After data collection, our sample was composed by 88 out of the 122 contacted HD patients with a participation rate of 72%. Main reasons for refusing the participation to our study were being too tired, or not being interested. The sociodemographic and clinical data of the patients in our sample are presented in table 1.
[TABLE 1 ABOUT HERE]
Our results are in line with previous data on this population (12,56,57): men represent the majority of respondent (65,9%). The average age is quite high reaching 69 years (SD=13,1), consequently the majority of respondents (68,2%) are already retired. Active people are only a small minority of respondents (11,4%). As for the clinical situation, patients were under HD for an average of 45 months (SD = 54,2), almost as little has previously used other form of treatment (10,2%), and less than half are on the transplantation waiting list (42,0%). Because of HD patients’ health conditions, the use of medical treatments is very common, in particular antihypertensives (54,6%), painkillers (44,3%), vitamins (38,6%), iron supplements (26,1%), and antidepressants (12,5%). Comorbidities were also widespread, specifically hypertension (55,7%) and diabetes (39,8%), both often related with ESRD.
Thirty symptoms typically associated with ESRD and HD (42) were explored (see table 2) and the patients showed an average prevalence of 8,9 symptoms (SD = 4,6), in line with previous studies on the same population (12,57). The most frequently observed are tiredness and lack of energy (63,6%), dry skin (58,0%), trouble staying asleep (45,5%), trouble falling asleep (44,3%), and shortness of breath (44,3%).
[TABLE 2 ABOUT HERE]
HD patients’ QoL was initially described by two overall dimensions: overall quality of life and overall perceived health. The former scores a fairly good level, 3.7 (SD=0.9) on a 1 to 5 Likert scale, the latter a moderate level, 3.0 (SD = 1.2). As for the four dimensions of HD patients’ QoL, the physical dimension of QoL, which is described as a person’s physical condition that influences their quality of life, has the lower score: 3.3 (SD = 0.8). The psychological dimension, which is described as a person’s psychological balance that influences their quality of life, received a higher score of HD patients’ QoL (4.1, SD = 0.7). The social dimension, which describes the impact of people network (social interaction?) on HD patients’ QoL, scores a bit lower at 3.9 (SD = 0.9). Finally, the highest value is presented by the environmental dimension 4,5 (SD = 0.5). It describes how the surrounding natural environment and housing conditions influence people’s QoL.
Finally, patients’ use of CAM is described in table 3. More than half of the interviewed HD patients have used at least one CAM (63,6%). The most used CAM was prayer (27,3%), herbal medicine (20,5%), and meditation (13,6%).
[TABLE 3 ABOUT HERE]
With the collected data on CAM used, we were able to define 5 groups of CAM users. The first group (CAM profile 0) was manually defined and include all the patients that don’t use any CAM (37,5%). The other group was defined using cluster analysis. The group “CAM profile 1” describes people using herbal medicine (CAM6) (20,5%). The people included in this cluster often use other CAM, in particular, prayer-based practices (CAM13), homeopathy (CAM1), and Osteopathy (CAM4). The “CAM profile 2” group includes the patients that use massages (CAM7) as CAM (9,1%). In this group, the presence of other CAMs are less present, even if we observe the presence of a few other practices, notably acupuncture (CAM2) and sophrology (CAM12). The group “CAM profile 3” describes people who use prayer-based practices (18,2%). These people almost never use other CAM except for a small presence of meditation (CAM8), a practice like some forms of prayer. Finally, the “CAM profile 4” group includes patients’ using the other types of CAM with a predominance of meditation (CAM8) (14,8%).
[GRAPH 1 ABOUT HERE]
The relations between HD patients’ symptoms, CAM use, and quality of life were described using regression analysis. To describe patients’ symptoms, we considered the number of symptoms reported. CAM use is considered in two ways. First, we simply divide users and non-users, and we compared these two groups. Second, we used the just defined typology of CAM users to test if every profile is equally connected with patients’ QoL. To describe patients’ quality of life, we use the dimension “overall health” and two dimensions “psychological QoL” and “physical Qol”. We limited the analysis to these dimensions as we expect them to be directly impacted by both patients’ symptoms and CAM use. Even if they may be indirectly affected; the general levels of QoL, (not needed?) environmental and social dimensions are more closely connected with other aspects of the patients’ lives[1].
Table 4 summarizes the relation between symptoms and CAM use. Both using the simple dichotomous variable user/non-user (model 1) and the type of CAM used (model 2), we observe no relation between the CAM use and the number of declared symptoms. As a sensitivity analysis (58) we have inverted the dependent and the independent variables. Still no significant relation is observed.
[TABLE 4 ABOUT HERE]
As for the overall health status (table 5), we observe a negative relation with patient’s symptoms (models 3 and 4). This is an expected result and is quantified as a decrement of 0.16 points on the 1 to 5 QoL Likert scale for each present symptom. Contrarily, CAM use, taking into consideration the use/non-use (model 3) and the users’ profiles (model 4), appear unrelated to patients’ overall health status.
[TABLE 5 ABOUT HERE]
We obtain similar results when analyzing the physical dimension of QoL (table 6). As expected, symptoms are negatively related (-0.11 to -0.16 points, on the 1 to 5 QoL Likert scale, for each symptom present) to patients’ physical QoL. As for use of CAM, the general use seems not to be linked to patients’ physical QoL (model 5) but a specific profile, the patients that use prayer-based practices, appear to have their physical QoL (model 6) affected positively. People that use prayer-based practices have a physical QoL that is, on average, 0.47 points higher than the people using no CAM.
[TABLE 6 ABOUT HERE]
Finally, we estimate the relation between patients’ symptoms, CAM use, and the psychological dimension of QoL (table 7). Results are clearer in this case. Not only are symptoms linked with psychological QoL (-0.08 points, on the 1 to 5 QoL Likert scale, for each symptom present) but also the relationship with CAM use presents significant values. The general use of CAM seems to be positively related to patients’ QoL (model 7): CAM users have a psychological QoL that is, on average, 0.57 points higher (SE = 0.14) than who doesn’t use CAM once the effects of control variables have been removed. Moreover, if we analyze the users’ profiles (model 8), we note that the overall relationship is driven by the people using prayers. + 0.73 Points compared to patients’ that don’t use any CAM and the group that uses a vast array of CAM, but principally meditation, +0.62.
[TABLE 7 ABOUT HERE]
[1] The absence of relationship between CAM use and “overall QoL” and two dimensions “psychological QoL” and “physical Qol” was tested and confirmed.