Background: Chronic renal failure is a chronic medical condition characterized by a progressive and irreversible loss of kidney function. Up to 50% of patients undergoing dialysis experience symptoms of depression and anxiety. The purpose of this research is to evaluate the physical, anxiety and insomnia, social dysfunction, and depressive symptoms, as well as any associations between these symptoms and demographic and clinical factors, of individuals with chronic kidney disease. Methods: This research used a descriptive cross-sectional design to examine the experiences of people with chronic renal failure in Holy Karbala City. Fifty patients with chronic renal disease who sought treatment at Imam Hussein Medical City were included in the analysis. Results: The results of the study showed that most of the patients with chronic kidney disease had moderate psychological problems. Also, showed there was significant association between psychological aspect and sociodemographic characteristic variables like age, residency and marital status while there was no significant association with other demographic variables like gender (p = 0.111), educational level (p = 0.069), economic status (p = 0.690), number of child in family (p = 0.366) and family size (p = 0.787). Conclusion: The effects of chronic kidney disease on patients' mental and physical well-being were found to be statistically significant, and the authors concluded that these effects were correlated with socio-demographic variables.
Keywords
Psychological Aspects
Chronic Renal Failure
INTRODUCTION
Renal function declines irreversibly in people with chronic renal failure (CRF). Numerous abnormalities affecting systems as diverse as the cardiovascular, skeletal, vascular, and nervous systems are common hallmarks of this condition. Renal function, quality of life, and overall survival can all be greatly improved in patients with CRF through hemodialysis, making it one of the most successful treatments available. Yet, psychological issues like depression, worry, and low quality of life are common among CRF patients on hemodialysis [1]. Chronic kidney disease (CKD) is described as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2 that has persisted for 3 months or more without an apparent improvement in cause. It's a condition in which the kidneys gradually stop working, leading to dialysis or a kidney donation as a last resort (dialysis or transplantation) [2]. Dialysis is a procedure used to purify the blood by removing waste products and excess water. It is a method of artificially restoring normal kidney function in people who have experienced renal failure. Although dialysis can't fully replace a kidney's function, it can control some of the kidney's metabolic processes through a combination of diffusion and ultrafiltration [3]. Briefly, chronic renal failure is characterized by a gradual loss of kidneys function. The kidneys function as the body main excretory organs eliminating the body’s metabolic waste products by filtering blood. Substances that are unneeded or present in excess are filtered out of the blood and forming the urine. By adjusting the blood composition, the kidneys are able to maintain blood volume and pressure, ensuring a balance of Sodium (Na+), Chloride (Cl-), Potassium (K+), Calcium (Ca2+), Hydrogen (H+) and pH and eliminating urea, uric acid and creatinine [4]. Males have a GFR of 127 20 mL/min and girls of 118 20 mL/min, respectively. After the age of 30, it drops by 1 mL/min annually. hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation are all examples of renal replacement treatments (RRT) that may be necessary when creatinine clearance falls below 15 mL/min. Chronic respiratory failure (CRF) is a potentially fatal illness that can severely impact one's physical, mental, and social health, severely limit one's ability to perform daily tasks, and lead to a substantial reduction in productivity. Patients' need to rely on the HD machine round-the-clock raises a freedom vs. dependence dilemma. Common responses include rejection of disease and HD therapy, feelings of dependence during treatment, and subsequent independence. The HD treatment results in a longer lifespan along with a longer duration of health problems, which may at times be seen as more dominant than the dread of dying [5]. Accepting one's new appearance and adjusting to one's current state of hemodialysis is an ongoing psychological process for patients and their families living with chronic renal failure [6]. Patients who need dialysis have a substantially lower quality of life because the treatment requires them to make significant adjustments in their day-to-day routines as well as their way of life, which impacts not only the patients but also their families [7]. Concurrently, their mental health, their functional status, the quality of their intimate relationships, as well as their social and economic standing, are all significantly impacted. The aims of the study to identify and study most properties of the patient socio-demographic characteristic variables. In addition, investigate individuals' mental health while they are undergoing treatment for chronic renal failure. Finally, to investigate how psychological factors are related to the socio-demographic characteristics of the individuals concerned and the variables involved.
MATERIALS AND METHODS
Patients and study DesignRG4 B
A cross-sectional descriptive study design was carried out, so as to attain the stated objectives. The study was conducted in Holy Karbala city (Imam Al-Hussein Medical City). Non-probability (Convenient sampling) of 50 chronic renal disease patients those who attended at the Imam Al-Hussein Medical City, are included in the study. Instrument of the study was adopted by the researcher to assess the chronic disease upon psychological well-being. An Arabic version of the General Health Questionnaire 27, was obtained from a previous literature the version is valid and reliable [8].
Include Two Section
This section included socio-demographic characteristics consisted of 8 items, which included age, gender, residence, marital status, children, socioeconomic status, educational level and family size.
The Psychosocial Screening Instruments
The physical domain has seven different things, the anxiety and insomnia domain has five different items, the social domain has nine different items, and the depression domain has six different items. The General Health Questionnaire-28, also known as the GHQ-28, is one of the instruments that is frequently used to evaluate the level of psychosocial suffering experienced by patients who are being treated in non-psychiatric clinical settings. In 1978, Goldberg was the one who initially conceived of this questionnaire [9]. The initial layout consists of sixty questions, and it can be reorganized into three different forms with a total of sixty, twenty-eight, or twelve questions. Since its inception, the format has been adapted in seventy different nations, translated into 38 different languages, and used in a total of fifty-eight of those languages. Additionally, it has been confirmed and validate The GHQ-28 is a screening instrument that was developed to differentiate those who are likely to have or are at risk of developing a psychiatric problem. It is a collection of 28 questions designed to measure feelings of misery in medical settings. The instrument was developed as a screening instrument [10]. The GHQ-28 is comprised of a total of four different subscales. It should take between ten and fifteen minutes to respond to all of the inquiries. When compared to other questionnaires, this one is considered to be shorter and easier on the patient as well as the burden of the illness. It also includes the necessary aspects for examining the psychosocial state of this particular group of people.
Data Collection
The study data were collected through the questionnaire which has been adopted from previous literatures (Firas, 2018) then has shown to panel of experts to take their opinions and notes, and the results of the pilot study and after obtaining the approval of Karbala City Health Directorate, the researcher met the director of the previously mentioned centre and discussed with him about the appropriate time and place of work. The researcher decided to collect the study sample from the dialysis unit of the hospital. The researcher also examined the patient's archive included laboratory tests, radiographs, magnetic resonance imaging and final diagnosis and those who are in the process of periodic follow-up, then identified and those who are subject to the study, the researcher used the questionnaire by the interview technique with the participants. When the participant is present, his consent is taken verbally and the subject is clearly explained with secrecy and confidentiality.
Scoring and Rating
The preceding forms stipulated that a total of three points should be used for scoring and rating. A modified version of the Likert measure was used to assess patients' psychological and physical well-being.
Study Instrument Validity
Regarding the reliability of the GHQ-27, the viewpoints of the vast majority of the experts were considered; however, only five experts were given the opportunity to respond to the questionnaire and provide their feedback.
Statistical Analysis
The following methods of statistical data analysis are put to use in order to analyze the data from the research using the statistical package (SPSS) version (25), as well as Microsoft Excel (2019).
RESULTS
Distribution of the Studied Sample According to (SDCv.)
Our result showed that the majority of study sample at the age group 25-45 (62%) and male more than the female and most of the patients from the urban area (60%).regarding to the marital status (78%) from the study sample was marride, 44% from the study sample have two children in their family.
Table 1: Distribution of the studied sample according to (SDCv.)
Demographic characteristics
Categories
Frequency
Percent
Cumulative Percent
Age groups
>25
3
6
6
25-35
15
30
36
36-45
16
32
68
46-55
11
22
90
56-65
5
10
100
Total
50
100
-
Mean ±1.46 SD± 503
Gender
male
27
54
54
female
23
46
100
Residency
urban
30
60
60
rural
20
40
100
Marital status
unmarried
9
18
18
married
39
78
96
divorced
2
4
100
Do you have Child
yes
34
68
68
no
16
32
100
Number of chilidren
<2
22
44.0
44.0
2-4
16
32.0
76.0
5-7
9
18.0
94.0
7-10
3
6.0
100.0
Economic situation
enough
14
28
28
suffiient to some extent
25
50
78
not enough
11
22
100
Level of
Educational
can't read or write
8
16
16
read and write
13
26
42
primary
11
22
64
secondary
9
18
82
preparatory
2
4
86
institute or college
7
14
100
Number of Family member
<3
6
12
12
3-6
28
56
68
6-9
12
24
92
9-12
2
4
96
>13
2
4
100
Table 2: Descriptive statistics (frequency and percentage) for items regarding physical domain among chronic renal failure patients and mean of scores for that items
No.
Physical Domain Item
N.
Mean
Std. Deviation
Assessment
1
Do you feel healthy and well?
50
1.90
0.544
Moderate
2
Do you feel that you need a special care?
50
2.32
0.844
Moderate
3
Do you feel tired and exhausted?
50
2.48
0.544
Moderate
4
Do you feel that you sick?
50
2.68
0.551
High
5
Do you feel like you have a headache?
50
2.16
0.710
Moderate
6
Do you feel tightness and pressure in your head?
50
2.20
0.606
Moderate
7
Do you feel that you have episodes of heat and cold inside your body?
50
2.20
0.606
Moderate
F. = frequency, % = percentage, Mean of score (poor =1–1.66 moderate = 1.67 –2.32 high = 2.33– 3)
Table 3: Descriptive Statistics (frequency and percentage) for Items regarding anxiety and insomnia domain Among Chronic Renal Failure Patients and Mean of Scores for those Items
No.
Anxiety And Insomnia Domain Item
N.
Mean
Std. Deviation
Assessment
1
Do you sleep less because you are anxious?
50
2.02
0.769
Moderate
2
Do you find it difficult to go back to sleep when you wake up?
50
2.16
0.766
Moderate
3
Do you feel that you are under psychological pressure?
50
1.98
0.622
Moderate
4
Do you get upset quickly and in a bad mood?
50
2.16
0.650
Moderate
5
Do you feel terrifying and scary without any reason?
50
1.70
0.763
Moderate
F. = frequency, % = percentage, Mean of score (poor = 1–1.66 moderate =1.67 –2.32 high = 2.33– 3)
Table 4: Descriptive statistics (frequency and percentage) for items regarding social dysfunction domain among chronic renal failure patients and mean of scores for that items
No.
Social Domain Item
N.
Mean
Std. Deviation
Assessment
1
Do you feel that you are carrying the burdens of the world on your shoulders?
50
2.08
0.724
Moderate
2
Do you feel stressed and anxious all the time?
50
2.08
0.752
Moderate
3
Do you feel that you are taking longer to do things you did before?
50
2.34
2.946
High
4
Do you feel satisfied with your actions?
50
2.46
0.646
High
5
Do you feel that you are doing an effective role at work?
50
2.00
0.756
Moderate
6
Do you feel that you are doing a useful work in the things you do?
50
2.14
0.756
Moderate
7
Do you feel that you are able to make decisions?
50
2.46
0.676
High
8
Do you feel that you are able to enjoy your activities?
50
1.90
0.614
Moderate
9
Do you have thoughts that you are useless?
50
1.72
0.809
Moderate
F. = frequency, % = percentage, Mean of score (poor =1–1.66 moderate =1.67 –2.32 high = 2.33– 3)
Table 5: Descriptive Statistics (Frequency and Percentage) For Items Regarding Depression Domain among Chronic Renal Failure Patients and Mean of Scores for those Items
No.
Depression Domain Item
N.
Mean
Std. Deviation
Assessment
1
Do you feel that life is worth nothing and without hope?
50
1.60
0.670
Poor
2
Do you feel that the world isn't worth to living in?
50
1.56
0.611
Poor
3
Do you have thoughts of being alone?
50
1.76
0.822
Moderate
4
Are there times when you cannot work because of your nervousness?
50
1.94
0.586
Moderate
5
Do you wish to be dead and away from everything?
50
1.24
0.431
Poor
6
Have you think about suicide to get rid of this life?
50
1.06
0.314
Poor
F. = frequency, % = percentage, Mean of score (poor= 1–1.66 moderate = 1.67 –2.32 high = 2.33– 3)
Table 6: Assessment of Patients’ overall responses to the psychological aspects
Assessment of
the overal
psychological
aspects domain
Levels
Frequency
percent
Mean
Assessment
Poor
10
20
2.9
Moderate
Moderate
25
50
High
15
30
Total
50
100
Table 7: Association between the Patients’ Psychosocial Aspects and Their Demographic and Clinical Data
Demographic characteristics
Chi-Square
d.f
Significance p-value
Age
9.760
4
0.005 S
Gender
2.534
1
0.111 Ns
Residence
9.764
1
0.006 S
Marital Status
16.116
3
0.001 Hs
Educational level
10.219
5
0.069 Ns
Economic status
4.091
2
0.690 Ns
No. of child
3.169
3
0.366 Ns
Family size
1.058
3
0.787 Ns
Non-significant at p-value >0.05; S, significant at p-value <0.05; HS, highly significant at p-value ˂0.01
Descriptive Statistics (Frequency and Percentage) For Items Regarding Physical Domain
Table 2. Shows the physical domain issues for patients with chronic renal failure indicating six items with moderate effected regarding to (feel healthy and well?) (Feeling in need that you need a special care?) (Feeling tired and exhausted?) (Felt that you have a headache?) (feel tightness and pressure in your head?) (feel that you have episodes of heat and cold inside your body?), while Highly response regarding (feel that you sick?)
Descriptive Statistics (Frequency and Percentage) For Items Regarding Anxiety and Insomnia Domain among Chronic Renal Failure Patients and Mean of Scores for That Items
Table 3.Our result showed that the majority of study sample shows moderate response regarding to anxiety and insomnia domain.
Descriptive Statistics (Frequency and Percentage) For Items Regarding Social Domain among Chronic Renal Failure Patients and Mean of Scores for those Items
Table 4. Shows the patients' responses to the social dysfunction domain which they are six items was moderate response while the other items is highly response.
Descriptive Statistics (Frequency and Percentage) For Items Regarding Depression Domain among Chronic Renal Failure Patients and Mean of Scores for those Items
Table 5. Shows that the patients responded to depression domain, four of this are poor response (feel that life is worth nothing and without hope), (feel that the world is not worth to living in) (wish to be dead and away from everything), and (have you think about suicide to get rid of this life) while the other have the moderate response.
Assessment of Patients’ Overall Responses to the Psychological Aspects
Table 6 showed moderate response regarding to overall assessment response to psychological aspects
Association between the Patients’ Psychosocial Aspects and Their Demographic and Clinical Data
Table 7 showed there was significant association between psychological aspect and sociodemographic characteristic variables like age, residency and marital status while there was no significant association with other demographic variables like gender (p = 0.111), educational level (p = 0.069), economic status (p = 0.690), number of child in family (p = 0.366) and family size (p = 0.787).
DISCUSSION
The study sample which represent that male are more than female among the participants which they were 27(54%) and that in agreement with study done by Guerra et al. [11]. The percentage of age group shows that from (36-45) are the most age group among the participants which they represent 16 (32%) of the patients. For residency shows that urban residency was 30 (60%) which more than rural residency for the patients. Regarding to the marital status show that most of them are married 39 (78%) and about the economic status are higher percentage of them have sufficient some extent economic status 25 (50%). Also the number of children from (2 – 4) represent 16 (32%), Also total family members (3-6) with percent 28 (56%). Educational level show that (26%) of the patients are literate, and (16%) are illiterate. The assessment of patients’ overall responses to the psychological aspects Our result show there was moderate effect and that result in agree with result done by McKercher et al. found there found moderate association between psychological affect and chronic renal failure [12]. Regarding to relationship between the psychosocial aspects and demographic data our result show there was significant association between age, residency and marital status and there was no significance with the other variables. Rosenberg et al. found, age is highly related to psychosocial aspects among chronic renal failure patients, older age patients developing more psychological problems like depression, anxiety, insomnia and social function impairment, than other age groups because even chronic renal failure disease is getting worse with advancing in age in addition to develop cognitive impairment [13]. According to residency studies have approved the relationship between psychological aspects of chronic diseases and residency, it has been found that rural residency is more related with psychiatric comorbidities also higher intensity and frequency of pain which produce more psychological problems [14]. It has mentioned by some researches that psychological domains like depression, stress and insomnia have highly relationship with marital status, it has mentioned that hemodialysis may cause changes in marital status and psychological problems may increase as these patients have more troubles in their marital relationships [15].
CONCLUSION
In conclusion, depending on results of study, the main conclusions of the study are: Most of the chronic renal failure patients had effects with psychosocial and physical aspects; Progression of chronic renal failure resulting in causing elevating psychological and physical condition. In addition, the psychological problems are correlated with the (age, residency, and marital status) of patients.
REFERENCE
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Fathy, Ashgan et al. "Psychological problems among patients undergoing hemodialysis." Egyptian Journal of Health Care, vol. 8, no. 4, 2017.
Elhadad et al. "Psychiatric comorbidity and quality of life in patients undergoing hemodialysis." Middle East Current Psychiatry, vol. 27, 2020, article 9.
Guan, Yun and Yu-xia He. "Effect of advanced care on psychological condition in patients with chronic renal failure undergoing hemodialysis." Medicine (Baltimore), vol. 98, no. 10, 2019, e14738.
Vaidya, Satyanarayana R. and Narothama R. Aeddula. Chronic renal failure. StatPearls Publishing, 2018.
Vadakedath, Sabitha and Venkataramana Kandi. "Dialysis: A review of the mechanisms underlying complications in the management of chronic renal failure." Cureus, vol. 9, no. 8, 2017, e1603.
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Kadhim, M. A. A. (2023) 'Assessment of the psychological aspects among chronic renal failure patients in Imam Al-Hussein Medical City' Himalayan Journal of Community Medicine and Public Health 4(2), pp. 1-5.
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Kadhim MAA. Assessment of the psychological aspects among chronic renal failure patients in Imam Al-Hussein Medical City. Himalayan Journal of Community Medicine and Public Health. 2023 Jul;4(2):1-5.
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