A longitudinal study on the psychological effects of hemodialysis treatment on primary caregivers of chronic renal failure patients

 

 

Abstract               Background: Chronic diseases required a prolonged period of supervision, observation, and predominant care. We often measure the effect of diseases on patients as well as on professional caregivers but tend to forget to determine disease effects on primary caregivers. Taking care of patients suffering from chronic disease produces physical as well as the psychological impact on caregivers. Aim: Assessment of psychological effects of hemodialysis treatment on primary caregivers of chronic renal failure patients. Methods: Present longitudinal study conducted at tertiary care teaching of a hospital. Total 148 primary caregivers of renal failure patients twice interviewed. Out of that; 75 were primary caregivers of patients undergoing pharmacotherapy with hemodialysis (group A) and 73 were those whose patients were on pharmacotherapy alone (group B). The Zarit burden interview tool was used to assess psychological effects. Results: Out of 148 primary caregivers males and females were 72.97% (108) and 27.07% (40) respectively. Initially in primary caregivers of group A; 41.3% and 54.7% had mild to moderate and moderate to severe type of disease burden while on second interview 57.3% and 34.7% responded to have moderate to severe and severe type of disease burden respectively. In group B initially, only 9.6% informed to have moderate to severe type of disease burden and remaining had either little or mild to moderate type of burden while on follow up interview 49.3% and 35.6% had mild to moderate and moderate to severe type of disease burden respectively. Conclusion: Hemodialysis with pharmacotherapy could increase the disease burden on primary caregivers as compared to pharmacotherapy alone.

Key Word: hemodialysis.

 

 

INTRODUCTION

As per commission on Chronic Illness in USA; chronic diseases are the one which are permanent, caused by non reversible pathology, leaves residual disability, requires rehabilitation and long period of supervision, observation and care.¹Chronic kidney disease affects around 10% population around the world². The prevalence of psychosocial problems in chronic dialysis patients such as anxiety, depression, hostility, and suicidal tendencies are relatively common.³But, Illness are never an isolated life event; like patients suffered, his family and caregivers also endure consequences. Often caregiver receive                little attention and the main focus           is on the patient. Taking                care of  patients               suffering from chroni disease produces physical as well as the psychological impact on caregivers. We often measure the effect of diseases on patients as well as on professional caregivers but tend to forget to determine disease effects on primary caregivers. With this background present study conducted on primary caregivers, who accompanied chronic renal failure patients for the hemodialysis treatment at tertiary care teaching hospital.

 

OBJECTIVES

1. Assessment of psychological effects of ‘hemodialysis with pharmacotherapy’ and ‘pharmacotherapy only’ treatment on primary care givers of chronic diseases patients
2. Compare the psychological effects of primary care givers of patients of hemodialysis with pharmacotherapy and pharmacotherapy only treatment.

 

MATERIAL AND METHODS

Present study conducted after the approval of Institutional and Ethical Committee (IEC). Study design: Observational. Study type: Descriptive Longitudinal Study. Study setting: Hemodialysis unit and Medicine OPD of Bharti Hospital of Bharti Vidyapeeth; (Deemed to be University) Study population: All Primary caregivers who accompanying patients    of chronic kidney failure patients for haemodialysis treatment. Primary      caregivers who accompanying patients of chronic kidney failure patients for treatment of pharmacotherapy (only) to medicine OPD. Study Period: 18 months (August 2019 to December 2020).

Inclusion criteria's: Primary caregivers of newly diagnosed patients. Primary caregivers of patients who were about to start hemodialysis treatment. Primary caregivers of 18 to 60 years of age.

Exclusion criteria's: Primary caregivers who were not willing to give informed consent. Caregivers who were not engaged as a full time carer of patient. Caregivers who has history of psychiatry morbidity, substance abuse etc. Sampling Method: Simple random sampling method used.

By assuming 50% prevalence of psychiatric morbidity among primary care givers of chronic renal failure patients. At 95% confidence level; Z:1.96. α 5% and d: 0.13. The calculated sample size was 57; By considering 10% loss to follow up; (57+6)= 63 was minimum calculated sample size, which was rounded to 70
Sample Size

Data collection: After the diagnosis and deciding the line of management by consultant nephrologist; primary caregivers of the chronic renal failure patients were screened as per inclusion and exclusion criteria's. Those who were found to be eligible to participate, were grouped and briefed about the aim and objectives of the present study in their local language.

Group A: Primary caregivers of patients who were on hemodialysis and pharmacotherapy

Group B: Primary caregivers of patients who were on pharmacotherapy only

After assuring the confidentiality of data and obtaining informed consent; primary care givers were twice interviewed according to pre- structured and pre-determined questionnaire.

Part 1: Basic Information	Part 2: Psychiatrics disorders	Part 3:Burden assessment and Quality of life
Socio- demographic data	Standard interview including mental status examination	Zarit Burden4 WHO well being index5

Statistical analysis

Data entry and coding was done in Microsoft excel and SPSS 22.0 statistical software was used for descriptive and inferential statistical analysis

 

 

 

 

 

 

OBSERVATION AND RESULTS

In present study; Primary caregivers of patients who were on haemodialysis and pharmacotherapy{Group I (n=75)}, and who were only on pharmacotherapy {Group II (n=73)}, after 06 months of first interview were again interviewed.

 

Table 1: Age and gender wise distribution of the participants (n=148)

Table 2a: Age and Gender wise distribution (Group I)

 

Table 2b: Age and Gender wise distribution (Group II)

 

Table 3: Age comparison of Group I and II

 

Table 4: Comparison of burden of primary care givers of group I

 

Table 5: Changes in burden of Primary care givers of group I

Table 6: Comparison of burden of primary care givers of group II

 

 

Table 7: Changes in burden of Primary care givers of group II

 

Table 8A: Changes in burden of Primary care givers of group I with respect to Female Gender

Chi-square (χ2) test:15.42, d.f:04, P:0.004 Significant

Table 8B: Changes in burden of Primary care givers of group I with respect to Male Gender

Chi-square (χ2) test:11.94, d.f:04, P:0.01 Significant

 

Table 9A: Changes in burden of Primary care givers of group II with respect to Female Gender

Chi-square (χ2) test:8.14, d.f:04, P:0.08 Non-Significant

 

Table 9B: Changes in burden of Primary care givers of group II with respect to Male Gender

Chi-square (χ2) test:18.69, d.f:06, P:0.005 Significant

Table 10 A: Changes in burden of Primary caregivers of Group I who were less than 40 years old

Chi-square test (χ2):12.52, d.f:04, P:0.01 Significant

 

Table 10 B: Changes in burden of Primary caregivers of Group I who were More than 41 years old

Chi-square test (χ2)12.75, d.f:02, P:0.002 Significant

 

 

 

 

Table 11A: Changes in burden of Primary caregivers of Group II who were less than 40 years old

Chi-square test (χ2):10.09, d.f:06, P:0.1 Non-Significant

 

Table 11B: Changes in burden of Primary caregivers of Group II who were more than 41 years old

Chi-square test (χ2):13.52, d.f:06, P:0.03 Significant

DISCUSSION

 

SUMMARY

Total 148 primary care givers (75 group I and 73 group II) were interviewed twice; 27% and 73% were males and females respectively. Mean difference of age in between group I and group II found to be non significant

 

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