Level of activation and quality of life related to the health of people in hemodialysis

Leone, Denise Rocha Raimundo; Pereira, Gabriela Amorim; Silva, Arison Cristian de Paula; Aguiar, Aline Silva de

doi:10.1590/2177-9465-EAN-2020-0486

Denise Rocha Raimundo Leone

Universidade Federal de Juiz de Fora, Faculdade de Medicina Curso de Doutorado em Saúde Coletiva, Programa de Pós-Graduação Stricto Sensu em Saúde Coletiva. Juiz de Fora, MG, Brasil.

https://orcid.org/0000-0002-6961-4989

Gabriela Amorim Pereira

Universidade Federal de Juiz de Fora, Faculdade de Medicina Curso de Doutorado em Saúde Coletiva, Programa de Pós-Graduação Stricto Sensu em Saúde Coletiva. Juiz de Fora, MG, Brasil.

https://orcid.org/0000-0002-7657-1139

Arison Cristian de Paula Silva

Universidade do Estado do Rio de Janeiro, Faculdade de Enfermagem, Residência de Enfermagem em Nefrologia. Rio de Janeiro, RJ, Brasil.

https://orcid.org/0000-0001-6911-5496

Aline Silva de Aguiar

Universidade Federal de Juiz de Fora, Departamento de Nutrição do Instituto de Ciências Biológicas. Juiz de Fora, MG, Brasil.

https://orcid.org/0000-0003-4903-2495

Corresponding author:Denise Rocha Raimundo Leone. E-mail: de_rocha@ymail.com.

Study design. Acquisition, data analysis, and interpretation of results. Writing and critical revision of the manuscript. Approval of the final version of the article. Responsibility for all aspects of the content and integrity of the published article. Denise Rocha Raimundo Leone Data analysis and interpretation of results. Writing and critical revision of the manuscript. Approval of the final version of the article. Responsibility for all aspects of the content and integrity of the published article. Gabriela Amorim Pereira Data analysis and interpretation of results. Writing and critical revision of the manuscript. Approval of the final version of the article. Responsibility for all aspects of the content and integrity of the published article. Arison Cristian de Paula Silva Study design. Data analysis and interpretation of results. Writing and critical revision of the manuscript. Approval of the final version of the article. Responsibility for all aspects of the content and integrity of the published article. Aline Silva de Aguiar

ASSOCIATE EDITOR

Cândida Caniçali Primo

Sociodemographic Data	Level PAM
	Level 1		Level 2		Level 3		Level 4
	n	%	n	%	n	%	n	%
Gender
Male	24	14.8%	29	17.9%	20	12.3%	29	17.9%
Female	14	8.7%	18	11.1%	10	6.2%	18	11.1%
Age
Under 60 years old	21	13%	16	9.9%	17	10.5%	22	13.6%
60 years or more	17	10.5%	31	19.1%	13	8%	25	15.4%
Skin color
Not White (black and brown)	29	17.9%	29	17.9%	19	11.7%	23	14.2%
White	9	5.6%	18	11.1%	11	6.8%	24	14.8%
Years of study
Illiterate or incomplete elementary school	25	15.4%	30	18.6%	13	8%	21	13%
Complete elementary education	2	1.2%	3	1.8%	3	1.8%	5	3.1%
High School or Technical School	9	5.6%	12	7.4%	10	6.2%	10	6.2%
Higher education	2	1.2%	2	1.2%	4	2.5%	11	6.8%
Marital status
With partner	17	10.5%	21	13%	16	9.9%	26	16%
Without companion	21	13%	26	16%	14	8.6%	21	13%
Lives alone
Yes	4	2.5%	9	5.6%	5	3.1%	8	4.9%
No	34	21%	38	23.4%	25	15.4%	39	24.1%
INSS beneficiary
Yes	35	21.6%	42	26%	23	14.2%	38	23.4%
No	3	1.8%	5	3.1%	7	4.3%	9	5.6%
Personal income
1 minimum wage	7	4.3%	13	8%	4	2.5%	13	8%
2 minimum wage	14	8.7%	11	6.8%	6	3.7%	11	6.8%
3 minimum wage	5	3.1%	10	6.2%	7	4.3%	6	3.7%
Over 3 minimum wages	10	6.2%	12	7.4%	12	7.4%	15	9.3%
Doesn't know/No answer	2	1.2%	1	0.6%	1	0.6%	2	1.2%
Economic classification of the household
A	2	1.2%	1	0.6%	5	3.1%	6	3.7%
B1	1	0.6%	4	2.5%	5	3.1%	9	5.6%
B2	12	7.4%	8	4.9%	3	1.8%	13	8%
C1	9	5.6%	9	5.6%	6	3.7%	9	5.6%
C2	8	4.9%	16	9.9%	10	6.2%	7	4.3%
D-E	6	3.7%	9	5.6%	1	0.6%	3	1.8%
Companion for hemodialysis
Yes	15	9.3%	18	11.1%	3	1.8%	3	1.8%
No	23	14.2%	29	17.9%	27	16.7%	44	27.2%
Needs caregiver for activities of daily living
No	30	18.6%	39	24.1%	28	17.3%	46	28.4%
Yes	8	4.9%	8	4.9¨%	2	1.2%	1	0.6%

Clinical data	Level 1		Level 2		Level 3		Level 4
Clinical data	n	%	n	%	n	%	n	%
Baseline disease
Hypertension	15	9.3%	21	13%	14	8.7%	15	9.3%
Diabetes	8	4.9%	13	8%	3	1.8%	4	2.5%
Hypertension + Diabetes Mellitus	9	5.6%	7	4.3%	6	3.7%	15	9.3%
Glomerulopathies	3	1.8%	2	1.2%	1	0.6%	3	1.8%
Others	1	0.6%	0	0%	3	1.8%	3	1.8%
Doesn't know/No answer	2	1.2%	4	2.5%	3	1.8%	7	4.3%
Number of comorbidities
1	18	11.1%	25	15.4%	16	9.9%	23	14.2%
2	16	9.9%	12	7.4%	10	6.2%	22	13.5%
>3	4	2.5%	10	6.2%	4	2.5%	2	1.2%
Time in HD
Less than 5 years	28	17.2%	37	22.8%	16	9.9%	37	22.8%
5 years or more	10	6.2%	10	6.2%	14	8.7%	10	6.2%
Vascular access type
Double lumen catheter	13	8%	15	9.2%	14	8.7%	15	9.2%
Arteriovenous fistula	24	14.8%	30	18.6%	16	9.9%	30	18.6%
Both	1	0.6%	2	1.2%	0	0%	2	1.2%
Previous Renal Replacement Therapy
No	37	22.8%	45	27.8%	26	16%	41	25.4%
Yes	1	0.6%	2	1.2%	4	2.5%	6	3.7%
Residual renal diurese
Yes	27	16.7%	40	24.7%	17	10.5%	38	23.4%
No	11	6.8%	7	4.3%	13	8%	9	5.6%
Continuous medication use
Yes	32	19.8%	44	27.2%	29	17.9%	43	26.5%
No	4	2.5%	3	1.8%	1	0.6%	4	2.5%
Doesn't know/No answer	2	1.2%	0	0%	0	0%	0	0%
Smoker
No	36	22.2%	42	26%	25	15.4%	43	26.5%
Yes	2	1.2%	5	3.1%	5	3.1%	4	2.5%
Drinker
No	32	19.8%	42	26%	23	14.2%	40	24.6%
Yes	6	3.7%	5	3.1%	7	4.3%	7	4.3%
KTV
>1.2	27	16.6%	42	26%	21	13%	27	16.6%
<1.2	11	6.8%	5	3.1%	9	5.6%	20	12.3%
Hemoglobin
>11 d/dL	11	6.8%	19	11.7%	14	8.7%	19	11.7%
<11 d/dL	27	16.6%	28	17.3%	16	9.9%	28	17.3%
Potassium
Adequate (between 3.5 and 5.0 mEq/L)	22	13.5%	24	14.8%	19	11.7%	17	10.5%
Inadequate	16	9.9%	23	14.2%	11	6.8%	30	18.6%
Fósforo
Adequate (between 3.5 and 5.0 mEq/L)	19	11.7%	29	17.9%	12	7.4%	22	13.5%
Inadequate	19	11.7%	18	11.2%	18	11.2%	25	15.4%
Sódio
Adequate (between 3.5 and 5.0 mEq/L)	33	20.4%	33	20.4%	24	14.8%	39	24%
Inadequate	5	3.1%	14	8.7%	6	3.7%	8	4.9%
Cálcio
Adequate (between 3.5 and 5.0 mEq/L)	25	15.4%	38	23.5%	23	14.2%	37	22.8%
Inadequate	13	8%	9	5.6%	7	4.3%	10	6.2%
Weight gain in the interdialytic interval
<5%	33	20.4%	40	24.7%	26	16%	40	24.7%
>5%	5	3.1%	7	4.3%	4	2.5%	7	4.3%

Quality of life
Dimensions	Mean		Median	Interval Interquartile	Minimum	Maximum	N
Specific dimensions
Symptoms		77.70	81.25	20.83	31.25	100.00	162
Effects of Chronic Kidney Disease		71.74	75.00	28.13	0.00	100.00	162
Burden of Chronic Kidney Disease		54.90	56.25	56.25	0.00	100.00	162
Work Status		25.00	0.00	50.00	0.00	100.00	162
Cognitive Function		81.28	86.67	26.67	13.33	100.00	162
Social Interaction		81.98	86.67	33.33	20.00	100.00	162
Sexual Function		84.76	100.00	25.00	0.00	100.00	73
Sleep		69.95	72.50	38.13	5.00	100.00	162
Social Support		86.63	100.00	16.67	0.00	100.00	162
Dialysis staff encouragement		86.81	100.00	25.00	0.00	100.00	162
Patient satisfaction		74.07	83.33	16.67	33.33	100.00	162
Generic Dimensions – SF36
Global health		68.95	70.00	30.00	0.00	100.00	162
Physical Function		53.46	55.00	55.00	0.00	100.00	162
Limitation of physical functions		42.44	50.00	75.00	0.00	100.00	162
Pain		65.12	70.00	65.00	0.00	100.00	162
General health		58.55	60.00	35.00	5.00	100.00	162
Emotional well-being		69.53	72.00	37.00	4.00	100.00	162
Emotional role		54.53	66.67	66.67	0.00	100.00	162
Social role		69.91	75.00	50.00	0.00	100.00	162
Fatigue/Energy		58.12	62.50	41.25	0.00	100.00	162
Physical Health Component		40.15	42.37	16.73	14.22	58.72	162
Mental health component		46.31	47.90	16.47	17.33	68.68	162

	Activation Level
OR (CI95%)	1	2	3	4
Symptom	1.0	2.12 (0.88-5.09)	1.71 (0.64-.53)	2.76 (1.14-6.68)^* * p value ˂ 0.05.
Effect of CKD	1.0	0.69 (0.29-1.64)	0.55 (0.21-1.46)	0.90 (0.37-2.13)
CKD Load	1.0	1.06 (0.45-2.50)	0.47 (0.17-1.30)	2.37 (0.97-5.73)
Work Status	1.0	1.19 (0.48-2.91)	1.47 (0.54-3.93)	2.00 (0.83-4.84)
Cognitive Function	1.0	1.31 (0.55-3.11)	1.05 (0.39-2.76)	1.07 (0.71-4.03)
Social Interaction	1.0	0.61 (0.25-1.44)	0.60 (0.22-1.58)	1.21 (0.51-2.87)
Sexual Function	1.0	0.54 (0.8-3.36)	0.50 (0.07-3.54)	0.57 (0.09-3.40)
Sleep	1.0	1.94 (0.81-4.66)	1.71 (0.64-4.53)	1.71 (0.64-4.53)
Social Support	1.0	0.93 (0.38-2.27)	1.00 (0.37-2.71)	2.15 (0.82-5.63)
Dialysis Incentive	1.0	4.22 (1.60-11.0)*	0.66 (0.25-1.75)	2.1 (0.88-5.16)
Global Health	1.0	1.11 (0.46-2.63)	0.68 (0.25-1.86)	1.11 (0.46-2.63)
Patient Satisfaction	1.0	0.88 (0.37-2.07)	1.50 (0.56-3.95)	1.35 (0.57-3.18)
Physical Functioning	1.0	1.19 (0.48-2.91)	2.51 (0.93-6.73)	3.72 (1.51-9.18)^* * p value ˂ 0.05.
Physical Function	1.0	0.71 (0.30-1.68)	0.80 (0.31-2.11)	1.09 (0.46-2.58)
Pain	1.0	1.43 (0.60-3.39)	0.91 (0.34-2.42)	1.85 (0.78-4.41)
General Health	1.0	2.18 (0.90-5.27)	0.96 (0.34-2.64)	3.72 (1.51-9.18)*
Emotional Well-Being	1.0	1.26 (0.52-3.05)	1.95 (0.73-5.18)	2.76 (1.14-6.68)*
Emotional Role	1.0	1.04 (0.44-2.45)	1.00 (0.38-2.60)	1.76 (0.73-4.21)
Social Role	1.0	0.91 (0.38-2.17)	0.80 (0.31-2.11)	1.90 (0.78-4.66)
Energy/Fatigue	1.0	2.07 (0.85-5.06)	1.89 (0.70-5.10)	4.62 (1.84-11.58)*
Physical Component	1.0	1.11 (0.46-2.63)	1.79 (0.68-4.73)	1.85 (0.78-4.41)
Mental Component	1.0	2.46 (1.006.00)*	1.89 (0.70-5.10)	3.82 (1.54-9.46)*

	Setting 1 ^* * Adjustment 1: Sex and Age.		Setting 2 ^ Adjustment 2: Sex; Age; Length of Hemodialysis; Number of Comorbidities; Hemoglobin and KTV.
	OR (95% CI)	Value p	OR (95% CI)		Value p
	Symptom
Activation Level
1	1.0		1.0
2	2.19 (0.89-5.40)	0.086	2.26 (0.89-5.73)		0.085
3	1.70 (0.63-4.61)	0.293	2.05 (0.73-5.75)		0.169
4	2.99 (1.20-7.41)	0.018	3.11 (1.21-7.94)		0.018
	Physical Functioning
Activation Level
1	1.0		1.0
2	1.28 (0.50-3.22)	0.597	1.03 (0.38-2.75)		0.949
3	2.58 (0.93-7.14)	0.068	3.07 (1.02-9.21)		0.045
4	3.94 (1.54-10.08)	0.004	4.48 (1.64-12.24)		0.003
	General Health
Activation Level
1	1.0		1.0
2	2.15 (0.90-5.25)	0.084	2.26 (0.91-5.61)	0.079
3	0.96 (0.35-2.60)	0.946	0.88 (0.31-2.50)	0.824
4	3.75 (1.52-9.26)	0.004	3.49 (1.39-8.75)	0.008
	Emotional well-being
Activation Level
1	1.0		1.0
2	1.30 (0.52-3.25)	0.572	1.24 (0.48-3.17)	0.643
3	1.98 (0.71-5.49)	0.186	1.98 (0.70-5.55)	0.191
4	3.13 (1.23-7.94)	0.016	3.12 (1.22-8.02)	0.018
	Energy/Fatigue
Activation Level
1	1.0		1.0
2	2.20 (0.88-5.48)	0.088	2.02 (0.79-5.14)	0.140
3	1.89 (0.69-5.17)	0.215	1.77 (0.62-5.01)	0.280
4	4.74 (1.85-12.10)	0.001	4.79 (1.82-12.55)	0.001
	Mental Component
Activation Level
1	1.0		1.0
2	2.53 (1.02-6.23)	0.043	2.31 (0.92-5.80)	0.074
3	1.87 (0.69-5.09)	0.216	1.81 (0.65-5.03)	0.252
4	3.88 (1.55-9.71)	0.004	4.33 (1.68-11.11)	0.002
	Dialysis Incentive
Activation Level
1	1.0		1.0
2	4.70 (1.73-12.75)	0.002	5.20 (1.86-14.53)	0.002
3	0.65 (0.24-1.78)	0.411	0.70 (0.25-1.90)	0.501
4	2.10 (0.85-5.18)	0.107	2.16 (0.86-5.14)	0.100

[1] Source: research data.

Level of activation and quality of life related to the health of people in hemodialysis

Abstract