Assessment of Female Patients Burden undergoing Hemodialysis at Shar Teaching Hospital in Sulaymaniyah City

1. INTRODUCTION

Chronic kidney disease is one of the main issues facing public health. Severe and irreversible renal dysfunction characterizes chronic renal failure, which makes it impossible for the body to maintain proper fluid, electrolyte, and metabolic balance [1].

A major worldwide health concern that affects 10% of the world’s population is chronic renal disease. More than 2 million people have dialysis to treat renal failure worldwide in the year 2020 [2]. The method of supplying blood extracted from a patient through vascular access by adjusting the fluid, electrolyte, and waste material content in an external machine is known as hemodialysis [3].

Hemodialysis patients may have a significant symptom load, accounting for 92% of cases. Distressing symptoms include exhaustion, appetite loss, difficulty concentrating, hand and foot edema, and muscular cramping can all have a severe impact on a patient’s quality of life and create daily anguish [4].

Hemodialysis therapy is costly, time-consuming, and necessitates dietary and hydration restrictions. Long-term dialysis therapy also requires hemodialysis 2 or 3 times a week, which can negatively affect caregivers by causing them to lose their independence, disrupt their social lives and marriages, and have their financial situation worsen. All of these factors can cause major disruptions to the lives of patients and their families [1].

The burden of chronic renal failure is demonstrated by the numerous and progressive metabolic, hormonal, and mental abnormalities that patients experience as their renal illnesses are near the terminal stage. Early on in the progression of renal failure, anemia and hyperparathyroidism are observed. Severe and accelerated vascular disease is the primary cause of morbidity and death in this patient population [5].

Males are more adept at hemodialysis than females. A significant percentage of women with long-term dialysis do not engage in sexual activity. Hyperprolactinemia is often observed in patients with end-stage renal disease (ESRD), and disturbance of the hypothalamic-pituitary axis has been associated with reduced testosterone levels. Menstrual abnormalities, anovulation, and infertility are prevalent in female end-stage renal failure patients. Therefore, the purpose of this study was to assess the burden of female patients receiving hemodialysis.

2. MATERIALS AND METHODS

3. RESULTS

Table 1 presents a distribution of sociodemographic variables. Fifty-three female patients completed the questionnaire. The study participants’ mean age was determined to be 55.8 ± 14.6 years, with the majority (41.0%) falling between the age range of 41 and 80 years. The “Educational level” metric reveals that 60.4% of the investigated respondents had no prior educational history, making them illiterate. In terms of occupation, 84.9% of the respondents identified as housewives. In terms of marital status, married respondents made up the bulk of the sample (90.6%). The largest proportion of participants’ residents (60.4%) was urban dwellers.

TABLE 1: Sociodemographic characteristic of the study sample

Table 2 displays the distribution of complaints related to hemodialysis among female patients. Of the study sample, the largest percentage (100%) reported fatigue, followed by decreased energy levels and weight change (98.1%), sleep disturbance (88.1%), and blurred vision (88.1%). The study’s lowest percentage of participants (5.7%) reported having social life problems.

TABLE 2: Distribution of complaints about hemodialysis among female study participants

The overall evaluation of the load on female patients receiving hemodialysis is displayed in (Table 3). The majority of participants (41.5%) had low assessments of the burden experienced by female patients undergoing hemodialysis, followed by those with high assessments (37.7%) and moderate assessments (20.8%) of the burden experienced by female patients undergoing hemodialysis.

TABLE 3: Overall assessment of female patient’s burden undergoing hemodialysis of the study sample

The relationship between sociodemographic traits and the overall assessment of the burden of female patients receiving hemodialysis is shown in (Table 4). The results indicate that when assessing the burden of female patients receiving hemodialysis, age groups, levels of education, and marital status were related to statistically significant relationships. Furthermore, the results indicate that there was no statistically significant correlation observed between the patients’ occupation, residency, length of hemodialysis treatment, and the overall assessment of the burden of female patients undergoing the treatment.

TABLE 4: Association between sociodemographic characteristics and overall assessment of female patient’s burden undergoing hemodialysis

4. DISCUSSION OF THE RESULTS

Fifty-three female patients burdened with hemodialysis were taking part in the research overall. Patients with obvious hemodyliasis frequently experience several physical, emotional, and social issues that significantly affect their health and burden their lives. Women’s issues are frequently distinct from men’s issues [6]. The current study investigates the health issues of female patients receiving HD maintenance phase. The majority of research participants view HD as an unpleasant treatment since it can cause several issues that negatively influence their quality of life. They are frequently compelled to make sacrifices in their social and familial lives [7].

The age group under investigation in this study had a mean of (Mean±SD 55.8±14.6), and 41% of the patients fell into the 40–80 year age range. Similar to Ibrahim et al.’s study from 2023 [8], the majority of patients’ ages were over 41 age range, which was 89.4% and above in the research. Karasneh et al.” Alaryni et al. discovered that the majority of participants were normally between the ages of 31 and 50. In contrast, a cross-sectional study conducted at 13 hospitals indicated that the mean (±SD) age of participants was 50.9±16.1 years [9], [10].

Sixty-four percent of the samples in this study were illiterate. In contrast, a survey conducted in 2022 by Aini et al. reveals that 84% of the participants had only completed elementary school [11].

According to the current study, 53% of patients’ complaints were related to weariness. On the other hand, the research Karasneh et al., 2020” [9]. According to a cross-sectional study conducted at 13 hospitals, muscle strain affects 62.6% of participants. Similar to this study, Almutary et al. found that 77% of the sample study participants complained of being tired [12]. Furthermore, it is evident from Song et al.’s 2020 study correlates of symptom burden of hemodialysis patients that 75% of the patients reported feeling exhausted or lacking energy [13].

In our study, the majority of patients had been receiving hemodialysis for longer than 10 years (60.4%). In comparison, a 2016 study by Almutary et al. discovered that 34.3% of patients had been receiving hemodialysis for 1.1–5 years [12]. Furthermore, only six participants in the study George et al. 2023 had been receiving HD for longer than 6 years [14].

The overall burden of female patients receiving hemodialysis was assessed in our study. 22 (41.5%) of the participants had low assessments of the burden experienced by female patients receiving hemodialysis, compared to 20 (37.7%) who had high assessments. Eleven (20.8%) participants had moderate assessments of the burden experienced by female patients receiving hemodialysis. The study conducted by Song et al. on the correlates of symptom burden of hemodialysis patients has generated controversy. The study found that the participants’ total scores of symptom burden ranged from 21 to 139, with a mean score of 74.12 (SD = 21.51). The patients’ reported symptom counts varied from 4 to 24, with a mean of 12 [13].

In contrast to our study, which found a mean score and SD of 18.2 ± 1.65, Song et al. report that the participants’ mean score of symptom load was 74.12, with a mean number of 12 symptoms. These results might be explained by the fact that Song et al.’s instrument only assesses the intensity of 10 symptoms. It is evident that hemodialysis patients have a high symptom burden and suffer several symptoms at once, despite the different diagnostic measures utilized. The three most common symptoms in our study were dry skin, itching, and fatigue or loss of energy, which is consistent with the results of other investigations [13].

5. CONCLUSION

The majority of cases involved housewives with illiteracy who had been receiving hemodialysis for more than 10 years. Most research samples exhibited lower energy levels, and almost all patients complained of being fatigued. The assessment of the burden of female patients receiving hemodialysis showed positive correlations with age groups, educational attainment, and marital status. Otherwise, no correlation was observed between the patients’ work, place of residence, length of hemodialysis treatment, and the overall estimate of the burden experienced by female patients.

6. ETHICAL CONSIDERATIONS

The University of Sulaymaniyah/College of Nursing, the College of Medicine’s ethical agreement, the Shar Teaching Hospital’s official directory of health, and approval letters were received to conduct the study. In addition, participants’ freely given verbal consent was collected.

8. CONFLICT OF INTEREST

The authors affirm that they have no conflicts of interest.

9. FUNDING

The authors fee provided financial support for the study.