was used to assess the quality of life of ESRD patients undergoing hemodialysis in Silver Oaks hospital of Mohali, Punjab.Present study was conducted at Silver Oaks hospital Mohali which is situated in Phase 9, Mohali, which is easily accessible to people living in adjacent cities of Chandigarh, Manimajra and Panchkula. Bus stand, railway station, taxi stand and airport are in seal proximity within 10 kms of radius. This advanced well equipped 150 bedded hospital is manned by specialized health care team members and provide expert services in varying fields like cardiac, neurology, nephrology and around the clock emergency services all along with OPD/IPD.All the ESRD patients undergoing hemodialysis in Silver Oaks hospital phase 9, Mohali, Punjab were the population of the study. Non probability purposive sampling technique was used to recruit 50 ESRD patients who were undergoing hemodialysis in Silver Oaks hospital phase 9, Mohali. The study includes the patients who were: diagnosed with ESRD, undergoing hemodialysis in Silver Oaks hospitals phase 9, Mohali, Punjab, able to communicate and write in English or Hindi. The study excludes the patients who were: suffering from any other associated health problem or on peritoneal dialysis.

 

Modified version of WHO quality of life-Biomedical Research and Education Facility (BREF), a generic health related questionnaire developed by the WHO QOL group was used to assess the quality of life of ESRD patients undergoing hemodialysis which consisted of two parts:

 

Part 1) Socio demographic profiles of the study subjects which includes Age, Gender, Educational status, occupation, Religion, marital status, Type of family, Family income, Habitat, Any addiction, Family history of CKD.

 

Part 2) Structured questionnaire on quality of life which includes multiple choice items on Physical domain, Psychological domain, Social domain and Spiritual domain. This part consisted of 55 questions with options. Each question of quality of life questionnaire carry highest marks 3.

 

Assessment of Quality of life in ESRD patients undergoing hemodialysis was divided into five categories.

Each questionof quality carry highest score 3.

·      Maximum scores 165

·      Minimum scores 55

 

 

Face, content and criterion validity of tool was determined by various experts in the field of clinical Nursing , Nursing education, Medicine and Surgery and their suggestions were incorporated after discussing with the guides.  The reliability of tool was found to be r=0.75 which means the tool was reliable.After obtaining permission from the concerned authorities, pilot study was conducted on five ESRD patients undergoing hemodialysis from Silver Oaks Hospital (which were excluded from the main study) to find out the feasibility and practicality of the study and the study was found feasible.

 

Ethical Considerations:

·      Written permission was obtained from Chairman of Silver oaks hospital, Phase 9 Mohali.

·      Written Informed consent was obtained from all study subjects after explaining them the purpose of the study.

·      Study participants were assured that the data obtained will be kept confidential and used only for the research purpose.

 

Data Analysis:

Data collected was analyzed using descriptive and inferential statistics. Chi square test was used to associate the quality of life of ESRD patients undergoing hemodialysis.The data analysis was carried out by calculating descriptive and inferential statistics. The level of significance was selected at p value 0.05 level.

 

Organization of analyzed data:

The analyzed data was organized according to the objectives and presented under following section.

 

Section A:

Socio demographic profile of study subjects.

 

Section B:

Percentage distribution of study subjects as per their quality of life.

 

Section C:

Association of the quality of life scores of ESRD patients undergoing hemodialysis with socio demographic variables

 

Table No. 1 - Frequency and percentage distribution as per Socio-Demographic profile of study subjects. N=50

 

Table No.-2 Distribution of study subjects as per their quality of life scores. N=50

 

 

Fig 1: Percentage distribution of study subjects as per their quality of life.

Table 2 and fig 1: clearly depicts that 60.0% of the study subjects had poor quality of life where as 40.0% of them had very poor quality of life.

 

Table No. -3 Mean, SD of quality of life in ESRD patients undergoing hemodialysis in a selected hospital of Mohali

 

Table No 3: depicts that Mean and Standard deviation of quality of life scores in ESRD patients undergoing hemodialysis was 79.54and 11.24

 

Table No- 4: Association of the quality of life scores of ESRD patients undergoing hemodialysis with socio demographic variables. N-50

Socio demographic variables	n	Very poor		Poor		Chi square	df	P-Value
		n	%	n	%
Age (in years) >40 <40	16 34	10 10	62.5 29.4	6 24	37.5 70.6	3.6803NS	1	0.0551
Gender Male Female	28 22	13 7	46.4 31.8	15 15	53.6 68.2	0.5716NS	1	0.4496
Edu. Status Illiterate Up to 10th Up to 12th Graduate or above	21 11 16 2	8 5 5 2	38.1 45.5 31.4 100.0	13 6 11 0	61.9 54.5 68.7 0.0	0.1774NS	2	0.9151
Occupation Homemaker Private job Govt. job Self employed	16 12 11 11	6 5 5 4	37.5 41.7 45.5 36.7	10 7 6 7	62.5 58.3 54.5 63.6	0.2525NS	3	0.9687
Religion Hindu Muslim Sikh Christian Any other	23 5 22 0 0	11 2 7 0 0	47.8 40.0 31.8 0.0 0.0	12 3 15 0 0	52.1 60.0 68.1 0.0 0.0	0.567NS	1	0.4515
Marital status Unmarried Married Divorce Widow	4 34 2 10	3 15 0 2	75.0 44.1 0.0 20.0	1 19 2 8	25.0 55.9 100.0 80.0	2.4168NS	1	0.1200
Type of family Nuclear family Joint family	36 14	17 3	47.2 21.4	19 11	52.8 78.6	1.8229NS	1	0.1770
Family income >10,000 <10,000	5 45	3 17	60.0 37.8	2 28	40.0 62.2	0.2315NS	1	0.6404
Habitat Rural Urban Semi-urban	25 28 7	12 6 2	48.0 21.4 28.6	13 12 5	52.0 42.9 71.4	0.181NS	1	0.5013

NS for Non-Significant

 

 

Table No 4: depicts the analysis of the association of all the socio demographic variables of the study subjects with the quality of life in ESRD patients undergoing hemodialysis. Chi-square test was applied to study this relationship. All variable were found to be independent and didn’t have significant association with the quality of life in ESRD patients undergoing hemodialysis.

 

DISCUSSION:

This part compares the findings of the present study with the findings of the studies conducted in the past. The present study findings have been discussed in accordance with the objectives of the study.

 

 

 

The first objectives of the study was to assess the quality of life in ESRD patients undergoing hemodialysis with references to their physical, psychological, social and environmental health dimensions. The study results revealed that (60.0%) of the subjects had poor quality of life and (40.0%) had very poor quality of life. The findings of the present study are in parallel to the findings of the study conducted by MukaddarMollaoglu’s (2013) on quality of life in patients undergoing hemodialysis in Cumhuriyat University. The study revealed that 70% of study subjects had low quality of life in all dimensions like physical, social and psychological health dimensions.

 

The findings of the present study are in contrary to the findings of the previous study conducted by ErisinNaclican, Hakendermiehindi (2012) on 144 adult patients to evaluate the quality of life and factor affecting chronic renal failure patients undergoing hemodialysis. The study revealed that the quality of life is lower in female in comparison to the male with chronic renal failure whereas the findings of present study are revealed that gender is not associated in the quality of life in ESRD patients undergoing hemodialysis.

 

The second objective of the study was to associate the quality of life of ESRD patients undergoing hemodialysis with selected socio demographic variables. The study results showed that there is no significant association between the quality of life in ESRD patients undergoing hemodialysis with selected socio demographic variables. The study conducted by BS Sathvik, G Parthasarthi, MG Narahari, KC Gurudev (2008)33 also supports the findings of the present study that there are no significant associating factors between socio demographic variables and quality of life in hemodialysis patients.

 

RECOMMENDATIONS:

On the basis of the findings of the present study the following recommendations have been made:

1.    A similar study can be replicated on a large scale to generalize the findings.

2.    A similar study can be conducted to compare the quality of life in ESRD patients undergoing hemodialysis in selected government and private hospital.

3.    Similar study can be conducted to compare quality of life of post renal transplant patients and patients on dialysis

 

CONCLUSION:

 It can be concluded that quality of life in ESRD patients was found to be independent of all the socio demographic variables. Mean quality of life scores for all the 50 study subjects in the present study found to be 79.54 with standard deviation of 11.24. The study also revealed that quality of life in ESRD patients undergoing hemodialysis was poor and very poor. (96.0%) study subjects having no family history of CKD and (4.0%) study subjects having family history of CKD.

 

REFERENCES:

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2.     Modi G, Jha V. Incidence of ESRD in India. 2011; 79:573

3.     Murali R, SathyanarayanaD ,assessement of quality of life in chronic kidney disease patients using the kidney quality of life-short form questionnaire in Indian population: a community based study.vol 8, issue 1,2015.

4.     RekhaRaju, Latha S. a correlational study on quality of life and coping strategy among dialysis patients in selected hospital at Mangalore. NUJHS VOL.2 Dec.2012, 8-11.

5.     ModiG,Jha V, Incidence of ESRD in India: a population based study, 2006;70:2031-33.

6.     Kamalshah, Indian chronic registry India:2010.http://www.kamalshah.com/2010/06/Indian-ckd-registry now exits.html.

7.     Anju M, Anju S, Anukuruvilla, Astudy to assess the quality of life of chronic renal failure patientsundergoing hemodialysis. 2007 jul-sep; 2 (35)

8.     Mani MK, Management of end stage renal disease in India.1998; 22 (6): 1 -44.

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10.   Barotfi, S. quality of life assessment in patients with chronic kidney disease. Budapest; Institute of Behavioural Medicine. 2005

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Received on 24.05.2017           Modified on 20.06.2017

Accepted on 20.11.2017         © A&V Publications all right reserved