Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2016  |  Volume : 27  |  Issue : 5  |  Page : 1063--1067

Relationship between anemia, quality of life, and laboratory indices in hemodialysis patients


Mahdi Sadeghi1, Hossein Ebrahimi2, Mohammad Abbasi3, Reza Norouzadeh4,  
1 Department of Nursing, Disaster and Emergency Medical Management Center, Shahroud University of Medical Sciences, Shahroud, Iran
2 Department of Nursing, Randomized Controlled Trial Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
3 Department of Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
4 Department of Nursing, School of Nursing and Midwifery, Shahed University, Tehran, Iran

Correspondence Address:
Dr. Hossein Ebrahimi
Department of Nursing, Randomized Controlled Trial Research Center, Shahroud University of Medical Sciences, Shahroud
Iran




How to cite this article:
Sadeghi M, Ebrahimi H, Abbasi M, Norouzadeh R. Relationship between anemia, quality of life, and laboratory indices in hemodialysis patients.Saudi J Kidney Dis Transpl 2016;27:1063-1067


How to cite this URL:
Sadeghi M, Ebrahimi H, Abbasi M, Norouzadeh R. Relationship between anemia, quality of life, and laboratory indices in hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2020 Jan 27 ];27:1063-1067
Available from: http://www.sjkdt.org/text.asp?2016/27/5/1063/190905


Full Text

To the Editor,

Chronic renal failure (CRF) is on the rise in developing countries. [1],[2] The prevalence of CRF has increased from 234 cases/million population in 2000 [3] to 357 in 2006. [4] About one million patients survive through dialysis in the world. [5] Hemodialysis (HD) is the most common method of treatment in many countries and also in Iran. [6] The growth of endstage renal disease in Iran has been reported as 12% per year. [7] HD patients have a lower quality of life (QOL) and survival and major lifestyle changes occur in these patients. [8],[9] HD affects health status and personal roles [10] leading to significantly reduced QOL compared with the general population. [11],[12]

Anemia in chronic kidney disease is a common problem that usually results from inadequate erythropoietin production. [13] According to studies, the outcome of correcting anemia in dialysis patients has been associated with general health improvement [14],[15],[16],[17],[18] as well as reducing the mortality rate in these patients. [19],[20] The lower than normal levels of hemoglobin (Hb) have a negative effect on QOL of these patients. [21],[22] DeVita et al showed that lower or higher than recommended levels of Hb in HD patients is associated with complications such as cardiovascular disorders, dysrhythmias and cardiac hypertrophy, stroke, and arteriovenous fistula dysfunction. [23] Anemia increases the risk of hospitalization, morbidity, and mortality in hemodialysis patients. [24],[25]

This study aims to determine the relationship between anemia, QOL, and some laboratory indices in HD patient.

In this cross-sectional study, HD patients older than 18 years in Imam Hossein (AS), Shroud, in 2014 were studied. This hospital is a referral center for dialysis patients. All participants of the study were informed about the purpose of the study and signed an informed consent form. Approval of the University Ethics Committee was obtained (code: 920/02).

Data collected included demographic information and QOL questionnaire for patients on dialysis (kidney disease quality of life). This questionnaire is a valid and reliable [26] and has a high degree of internal consistency and correlation [27] and offers a deep and broad interpretation of the variables related to the QOL in HD patients. [28] Yekaninejad et al confirm the good reliability and validity of the questionnaire in the Iranian population. [29] Higher scores indicate higher QOL. We also extracted from medical records: the serum values of albumin, bilirubin, potassium, calcium, phosphorus, fasting blood glucose, creatinine, and sodium. The tests were performed in the laboratory of Imam Hossein Hospital. After collecting the data, the correlation between variables and QOL was analyzed using the Pearson correlation coefficient.

Ninety-nine patients were enrolled in this study. The mean age was 5.98 ± 10.98 year; 61.6% were male. Sixty-three patients had been on dialysis for more than two years. Seventy of the patients receive three or more dialysis session a week [Table 1]. The result showed that the mean Hb was 10.36 ± 0.95 (g/dL) and hematocrit (HCT) was 32.60 ± 3.25 (%). Pearson correlation coefficients showed a significant positive correlation between Hb and HCT with the QOL, i.e., the patients with higher levels of index had a higher QOL [Table 2].{Table 1}{Table 2}

Furthermore, the Pearson correlation coefficient showed there was a correlation between Hb and HCT with albumin, bilirubin, potassium, calcium, and phosphorus. While did not show significant with glucose, creatinine, and sodium [Table 3].{Table 3}

In this study, the mean of Hb was 10.36 ± 0.95 and HCT was 32.60 ± 3.25 which is similar to that reported by Hanafusa. [25] Recommended values for Hb in HD patient for men is >13.5 g/dL and for women is >12 g/dL. [30]

We found a positive correlation between Hb and the QOL score. Following the use of erythropoietin and increasing the Hb, the QOL in HD patients improved considerably [31] including higher levels of physical, cognitive, and psychological QOL. [20],[32],[33],[34],[35],[36],[37],[38],[39]

We also found a significant correlation between Hb and HCT with the following laboratory indices: albumin, bilirubin, potassium, calcium, and phosphorus but not with blood glucose, creatinine, and sodium. The results of several studies have shown improvements in physical, sexual, cognitive functions as well as correction of metabolic disorders. [40],[41] In this regard, the nurses can help to health promotion with patient and family education about dietary requirement to increase the Hb and Hb level. [42]

Based on the findings, it is concluded the higher Hb associated with more favorable of QOL and laboratory indices.

The limitations of this study include the small number of the sample studied and the crosssectional nature of the study.

Conflict of interest: None declared.

References

1Imani E, Khademi Z, Hosseini Teshnizi S, et al. The role of face-to-face education on body weight and some serum parameters in hemodialysis patients. Modern Care 2013;10:115-23.
2Prodjosudjadi W. Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia. Ethn Dis 2006;16 2 Suppl 2:S2.
3Haghighi AN, Broumand B, D'Amico M, Locatelli F, Ritz E. The epidemiology of endstage renal disease in Iran in an international perspective. Nephrol Dial Transplant 2002; 17:28-32.
4Mahdavi-Mazdeh M, Zamyadi M, Nafar M. Assessment of management and treatment responses in haemodialysis patients from Tehran province, Iran. Nephrol Dial Transplant 2008; 23:288-93.
5Hakim RM, Depner TA, Parker TF 3rd. Adequacy of hemodialysis. Am J Kidney Dis 1992;20:107-23.
6Shafi Pour V, Jafari H, Shafi Pour L. Relation of quality of life and stress intensity in hemodialysis patient. Kowsar Med J 2009;14: 169-74.
7Otaghi M, Hassani P, Zagharie Tafreshi M, Nikbakht Nasrabadi A. Challenge in acceptance of heamodialysis: A part of a grounded theory. J Res Dev Nurs Midwifery (Res) 2013; 10:26-34.
8Sreejitha NS, Devi KS, Deepa M, Narayana GL, Anil M, Rajesh R. The quality of life of patients on maintenance hemodialysis and those who underwent renal transplantation. Amrita J Med 2012;8:1-44.
9Kao TW, Lai MS, Tsai TJ, Jan CF, Chie WC, Chen WY. Economic, social, and psychological factors associated with health-related quality of life of chronic hemodialysis patients in northern Taiwan: A multicenter study. Artif Organs 2009;33:61-8.
10Kutner NG, Muntner P, Huang Y, et al. Effect of Hurricane Katrina on the mortality of dialysis patients. Kidney Int 2009;76:760-66.
11Ebrahimi H, Sadeghi M, Amanpour F, Dadgari A. Influence of nutritional education on hemodialysis patients' knowledge and quality of life. Saudi J of Kidney Dis Transpl 2016;27(2):250.
12Mollaoglu M. Fatigue in people undergoing hemodialysis. Dial Transplant 2009;38:216-20.
13Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006; 355:2085-98.
14Weiner DE, Tighiouart H, Vlagopoulos PT, et al. Effects of anemia and left ventricular hypertrophy on cardiovascular disease in patients with chronic kidney disease. J Am Soc Nephrol 2005;16:1803-10.
15Ofsthun N, Labrecque J, Lacson E, Keen M, Lazarus JM. The effects of higher hemoglobin levels on mortality and hospitalization in hemodialysis patients. Kidney Int 2003;63: 1908-14.
16Collins AJ. Anaemia management prior to dialysis: Cardiovascular and cost-benefit obser-vations. Nephrol Dial Transplant 2003; 18 Suppl 2:ii2-6.
17Locatelli F, Pisoni RL, Akizawa T, et al. Anemia management for hemodialysis patients: Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines and Dialysis Outcomes and Practice Patterns Study (DOPPS) findings. Am J Kidney Dis 2004;44 5 Suppl 2:27-33.
18Pisoni RL, Bragg-Gresham JL, Young EW, et al. Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:94-111.
19Foley RN, Parfrey PS, Morgan J, et al. Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int 2000;58:1325-35.
20Parfrey PS, Foley RN, Wittreich BH, Sullivan DJ, Zagari MJ, Frei D. Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptommatic heart disease. J Am Soc Nephrol 2005;16:2180-9.
21Johansen KL, Finkelstein FO, Revicki DA, et al. Systematic review of the impact of erythropoiesis-stimulating agents on fatigue in dialysis patients. Nephrol Dial Transplant 2012;27:2418-25.
22Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol 2001;12:2797-806.
23DeVita MV, Frumkin D, Mittal S, Kamran A, Fishbane S, Michelis MF. Targeting higher ferritin concentrations with intravenous iron dextran lowers erythropoietin requirement in hemodialysis patients. Clin Nephrol 2003;60: 335-40.
24Locatelli F, Conte F, Marcelli D. The impact of haematocrit levels and erythropoietin treatment on overall and cardiovascular mortality and morbidity - The experience of the Lombardy Dialysis Registry. Nephrol Dial Transplant 1998;13:1642-4.
25Hanafusa N, Nomura T, Hasegawa T, Nangaku M. Age and anemia management: Relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients. Nephrol Dial Transplant 2014;29:2316-26.
26Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the kidney disease quality of life (KDQOL) instrument. Qual Life Res 1994;3:329-38.
27Hays R, Kallich J, Mapes D, Conos S, Carter W. Kidney Disease Quality of Life Short Form (KDQOL-SF), Version 1.2. Vol. 79. Santa Monica, CA: RAND Corporation; 1995. p. 28.
28Merkus MP, Jager KJ, Dekker FW, Boeschoten EW, Stevens P, Krediet RT. Quality of life in patients on chronic dialysis: Self-assessment 3 months after the start of treatment. The Necosad Study Group. Am J Kidney Dis 1997;29:584-92.
29Yekaninejad M, Mohammadi Zeidi I, Akaberi A, Golshan A, pakpour A. Validity and reliability of the Kidney Disease Quality of Life - Short Form (KDQOL-SF™ 1.3) in Iranian patients. J N Khorasan Univ Med Sci 2012;4:273.
30KDOQI; National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 2006;47 5 Suppl 3:S11-145.
31Revicki DA, Brown RE, Feeny DH, et al. Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients. Am J Kidney Dis 1995;25:548-54.
32Moreno F, Sanz-Guajardo D, López-Gómez JM, Jofre R, Valderrábano F. Increasing the hematocrit has a beneficial effect on quality of life and is safe in selected hemodialysis patients. Spanish Cooperative Renal Patients Quality of Life Study Group of the Spanish Society of Nephrology. J Am Soc Nephrol 2000;11:335-42.
33McMahon LP, Mason K, Skinner SL, Burge CM, Grigg LE, Becker GJ. Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end-stage renal failure. Nephrol Dial Transplant 2000; 15:1425-30.
34Drüeke TB, Locatelli F, Clyne N, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071-84.
35Valderrábano F. Erythropoietin in chronic renal failure. Kidney Int 1996;50:1373-91.
36NKF-DOQI clinical practice guidelines for the treatment of anemia of chronic renal failure. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis 1997;30 4 Suppl 3:S192-240.
37Besarab A, Bolton WK, Browne JK, et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med 1998;339:584-90.
38Eknoyan G, Levin N. Clinical Practice Guidelines: Final Guideline Summaries from the Work Groups of the National Kidney Foundation. Dialysis Outcomes Quality Initiative. New York: National Kidney Foundation; 1997.
39Lim VS. Recombinant human erythropoietin in predialysis patients. Am J Kidney Dis 1991;18 4 Suppl 1:34-7.
40Winearls CG, Oliver DO, Pippard MJ, Reid C, Downing MR, Cotes PM. Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet 1986;2:1175-8.
41Canaud B, Polito-Bouloux C, Garred LJ, et al. Recombinant human erythropoietin: 18 months' experience in hemodialysis patients. Am J Kidney Dis 1990;15:169-75.
42Ebrahimi H, Sadeghi M. The effect of dietary regimen education on the laboratory variables in hemodialysis patients. J Nurs Educ (Quant Res) 2014;2:12-22.