A Correlative Study Of The Psychological State, Quality Of Life And Cognitive Dysfunction In Maintenance Hemodialysis Patients

Background and objective HD is the earliest and most widely used treatment of renal replacement . More and more ESRD patients gained a new life through HD. Although the extended survival of patients, but HD treatment also can not entirely replace the physiological functions of the kidney. HD could not prevent the deterioration of the original disease and difficult to change the progress of multiple organ damage caused by kidney failure. Therefore, the shadow of death has been shrouded with patients. HD itself is a painful process. Many times in a week with thick needles puncture vascular caused physical pain and lonely lying for 4-5 hours each time of HD caused depressed and helpless. Some discomfortments in dialysis process may often caused fearless and despairment. Not working of illness may reduced contactment with the other people and decreased responsibilities of the family.Which reduces their social value and access the opportunities by social support. At the same time cost of HD bring the large financial burden on patients and their families .Which make them feeling their lives depend on the factors beyond their control. These cause anxiety, fear, depression, worthlessness, helpless and other psychological disorder of the HD patients. These factors seriously affect the psychological status, quality of life and cognitive function of patients. The study attempted to investigate psychological state,quality of life,cognitive dysfunction and its correlative factors of chronic hemodialysis patients so as to provide scientific evidence for increasing mental health level,quality of life and cognitive capacity.Methods 64 patients with maintenance HD and 65 normal controls were involved in the study.The data of two groups have no significant difference by banlance test.All the subjects themselves completed the following questionnaires,general condition questionnaire,SDS,SAS,SF一36,MMSE and measured blood routine,biochemistry routine and PTH.Results (1)The total scores of SDS and SAS in HD patients were significantly higher than those in the normal subjects. Low body weight with depression in HD patients is more obvious compared with those without depression. Single patients in HD group have higher dangers with anxiety disorders compared with having spouse.female, poor economic conditions, living in rural areas patients were significantly increased anxiety disorder and depression. The total average scores of SDS in HD patients have negtive relationship with hemoglobin and serum creatinine.The total average scores of SAS in HD patients have negtive relationship with serum creatinine. (2) The total average scores of SF -36 and the scores of PF, RP, BP, GH, VT, SF, RE, MH , PCS and MCS in HD group were significantly lower than those in the normal subjects.Patients with high body weight have higher quality of life than those with low-weight in HD patients. Combined with anxiety or depression have bad quality of life in patients. Quality of life have negtive relationship with the number of complications , the total scores of SDS and SAS in HD patients . Quality of life have positive relationship with serum creatinine in HD patients . (3) The scores of MMSE in HD group was lower than the normal group.Attention and calculation ability, Visual spatial ability in HD group were significantly lower than those in the normal subjects.The scores of MMSE have positive relationship with level of education, PTH, serum creatinine level.But negatively related to age, female,unemployed, number of complications, the total scores of SDS and diabetes . The scores of MMSE have no relationship with serum albumin, hemoglobin concentration, dialysis time in every week, Kt / v .Conclusions Low weight, marital status, low hemoglobin,low serum creatinine, high total scores of SDS and SAS has the greater impact on psychological status in HD patients. Psychological factors and dialysis treatment itself have impact on QOF of HD patients. Cognitive capacity decline in HD patiems is closely associated with elderly, diabetes, low levels of education, lower vitality and role emotional.