Impact of chronic kidney disease on functionality level among patients

C Vasantha Kalyani; Priyanka Malhotra; Kusum K Rohilla

doi:10.4103/jssrp.jssrp_10_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 3 | Issue : 3 | Page : 59-62

Impact of chronic kidney disease on functionality level among patients

C Vasantha Kalyani¹, Priyanka Malhotra², Kusum K Rohilla¹
¹ Professor and Nursing Tutor, College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
² Professor and Nursing Tutor, M.M. College of Nursing, Mullana, Haryana, India

Date of Submission	04-Aug-2022
Date of Decision	12-Sep-2022
Date of Acceptance	08-Oct-2022
Date of Web Publication	19-Dec-2022

Correspondence Address:
Kusum K Rohilla
College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jssrp.jssrp_10_22

Abstract

Background: In recent years, there has been a greater focus on the rise of noncommunicable diseases, i.e., chronic kidney diseases (CKD) and their impact in low- and middle-income nations. Due to raised number of noncommunicable cases, functionality level of patients are affected so much. The present study aimed as exploring chronic kidney disease impact on level of functionality of patients. Materials and Methods: The current study used a purposive sampling strategy to survey 399 CKD patients who were visiting the dialysis unit of the All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Results: The mean age of study patients was 50.4 years. Majority of patients were female (58%), married (80%), and belongs to urban community (84%). Majority of patients belonged to lower middle class (49%) socioeconomic status and were overweight (64%). Patient's functionality on Chronic Illness Scale showed that 55% patient's had a low impact of chronic illness on their life. Overall chronic kidney patients showed a medium (59%) functionality level on the Chronic Illness Scale. Conclusion: Chronic diseases have a negative impact on a patient's quality of life. As the patient advanced through the stages of CKD, his quality of life decreased. During the course of the disease, physical domains are severely impacted, which has an impact on mental quality of life as well.

Keywords: Chronic kidney disease, functionality, impact

How to cite this article:
Kalyani C V, Malhotra P, Rohilla KK. Impact of chronic kidney disease on functionality level among patients. J Surg Spec Rural Pract 2022;3:59-62

How to cite this URL:
Kalyani C V, Malhotra P, Rohilla KK. Impact of chronic kidney disease on functionality level among patients. J Surg Spec Rural Pract [serial online] 2022 [cited 2023 Mar 31];3:59-62. Available from: http://www.jssrp.org/text.asp?2022/3/3/59/364426

Introduction

Globally, one of the major health problems is chronic kidney disease (CKD) with an estimated prevalence about 8%–16%.^[1],[2] In India, around 16,600 patients are dialyzed in 355 hemodialysis units of the country in each year and this number is continuously increasing annually.^[3]

CKD is defined as kidney damage manifested by decreased kidney function followed by abnormal albumin excretion.^[4] Its most common measurement is done by calculating estimated glomerular filtration rate (eGFR), i.e., more than 3 months.^[5] Another parameter, i.e., creatinine clearance, is also measured, which is more practical approach to estimate eGFR.^[6]

The National Kidney Foundation for Kidney Disease Outcomes Quality Initiative (NKF KDOQI™) classifies kidney diseases according to severity:^[7] stage 1 where glomerular filtration rate (GFR) ≥90 mL/min/1.73 m² and persistent albuminuria, stage 2 where GFR = 60–89 mL/min/1.73 m², stage 3 where GFR = 30–59 mL/min/1.73 m², stage 4 where GFR = 15–29 mL/min/1.73 m², and stage 5 where GFR <15 mL/min/1.73 m² or end-stage renal disease.^[8]

Chronic kidney disease majorly affects all aspects of human life.^[9] Its degree of influence varies according to the severity of disease.^[10] Reduction of living standards, physical, psychological problems,^[11] and restrictions in recreational, social, and employment activities are common domains which are affected depending upon the severity of diseases.^[12] Despite of all these challenges, patients also feel isolated, disappointment, and failure due to the lack of support system.^[13] More studies must be conducted to assess and evaluate impact of chronic kidney disease on functionality of patients.

Aim of the study

In the present study, we would like to explore the impact of chronic kidney disease on functionality level of chronic kidney disease (CKD) patients.

Materials and Methods

Study design and participants

The present study was a hospital-based survey which was conducted on 399 CKD patients who were visiting to dialysis unit of All India Institute of Medical Sciences (AIIMS), Rishikesh, India. The study patients were selected by using purposive sampling technique. Inclusion criteria for the present study were patients who were suffering from CKD, attending nephrology OPD, admitted in ward, attending dialysis unit, and having age of more than 18 years were included. Critically ill patients and patients suffering from any mental deformity or speech/cognitive or hearing impairment were excluded from this study. Data collection was done from January 2020 to May 2021.

Study instruments

Data collection tools were semi-structured questions mainly consisting of three sections. Section I consists of questions related to demographic profile, i.e., age, gender, and educational status. Section II consists of questions related to clinical profile, i.e., body mass index, duration of hospital stays, history of addiction, duration of present illness, history of chronic illness, previous history of hospitalization, and number of dialysis. Section III mainly consists of three parts with eight questions, which included a structured tool to assess functionality level on the Chronic Illness Scale in patients who were suffering from CKD. Patients functionality level on the Chronic Illness Scale consist of three parts. Part 1 consists questions related to subjective assessment of patient's impact of illness on their life, part 2 questions related to opinions of patient's on disease impact, and part 3 questions related to attitude of patient's toward new circumstances/life. The Institutional Ethics Committee (AIIMS/IEC/19/1298) approved this project for ethical clearance. Informed consent was obtained from each study participant in written. The confidentiality and anonymity of each participant were maintained during the study.

Statistical analysis

Data were analyzed by using SPSS version 26.0. Frequency, percentage, mean, and standard deviation (SD) were calculated to do statistical analysis.

Results

Out of 399 patients, the mean age of patients was 50.4 years. Majority of CKD patients were female (58%), married (80%), belongs to urban areas (84%) and had Hindu (71%) religion. Most of them had 4–6 family members (84%), had two children (60%), and belonged to lower middle class (49%) socioeconomic status [Table 1].

Table 1: Bio-demographic of patients (n=399)

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The clinical profile of patients depicted that most of them were overweight (64%), had short-term hospital stay (86%), had no history of smoking (58%) and alcoholism (58%), and had history of chronic illness (100%), i.e., majority were suffering from diabetes mellitus (64%). Majority of patients had history of previous hospitalization (100%) and they underwent for three types dialysis per week (68%) [Table 2]. Majority of patients were suffering from chronic kidney disease (31%) for 49–60 months, i.e., they are having CKD disease for 4–5 years and undergoing hemodialysis [Figure 1].

Figure 1: Duration of chronic kidney disease illness (in months)

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Table 2: Clinical profile of patients

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Patient's functionality on Chronic Illness Scale showed that 55% patient's had a low impact of chronic illness on their life. Patients had medium (68%) opinions that the course of illness has an impact on their life. Patients also had a medium (55%) attitude toward new circumstances/life during the course of chronic illness. Most of them were also history of previous hospitalization (100%) and underwent 3 dialysis/week (68%) [Table 2]. Hence, overall chronic kidney patients showed a medium (59%) functionality level on the Chronic Illness Scale [Table 3].

Table 3: Patient's functioning in the Chronic Illness Scale

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Discussion

Incidence of chronic kidney diseases

Around the world, chronic diseases from low- and middle-income countries now account for four out of every five chronic disease fatalities,^[14] which was formerly assumed to be a problem that affects the health and wealthy of any country. In India, chronic disease-related deaths exponentially increased by 7.5 million.^[15],[16]

Effect of chronic kidney diseases

Any chronic diseases have an impact on all aspects of a person's life.^[17] Physical, mental, spiritual well-being and social functioning are all affected by chronic illness.^[18] As a result of functional constraints, patients with chronic diseases experience lower self-value assessments, decreased well-being, greater worry, and experience fear about their future. Studies done on effect of chronic disease on human life till date showed that several isolated factors yet need to be explored to assess comprehensive quality of life,^[19] i.e., physical, mental functioning, self-efficacy, or self-health control of patients.

According to the Global Burden of Disease Report 2019, 1.2 million people died of renal failure in 2019, which is a significantly high number.^[20] Around 1.7 million people die predicted per year as a result of acute renal failure.^[21] As a result, renal disease claims the lives of an estimated 5–10 million people each year.^[22] Such statistics are likely to underestimate the true prevalence of renal disease due to a lack of epidemiological data, widespread ignorance, and often limited access to laboratory facilities. That a result, at least as many deaths are likely to occur each year. In Thailand, a Global SEEK Initiative identified a 17% prevalence of CKD, and in Saudi Arabia, CKD was found in 5% of the population.^[23] Another study also discovered that the prevalence of CKD was about 0.7% in the Indian population which is a significantly high number. Another study found that CKD is frequent in a number of Asian countries.^[24]

Another systematic review done in Asia countries also reported that CKD was common among in fifties and sixties years of age and found equal frequency in both males and females,^[25] whereas in this present study the mean age of CKD patients was 50.36 years but majority of patients were female (58%).

Effect of chronic kidney diseases on functionality

The main finding of this study using a purposive design is that majority of patients (31%) had chronic kidney disease more than 4 years, implying that they were on hemodialysis treatment. Patients' subjective assessments on the Chronic Illness Scale revealed that they had a low (55%) impact of illness on their lives. Patients' opinions suggested that the course of illness had a medium (68%) impact on their lives. 55% patients had medium attitude towards new circumstances/life which showed they are they are not doing having full functioning attitude while they diagnosed with any chronic illness like CKD. Overall, patients had a medium degree of functionality (59%) on the Chronic Illness Scale.

In the present study, we can conclude that physical functioning, body discomfort, vitality, and social functioning were found to be a statistically significant relationship with CKD stages. These domains make the physical quality of life (QOL) of patients more badly than other domains that also make up poor mental QOL. These data are consistent with earlier research findings, which also showed that physical component QOL in renal patients was lower than mental component QOL.^[26] This is most likely owing to the chronic nature of the condition; patients may adapt not only to the disease and its treatment^[27] but also to their psychosocial surroundings, which have a direct impact on patients' QOL over time.

Conclusion

CKD affects the quality of life of every patient. In our study, patients also found a medium degree of functionality. Physical functioning and social functioning were affected very badly during disease course, which further affects the mental quality of life too. Future researches must be conducted to assess the physical and mental effects of CKD disease among patients with low income.

Author's declaration

The authors want to declare that the research work was done at AIIMS, Rishikesh.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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