Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Nursing, Amol School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
Sci Rep. 2024 May 1;14(1):9981. doi: 10.1038/s41598-024-60679-2.
Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.
血液透析是终末期肾病的保守治疗方法。它有各种并发症，会对生活质量（QOL）产生负面影响。本研究旨在探讨接受血液透析的患者的疲劳、瘙痒和口渴困扰（TD）与 QOL 的关系，同时考虑治疗依从性（TA）的中介作用。这是一项 2023 年在伊朗几个透析中心进行的横断面研究。参与者是连续招募的。使用人口统计学信息表、疲劳评估量表、口渴困扰量表、瘙痒严重程度量表、12 项简短健康调查和希腊简化血液透析患者用药依从性问卷的修订版收集数据。基于协方差的结构方程模型用于数据分析。结构模型和假设检验结果表明，本研究中所有假设均得到支持。QOL 与疲劳、瘙痒和 TD 呈显著负相关，与 TA 呈显著正相关。TA 部分中介了 QOL 与疲劳、瘙痒和 TD 的关联，表明它有助于抵消这些并发症对 QOL 的负面影响。该模型解释了 QOL 总方差的 68.5%。疲劳、瘙痒和 TD 与接受血液透析的患者的 QOL 呈负相关，而 TA 则减少了这些负相关。因此，TA 对于管理这些并发症的关联和改善患者结局非常重要。医疗保健提供者需要高度重视提高这些患者的 TA，以减轻他们的疲劳、瘙痒和 TD，提高他们的 QOL。需要进一步研究以确定改善 TA 和减轻该患者群体并发症负担的最有效策略。
