DOI QR코드

DOI QR Code

Association of diet-related quality of life with dietary regimen practice, health-related quality of life, and gastrointestinal symptoms in end-stage renal disease patients with hemodialysis

혈액투석을 실행중인 말기 신부전 환자의 식사관련 삶의 질(Diet-Related Quality of Life)과 식사요법 실천도, 건강관련 삶의 질 및 위장관 증상과의 관련성 연구

  • Lee, JinJu (The Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • Kim, Ji-Myung (Department of Food and Nutritional Sciences, Hanbuk University) ;
  • Kim, Yuri (The Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 이진주 (이화여자대학교 임상보건과학대학원 임상영양학전공) ;
  • 김지명 (한북대학교 식품영양학과) ;
  • 김유리 (이화여자대학교 임상보건과학대학원 임상영양학전공)
  • Received : 2013.01.30
  • Accepted : 2013.03.13
  • Published : 2013.04.30

Abstract

The purpose of this study was to evaluate diet-related Quality of Life (QOL) and to analyze the relationship among diet-related QOL, dietary regimen practice, health-related QOL, and gastrointestinal symptoms in hemodialysis patients. Subjects were recruited from an artificial kidney center in Seoul. The self-report questionnaire consisted of socio-demographic characteristics, diet-related QOL, compliance with dietary regimen practice, health-related QOL, and gastrointestinal symptoms was distributed. Diet-related QOL includes a 'Quality of Life and Related to Dietary Change Questionnaire', 'Satisfaction Survey', and 'Dietary Impact Survey'. According to their responses, participants had experienced the greatest difficulty with 'Dietary Impact'. In particular, the mean score for general health was low. Association of dietary regimen practice showed a positive association with 'Cost' and 'Self-care' score. In addition, diet-related QOL showed positive correlation with health-related QOL, particularly in 'taste'. Scores for 'Taste', 'Convenience', and 'Dietary Impact' were lower for subjects with constipation compared to those of subjects without constipation. Scores for 'Taste' and 'Dietary Impact' were lower in subjects with irritable bowel syndrome compared to those of subjects without the syndrome (p < 0.05). Diet-related QOL showed a positive association with health-related QOL (p < 0.05), whereas it showed a negative association with constipation (p < 0.01). In conclusion, hemodialysis patients in Korea suffer from burden of dietary regimen practice and most scores for diet-related QOL and health-related QOL from patients with gastrointestinal symptoms were low. Therefore, appropriate nutrition education considering gastrointestinal symptoms is necessary for improvement of patients' QOL during dietary regimen practice.

혈액투석 식사요법을 실천하고 있는 말기 신부전 환자들을 대상으로 식사관련 삶의 질을 측정하고 식사관련 삶의 질과 식사요법 실천정도, 건강관련 삶의 질, 위장관 증상과의 관계를 살펴본 결과는 다음과 같다. 1) 대상자들의 평균 연령은 53.0세, 남성의 비율이 58.4%, 운동을 하는 대상자는 55.4%, 흡연비율은 11.9%, 음주비율은 10.9%로 대체적으로 자기관리를 하고 있는 것으로 나타났으며, 대상자들의 66.3%가 영양교육 경험이 있었다. 합병증으로 당뇨가 38.6%, 고혈압이 32.7%이었고, 위장관 증상으로 대상자의 72.3%가 변비, 14.9%가 과민성 장 증후군인 것으로 나타났다. 2) 식사요법 실천정도는 55점 만점에 35.4점으로 나타났고, 식사요법 실천정도가 상승할수록 식사요법과 관련된 비용, 자기관리에 대한 만족감 영역의 삶의 질이 증가 (p < 0.05)하는 것으로 나타났다. 3) 식사관련 삶의 질은 건강관련 삶의 질과 여러 항목들과 양의 상관관계가 있는 것으로 나타났고 (p < 0.05, p < 0.01), 특히 만족감 영역, 정신적 영역에서의 관련성이 높은 것으로 나타났다 (p < 0.01). 4) 변비가 있는 대상자의 식사관련 삶의 질은 변비가 없는 대상자에 비해 맛, 편의성, 식사에 대한 부담감 영역의 식사관련 삶의 질이 유의적으로 낮았고 (p < 0.05), 과민성 장 증후군이 있는 대상자의 맛, 식사에 대한 부담감 영역 (p < 0.05)의 식사관련 삶의 질이 유의적으로 낮았다. 5) 대상자들의 식사관련 삶의 질에 영향을 미치는 변수들에 대한 다중회귀 분석 결과, 건강관련 삶의 질 (p < 0.05)과 변비 (p < 0.01)가 식사관련 삶의 질에 유의한 영향을 미치는 것으로 나타났다. 결론적으로, 식사요법을 실천중인 혈액투석 환자들은 식사요법 실천정도가 높았으나, 식사요법으로 인한 부담감이 크고 전반적인 건강영역의 삶의 질이 저하되어 있고, 더불어 위장관 증상에 따라 식사관련 삶의 질의 차이를 보였다. 따라서 영양교육 시에는 개개인의 식사관련 삶의 질, 식사요법 실천정도, 건강관련 삶의 질, 위장관 증상 등을 고려한 균형 있는 영양관리, 삶의 질 관리가 요구된다. 또한 식사 관련 삶의 질은 혈액투석 환자가 식사요법으로 인해 받는 사회적, 심리적 영향을 잘 반영할 수 있어 앞으로 영양교육이나 식사요법의 효과를 다각도로 평가하는데 있어서 좋은 도구로 사용 될 수 있을 것으로 기대된다.

Keywords

References

  1. Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med 2006; 354(23): 2473-2483 https://doi.org/10.1056/NEJMra054415
  2. Spiegel BM, Melmed G, Robbins S, Esrailian E. Biomarkers and health-related quality of life in end-stage renal disease: a systematic review. Clin J Am Soc Nephrol 2008; 3(6): 1759-1768 https://doi.org/10.2215/CJN.00820208
  3. Cruz MC, Andrade C, Urrutia M, Draibe S, Nogueira-Martins LA, Sesso Rde C. Quality of life in patients with chronic kidney disease. Clinics (Sao Paulo) 2011; 66(6): 991-995 https://doi.org/10.1590/S1807-59322011000600012
  4. ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea -Insan Memorial Dialysis Registry-. Seoul: ESRD Registry Committee, Korean Society of Nephrology; 2011
  5. Bossola M, Luciani G, Rosa F, Tazza L. Appetite and gastrointestinal symptoms in chronic hemodialysis patients. J Ren Nutr 2011; 21(6): 448-454 https://doi.org/10.1053/j.jrn.2010.09.003
  6. Chumlea WC, Dwyer J, Bergen C, Burkart J, Paranandi L, Frydrych A, Cockram DB, Kusek JW, McLeroy S; Hemodialysis Study Group. Nutritional status assessed from anthropometric measures in the HEMO study. J Ren Nutr 2003; 13(1): 31-38 https://doi.org/10.1053/jren.2003.50003
  7. Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi Fanelli F, Luciani G. Malnutrition in hemodialysis patients: what therapy? Am J Kidney Dis 2005; 46(3): 371-386 https://doi.org/10.1053/j.ajkd.2005.05.031
  8. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990; 15(5): 458-482 https://doi.org/10.1016/S0272-6386(12)70364-5
  9. Lowrie EG, Huang WH, Lew NL. Death risk predictors among peritoneal dialysis and hemodialysis patients: a preliminary comparison. Am J Kidney Dis 1995; 26(1): 220-228 https://doi.org/10.1016/0272-6386(95)90177-9
  10. Leung J, Dwyer J, Miller J, Patrick SW, Rocco M, Uhlin L. The role of the dietitian in a multicenter clinical trial of dialysis therapy: the Hemodialysis (HEMO) Study. J Ren Nutr 2001; 11(2): 101-108 https://doi.org/10.1016/S1051-2276(01)09506-1
  11. Kutner NG, Johansen KL, Kaysen GA, Pederson S, Chen SC, Agodoa LY, Eggers PW, Chertow GM. The comprehensive dialysis study (CDS): a USRDS special study. Clin J Am Soc Nephrol 2009; 4(3): 645-650 https://doi.org/10.2215/CJN.05721108
  12. Cho MK, Choe MA. Self care behavior of hemodialysis patients. J Korean Biol Nurs Sci 2007; 9(2): 105-117
  13. McCloskey C, Clarke J, Rayner H. Dialysis patients' understanding of nutritional advice. J Ren Nutr 1997; 7(2): 90-101 https://doi.org/10.1016/S1051-2276(97)90045-5
  14. Silva LF, Lopes GB, Matos CM, Brito KQ, Amoedo MK, Azevedo MF, Sá Araújo MJ, Martins MS, Lopes AA. Gastrointestinal symptoms and nutritional status in women and men on maintenance hemodialysis. J Ren Nutr 2012; 22(3): 327-335 https://doi.org/10.1053/j.jrn.2011.07.007
  15. Cano AE, Neil AK, Kang JY, Barnabas A, Eastwood JB, Nelson SR, Hartley I, Maxwell D. Gastrointestinal symptoms in patients with end-stage renal disease undergoing treatment by hemodialysis or peritoneal dialysis. Am J Gastroenterol 2007; 102(9): 1990- 1997 https://doi.org/10.1111/j.1572-0241.2007.01321.x
  16. Kahvecioglu S, Akdag I, Kiyici M, Gullulu M, Yavuz M, Ersoy A, Dilek K, Yurtkuran M. High prevalence of irritable bowel syndrome and upper gastrointestinal symptoms in patients with chronic renal failure. J Nephrol 2005; 18(1): 61-66
  17. Park JM, Choi MG, Kim YS, Choi CH, Choi SC, Hong SJ, Jeong JJ, Lee DH, Lee JS, Lee KJ, Son HJ, Sung IK. Quality of life of patients with irritable bowel syndrome in Korea. Qual Life Res 2009; 18(4): 435-446 https://doi.org/10.1007/s11136-009-9461-7
  18. Jeong JJ, Choi MG, Cho YS, Lee SG, Oh JH, Park JM, Cho YK, Lee IS, Kim SW, Han SW, Choi KY, Chung IS. Chronic gastrointestinal symptoms and quality of life in the Korean population. World J Gastroenterol 2008; 14(41): 6388-6394 https://doi.org/10.3748/wjg.14.6388
  19. Afsar B, Elsurer R, Yilmaz MI, Eyileten T, Yenicesu M. Irritable bowel syndrome in haemodialysis: Prevalence, link with quality of life and depression. Nephrology (Carlton) 2010; 15(2): 197- 202 https://doi.org/10.1111/j.1440-1797.2009.01189.x
  20. Kalantar-Zadeh K, Unruh M. Health related quality of life in patients with chronic kidney disease. Int Urol Nephrol 2005; 37(2): 367-378 https://doi.org/10.1007/s11255-004-0012-4
  21. Lacson E Jr, Xu J, Lin SF, Dean SG, Lazarus JM, Hakim RM. A comparison of SF-36 and SF-12 composite scores and subsequent hospitalization and mortality risks in long-term dialysis patients. Clin J Am Soc Nephrol 2010; 5(2): 252-260 https://doi.org/10.2215/CJN.07231009
  22. Braga SF, Peixoto SV, Gomes IC, Acúrcio Fde A, Andrade EI, Cherchiglia ML. Factors associated with health-related quality of life in elderly patients on hemodialysis. Rev Saude Publica 2011; 45(6): 1127-1136 https://doi.org/10.1590/S0034-89102011000600015
  23. Wiser NA, Shane JM, McGuigan AT, Memken JA. Olsson PJ. The effects of a group nutrition education program on nutrition knowledge, nutrition status, and quality of life in hemodialysis patients. J Ren Nutr 1997; 7(4): 187-193 https://doi.org/10.1016/S1051-2276(97)90017-0
  24. Min H, Ko KS, Kim MS, Moon SS, Park WD, Park CW, Suh SY, Yu BH, Lee YK, Chung TS, Shin YT. The influencing factors of quality of life in hemodialysis patients. Korean J Nephrol 1999; 18(5): 714-732
  25. Delahanty LM, Hayden D, Ammerman A, Nathan DM. Medical nutrition therapy for hypercholesterolemia positively affects patient satisfaction and quality of life outcomes. Ann Behav Med 2002; 24(4): 269-278 https://doi.org/10.1207/S15324796ABM2404_03
  26. Barr J, Schumacher G. Using focus groups to determine what constitutes quality of life in clients receiving medical nutrition therapy: first steps in the development of a nutrition quality-oflife survey. J Am Diet Assoc 2003; 103(7): 844-851 https://doi.org/10.1016/S0002-8223(03)00385-7
  27. Sato E, Suzukamo Y, Miyashita M, Kazuma K. Development of a diabetes diet-related quality-of-life scale. Diabetes Care 2004; 27(6): 1271-1275 https://doi.org/10.2337/diacare.27.6.1271
  28. Perry L, McLaren S. An exploration of nutrition and eating disabilities in relation to quality of life at 6 months post-stroke. Health Soc Care Community 2004; 12(4): 288-297 https://doi.org/10.1111/j.1365-2524.2004.00494.x
  29. Lee SJ, Park HS, Han JH, Kim HJ, Seo MW, Choi EA, Im EY, Choi MR, Choi SS, Park KO, Kim KO. Effects of an individualized educational program on knowledge, compliance and physiologic parameters in non-compliant hemodialysis patients. J Korean Clin Nurs Res 2009; 15(3): 5-16
  30. Park HM, Lee HS. Effects of empowerment education program for hemodialysis patients on self-efficacy, self-care agency, selfcare activities and physiologic parameters. Korean J Rehabil Nurs 2010; 13(2): 151-160
  31. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39(2 Suppl 1): S1-S266
  32. Lee HS, Joo J, Choue R. Study on diet-related quality of life in online self-help diabetes mellitus patients who practice dietary regimen. Korean J Community Nutr 2011; 16(1): 136-144 https://doi.org/10.5720/kjcn.2011.16.1.136
  33. Blackburn SL. Dietary compliance of chronic hemodialysis patients. J Am Diet Assoc 1977; 70(1): 31-37
  34. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30(6): 473-483 https://doi.org/10.1097/00005650-199206000-00002
  35. Kim HS, Lee KB, Lee YS, Kim H, Seh BS, Lim SW, Shin HC. The reliability and the validity of health related QOL Measurement Method in hemodialysis patients. Korean J Nephrol 2008; 27(1): 78-84
  36. Kim HY, Lee JC, Kim SG, Park JJ, Lee DH, Lee ST, Lee EH, Lee JH, Choi SL, Ham KB. Development of index of dyspepsia symptoms- Korean IDS-K. Annual meeting of the Korean Society of Gastroenterology; 2013 Nov 19-21. Seoul: Korean Society of Gastroenterology; 2003. p.562-579
  37. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999; 45 Suppl 2: II43-II47
  38. Drossman DA, Corazziari E, Delvaux M, Spiller R, Talley NJ, Thompson WG. Appendix B: Rome III diagnostic criteria for functional gastrointestinal disorders. Rev Gastroenterol Mex 2010; 75(4): 511-516
  39. Byham-Gray L, Wiesen K. A clinical guide to nutrition care in kidney disease. Chicago, IL: American Dietetic Association; 2004
  40. Lee SL, Kim YL, Lee SJ, Cho YK, Choi YK, Chun CH, Chang YK. Effects of diabetes education on diabetic management in non-insulin-dependent diabetics mellitus patients. J Korean Diet Assoc 2004; 10(3): 300-308
  41. Allen KL, Miskulin D, Yan G, Dwyer JT, Frydrych A, Leung J, Poole D; Hemodialysis (HEMO) Study Group. Association of nutritional markers with physical and mental health status in prevalent hemodialysis patients from the HEMO study. J Ren Nutr 2002; 12(3): 160-169 https://doi.org/10.1053/jren.2002.33512

Cited by

  1. Family-Centered Education and Its Clinical Outcomes in Patients Undergoing Hemodialysis Short Running vol.17, pp.5, 2015, https://doi.org/10.5812/ircmj.17(5)2015.20705
  2. Hemodialysis Patients' Experience of Adapting to Dietary Therapy vol.28, pp.3, 2016, https://doi.org/10.7475/kjan.2016.28.3.323
  3. Effects of Dietary Program based on Self-efficacy Theory on Dietary Adherence, Physical Indices and Quality of Life for Hemodialysis Patients vol.46, pp.4, 2016, https://doi.org/10.4040/jkan.2016.46.4.598
  4. Comparison Between Semi-Quantitative Frequency Methods and 7-day Dietary Records Methods in Food and Nutrition Intake Status For Hemodialysis Patients vol.22, pp.5, 2017, https://doi.org/10.5720/kjcn.2017.22.5.426
  5. Self-Management Knowledge, Self-Management, Physiological Indexes, and Symptoms Experience according to Dialysis Methods vol.25, pp.3, 2018, https://doi.org/10.7739/jkafn.2018.25.3.220
  6. Fatty Acid Composition of Milk of Refugee Karen and Urban Korean Mothers. Is the Level of DHA in Breast Milk of Western Women Compromised by High Intake of Saturated Fat and Linoleic Acid? vol.18, pp.4, 2013, https://doi.org/10.1177/026010600701800402
  7. 태충·삼음교의 침 자극이 Streptozotocin으로 유발된 당뇨쥐의 신장 손상에 미치는 영향 vol.32, pp.3, 2013, https://doi.org/10.13045/acupunct.2015037
  8. 혈액투석 환자에서 당뇨병 유무에 따른 영양상태와 영양섭취량 비교 vol.23, pp.1, 2017, https://doi.org/10.14373/jkda.2017.23.1.1
  9. 혈액투석 환자의 음식갈망 영향요인 vol.23, pp.3, 2013, https://doi.org/10.22650/jkcnr.2017.23.3.398
  10. 투석치료 중인 만성신부전 환자의 영양지식 수준과 식사요법 실천 정도 및 교육요구도 vol.24, pp.2, 2018, https://doi.org/10.14373/jkda.2018.24.2.117
  11. 혈액 투석 환자의 변비 완화 및 생리적 지표 향상을 위한 융합형 미숫가루 음용 섭취 프로그램 개발 예비 조사 vol.9, pp.5, 2013, https://doi.org/10.22156/cs4smb.2019.9.5.040
  12. Effects of the Combination of Auricular Acupressure and a Fluid-Restriction Adherence Program on Salivary Flow Rate, Xerostomia, Fluid Control, Interdialytic Weight Gain, and Diet-Related Quality of L vol.18, pp.19, 2013, https://doi.org/10.3390/ijerph181910520