Resumen
Introducción: los cuidadores de pacientes con enfermedad renal crónica terminal (ERCT) en diálisis sufren un proceso de erosión física-emocional derivado de las implicaciones del tratamiento y del cuidado permanente por largos periodos de tiempo.
Objetivo: evaluar la calidad de vida (CV) de cuidadores primarios de pacientes con ERCT en diálisis, e identificar predictores de baja CV.
Material y métodos: estudio multicéntrico transversal. De mayo a septiembre de 2019 se entrevistó a 137 cuidadores y 174 pacientes residentes de la ciudad de Chihuahua de cuatro hospitales. Los instrumentos empleados incluyeron: 1) un cuestionario para datos sociodemográficos/clínicos; 2) cuestionarios SF-36 y KD-SF para evaluar CV en cuidadores y pacientes con ERCT, respectivamente; 3) la escala de sobrecarga de Zarit para cuidadores, y 4) el inventario de síntomas para ansiedad y depresión de Goldberg.
Resultados: excepto para salud mental, donde las puntuaciones medias de CV fueron similares entre pacientes, cuidadores y no cuidadores sanos de referencia externa, las medias fueron mayores en cuidadores y no cuidadores para los demás dominios. Los cuidadores tuvieron menores medias para los componentes físico y mental, en comparación con los no cuidadores sanos. La edad del cuidador, la ansiedad, el tiempo en diálisis y la CV del paciente fueron predictores de baja CV.
Conclusiones: los cuidadores de pacientes en diálisis tienen mejor calidad de vida que los pacientes, y relativamente similar a la de individuos sanos que no cuidan pacientes.
Abstract
Background: Caregivers of patients with end-stage renal disease (ESRD) in dialysis endure a process of physical/ emotional erosion derived from the implications of treatment and permanent care for prolonged periods of time.
Objective: To assess the quality of life (QoL) of primary caregivers of patients with ESRD in dialysis, and to identify predictors of low QoL.
Material and methods: Cross-sectional multicenter study. From May to September 2019, 137 caregivers and 174 patients, residents of Chihuahua city, were interviewed from four hospitals. Instruments used included: 1) questionnaire for sociodemographic/clinical data, 2) SF-36 and KD-SF to assess QoL of caregivers and patients with ESRD, respectively, 3) Zarit burden interview for caregivers, and 4) Goldberg anxiety/depression scale symptom inventory.
Results: Except for mental health, where mean QoL scores were similar between patients, caregivers, and non-caregivers, means were higher in caregivers and non-caregivers for all other domains. Caregivers showed lower summary scores compared with healthy non-caregivers in both physical and mental components. Caregiver’s age, anxiety, time in dialysis, and patient’s QoL were predictors of low QoL.
Conclusions: Caregivers of patients in dialysis have better QoL compared with patients, but relatively similar to healthy individuals who do not take care of patients.
Tamayo Orozco J, Lastiri Quirós S. La enfermedad renal crónica en México. In: Enfermedad renal crónica en México: una política nacional todavía pendiente [Internet]. Ciudad de México: Consejo Nacional de Ciencia y Tecnología; 2016. p. 82. Disponible en: http://www.anmm.org.mx/publicaciones/ultimas_publicaciones/ENF-RENAL.pdf
Cueto-Manzano AM, Cortés-Sanabria L, Martínez-Ramírez HR, Rojas-Campos E, Gómez-Navarro B, Castillero-Manzano M. Prevalence of chronic kidney disease in an adult population. Arch Med Res. 2014;45(6):507-13. Disponible en: https://doi.org/10.1016/j.arcmed.2014.06.007
CENATRA. Boletín estadistico informativo del Centro Nacional de Transplantes BEI-CENATRA [Internet]. Mexico City: CENATRA; 2018. Disponible en: https://www.gob.mx/cms/uploads/attachment/file/484466/BEI-CENATRA_Vol._III__No._2_ENE-DIC_2018_WEB.pdf
Gilbertson EL, Krishnasamy R, Foote C, Kennard AL, Jardine MJ, Gray NA. Burden of Care and Quality of Life Among Caregivers for Adults Receiving Maintenance Dialysis: A Systematic Review. Am J Kidney Dis. 2019;73(3):332-43. Disponible en: https://doi.org/10.1053/j.ajkd.2018.09.006
Grapsa E, Gerogianni G. Caregivers of Patients on Haemodialysis. Caregiving and Home Care. London, U.K.: IntechOpen; 2017. https://doi.org/10.5772/intechopen.72400
Figueiredo AE, Bernardini J, Bowes E, Hiramatsu M, Price V, Su C, et al. A syllabus for teaching peritoneal dialysis to patients and caregivers. Perit Dial Int. 2016;36(6):592-605. Disponible en: https://doi.org/10.3747/pdi.2015.00277
Suri RS, Larive B, Hall Y, Kimmel PL, Kliger AS, Levin N, et al. Effects of frequent hemodialysis on perceived caregiver burden in the frequent hemodialysis network trials. Clin J Am Soc Nephrol. 2014;9(5):936-42. Disponible en: https://doi.org/10.2215/CJN.07170713
Sajadi SAM, Ebadi AP, Moradian STP. Quality of Life among Family Caregivers of Patients on Hemodialysis and its Relevant Factors: A Systematic Review. Int J community based Nurs midwifery. 2017;5(3):206-18.
Pereira BDS, Fernandes N da S, de Melo NP, Abrita R, Grincenkov FRDS, Fernandes NM da S. Beyond quality of life: a cross sectional study on the mental health of patients with chronic kidney disease undergoing dialysis and their caregivers. Health Qual Life Outcomes. 2017;15(1):74. Disponible en: https://doi.org/10.1186/s12955-017-0646-4
Ware J, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual and Interpretation Guide. Boston, Massachusetts: The Health Institute, New England Medical Center. 1993.
Sánchez-Aragón R, García-Meraz M, Martínez-Trujillo BD. Encuesta de Salud SF-36: Validación en tres contextos culturales de México. Rev Iberoam Diagn Eval Psicol 2017;3(45):5-16.
Dehesa-López E, Correa-Rotter R, Olvera-Castillo D, González-Parra C, Baizabal-Olarte R, Orozco-Vega R. Transcultural adaptation and validation of the Mexican version of the kidney disease questionnaire KDQOL-SF36 version 1.3. Qual life Res an Int J Qual life Asp Treat care Rehabil. 2017;26(1):193-8. Disponible en: https://doi.org/10.1007/s11136-016-1365-8
Montero-Pardo X, Jurado-Cárdenas S, Valencia-Cruz A, Venegas JM, Mora-Magaña I. Escala de carga del cuidador de Zarit: evidencia de validez en México. Psicooncología. 2014;11(1):71-85. Disponible en: https://doi.org/10.5209/rev_PSIC.2014.v11.n1.44918
Holm J, Holm L, Bech P. Monitoring improvement using a patient-rated depression scale during treatment with anti-depressants in general practice. A validation study on the Goldberg Depression Scale. Scand J Prim Health Care. 2001;19(4):263-6. Disponible en:https://doi.org/10.1080/02813430152706819
Ambriz-Murillo Y, Menor-Almagro R, Campos-González ID, Cardiel MH. Health related quality of life in rheumatoid arthritis, osteoarthritis, diabetes mellitus, end stage renal disease and geriatric subjects. Experience from a General Hospital in Mexico. Reumatol Clin. 2015;11(2):68-72. Disponible en: https://doi.org/10.1016/j.reuma.2014.03.006
Ortiz-Garrido O, Ortiz-Olvera NX, González-Martínez M, Morán-Villota S, Vargas-López G, Dehesa-Violante M, et al. Evaluación clínica y de la calidad de vida relacionada con la salud en pacientes con dolor torácico no cardiaco. Rev Gastroenterol México. 2015;80(2):121-9. Disponible en: https://doi.org/https://doi.org/10.1016/j.rgmx.2015.03.005
Roser K, Mader L, Baenziger J, Sommer G, Kuehni CE, Michel G. Health-related quality of life in Switzerland: normative data for the SF-36v2 questionnaire. Qual life Res an Int J Qual life Asp Treat care Rehabil. 2019;28(7):1963-77. Disponible en: https://doi.org/10.1007/s11136-019-02161-5
Gray NA, Zuo L, Hong D, Smyth B, Jun M, De Zoysa J, et al. Quality of life in caregivers compared with dialysis recipients: The Co-ACTIVE sub-study of the ACTIVE dialysis trial. Nephrology (Carlton). 2019;24(10):1056-63. Disponible en: https://doi.org/10.1111/nep.13530
Fekete C, Tough H, Siegrist J, Brinkhof MW. Health impact of objective burden, subjective burden and positive aspects of caregiving: an observational study among caregivers in Switzerland. BMJ Open. 2017;7(12):e017369. Disponible en: https://doi.org/10.1136/bmjopen-2017-017369
Cohen CA, Colantonio A, Vernich L. Positive aspects of caregiving: rounding out the caregiver experience. Int J Geriatr Psychiatry. 2002;17(2):184-8. Disponible en: https://doi.org/10.1002/gps.561
Koerner SS, Kenyon DB, Shirai Y. Caregiving for elder relatives: which caregivers experience personal benefits/gains? Arch Gerontol Geriatr. 2009;48(2):238-45. Disponible en: https://doi.org/10.1016/j.archger.2008.01.015
Backx APM, Spooren AIF, Bongers-Janssen HMH, Bouwsema H. Quality of life, burden and satisfaction with care in caregivers of patients with a spinal cord injury during and after rehabilitation. Spinal Cord. 2018;56(9):890-9. Disponible en: https://doi.org/10.1038/s41393-018-0098-7
Jafari H, Ebrahimi A, Aghaei A, Khatony A. The relationship between care burden and quality of life in caregivers of hemodialysis patients. BMC Nephrol. 2018;19(1):321. Disponible en: https://doi.org/10.1186/s12882-018-1120-1
Ferrario S, Zotti A, Baroni A, Cavagnino A, Fornara R. Emotional reactions and practical problems of the caregivers of hemodialysed patients. J Nephrol. 2002;15(1):54-60.
Garcia RSA, Pinheiro B V, Lucinda LMF, Pimentel AL, Júnior JMP, Paula RB, et al. Association between exercise training in haemodialysis patients and burden of their family caregivers: A cross-sectional study. Nephrology. 2020;25(4):332-8. Disponible en: https://doi.org/10.1111/nep.13620
van Wijnen HG, Rasquin SM, van Heugten CM, Verbunt JA, Moulaert VR. The impact of cardiac arrest on the long-term wellbeing and caregiver burden of family caregivers: a prospective cohort study. Clin Rehabil. 2017;31(9):1267-75. Disponible en: https://doi.org/10.1177/0269215516686155
Nagarathnam M, Sivakumar V, Latheef SAA. Burden, coping mechanisms, and quality of life among caregivers of hemodialysis and peritoneal dialysis undergoing and renal transplant patients. Indian J Psychiatry. 2019;61(4):380-8. Disponible en: https://doi.org/10.4103/psychiatry.IndianJPsychiatry_401_18
Karademas EC. The psychological well-being of couples experiencing a chronic illness: a matter of personal and partner illness cognitions and the role of marital quality. J Health Psychol. 2014;19(11):1347-57. Disponible en: https://doi.org/10.1177/1359105313488983
Farzi S, Farzi S, Moladoost A, Ehsani M, Shahriari M, Moieni M. Caring Burden and Quality of Life of Family Caregivers in Patients Undergoing Hemodialysis: A Descriptive-Analytic Study. Int J community based Nurs midwifery. 2019;7(2):88-96. Disponible en: https://doi.org/10.30476/IJCBNM.2019.44888
van Wamelen DJ, Grigoriou S, Chaudhuri KR, Odin P. Continuous Drug Delivery Aiming Continuous Dopaminergic Stimulation in Parkinson’s Disease. J Parkinsons Dis. 2018;8(s1):S65-72. Disponible en: https://doi.org/10.3233/JPD-181476
Mahoney DF. A content analysis of an Alzheimer family caregivers virtual focus group. Am J Alzheimer’s Dis. 1998;13(6):309-16. Disponible en: https://doi.org/10.1177/153331759801300606