The Suffering of Advanced Chronic Renal Patients and Their Relationship with Symptoms in Loja, Ecuador
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Settings
2.2. Sampling and Inclusion
2.3. Measures
2.4. Statistical Analysis
2.5. Ethical Considerations
3. Results
3.1. Descriptive Characteristics of the Sample
3.2. Edmonton Symptoms Assessment System Revised and the DT at Baseline and 2-Month Follow-Up
3.3. Edmonton Symptoms Assessment System Revised and the DT by Number of Concomitant Disorders at the Baseline Period
3.4. Factors Associated with the Number of Problems Perceived According to the DT
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Variables | Total Sample | Cornelio Samaniego | Isidro Ayora Hospital | Nefroloja | p-Value |
---|---|---|---|---|---|
n = 246 | n = 63 | n = 61 | n = 122 | ||
Sociodemographics | |||||
Age (Years Old) | 61.05 (13.76) | 61.95 (12.05) | 56.00 (15.60) | 63.11 (12.57) | 0.018 |
Gender | |||||
Female | 108 (43.9) | 22 (34.9) | 25 (41.00) | 61 (50.00) | 0.128 |
Male | 138 (56.1) | 41 (65.1) | 36 (59.00) | 61 (50.00) | |
Marital Status | |||||
Single | 48 (19.51) | 12 (19.0) | 14 (23.0) | 22 (18.0) | 0.326 |
Married | 144 (58.54) | 43 (68.3) | 32 (52.5) | 69 (56.6) | |
Separated/Divorced | 23 (9.35) | 4 (6.3) | 8 (13.1) | 11 (9.0) | |
Widowed | 31 (12.60) | 4 (6.3) | 7 (11.5) | 20 (16.4) | |
Religion | |||||
Catholic | 228 (92.68) | 59 (93.7) | 58 (95.1) | 111 (91.0) | 0.57 |
Other or No Religion | 18 (7.32) | 4 (6.3) | 3 (4.9) | 11 (9.0) | |
Occupational Status | |||||
Actively Employed | 47 (19.11) | 17 (27.0) | 11 (18.0) | 19 (15.6) | 0.000 |
Unemployed | 128 (52.03) | 17 (27.0) | 43 (70.5) | 68 (55.7) | |
Retiree | 71 (28.86) | 29 (46.0) | 7 (11.5) | 35 (28.7) | |
Schooling Level | |||||
No Studies | 4 (1.63) | 1 (1.6) | 1 (1.6) | 2 (1.6) | 0.084 |
Basic/Primary Studies | 142 (57.72) | 29 (46.0) | 35 (57.4) | 78 (63.9) | |
Secondary Studies/Technology or Technical | 62 (25.20) | 17 (27.0) | 20 (32.8) | 25 (20.5) | |
Third Level/Tertiary/University Studies | 38 (15.45) | 16 (25.4) | 5 (8.2) | 17 (13.9) | |
Characteristics Related to Treatment (Hemodialysis) | |||||
Diagnosis Time (Years) | 5.41 (5.47) | 6.65 (5.57) | 6.44 (6.30) | 4.26 (4.73) | 0.004 |
Hemodialysis Treatment Time (Years) | 4.29 (4.39) | 4.37 (4.74) | 4.22 (3.24) | 4.28 (4.73) | 0.983 |
Number of Weekly Sessions | 2.98 (0.15) | 3 (0.00) | 3.00 (0.00) | 2.95 (0.22) | 0.045 |
Estimated Time of Arrival at the Hospital/Clinic (Minutes) | 68.19 (77.62) | 57.14 (63.24) | 47.46 (41.76) | 84.26 (93.51) | 0.004 |
Use of Health Transport [No] | 244 (99.19) | 63 (100) | 61 (100) | 120 (98.4) | 0.359 |
Comorbidities | 0.000 | ||||
Cause of Chronic Kidney Disease | |||||
Type II Diabetes Mellitus | 137 (55.69) | 35 (55.6) | 28 (45.9) | 74 (60.7) | |
High Blood Pressure | 84 (34.15) | 28 (44.4) | 23 (37.7) | 33 (27.0) | |
Type II Diabetes Mellitus and High Blood Pressure | 10 (4.07) | 0 (0.00) | 0 (0.00) | 10 (8.2) | |
Other Causes | 15 (6.10) | 0 (0.00) | 10 (16.4) | 5 (4.1) | 0.000 |
Concomitant Disorders | |||||
No Disorder | 82 (33.33) | 23 (36.5) | 37 (60.7) | 22 (18.0) | |
1 Disorder | 92 (37.40) | 31 (49.2) | 19 (31.1) | 42 (34.4) | |
2 Disorders | 54 (21.95) | 8 (12.7) | 3 (4.9) | 43 (35.2) | |
3 or More Disorders | 18 (7.32) | 1 (1.6) | 2 (3.3) | 15 (12.3) |
References
- Ministerio de Salud Pública de Ecuador. Recomendaciones Para el Manejo de Pacientes con Enfermedad Renal Frente a la Pandemia de (Covid-19). 2020. Available online: https://www.salud.gob.ec/wp-content/uploads/2020/09/Recomendaciones-para-el-manejo-de-pacientes-con-enfermedad-renal-frente-a-la-pandemia-de-Covid-19-1.pdf (accessed on 1 March 2021).
- Bagasha, P.; Leng, M.; Katabira, E.; Petrova, M. Health-related quality of life, palliative care needs and 12-month survival among patients with end stage renal disease in Uganda: Protocol for a mixed methods longitudinal study. BMC Nephrol. 2020, 21, 531. [Google Scholar] [CrossRef] [PubMed]
- Gorostidi, M.; Sánchez-Martínez, M.; Ruilope, L.M.; Graciani, A.; Juan, J.; Santamaría, R.; Del Pino, M.D.; Guallar-Castillón, P.; de Álvaro, F.; Rodríguez-Artalejo, F.; et al. Chronic kidney disease in Spain: Prevalence and impact of accumulation of cardiovascular risk factors. Nefrologia 2018, 38, 606–615. [Google Scholar] [CrossRef]
- Lam, D.Y.; Scherer, J.S.; Brown, M.; Grubbs, V.; Schell, J.O. A Conceptual Framework of Palliative Care across the Continuum of Advanced Kidney Disease. Clin. J. Am. Soc. Nephrol. 2019, 14, 635–641. [Google Scholar] [CrossRef]
- Gregory, D.M.; Way, C.Y.; Hutchinson, T.A.; Barrett, B.J.; Parfrey, P.S. Patients’ perceptions of their experiences with ESRD and hemodialysis treatment. Qual. Health Res. 1998, 8, 764–783. [Google Scholar] [CrossRef]
- Kimmel, P.L.; Peterson, R.A. Depression in end-stage renal disease patients treated with hemodialysis: Tools, correlates, outcomes, and needs. Semin. Dial. 2005, 18, 91–97. [Google Scholar] [CrossRef]
- Cervantes, L.; Hull, M.; Keniston, A.; Chonchol, M.; Hasnain-Wynia, R.; Fischer, S. Symptom Burden among Latino Patients with End-Stage Renal Disease and Access to Standard or Emergency-Only Hemodialysis. J. Palliat. Med. 2018, 21, 1329–1333. [Google Scholar] [CrossRef] [PubMed]
- Gamondi, C.; Galli, N.; Schönholzer, C.; Marone, C.; Zwahlen, H.; Gabutti, L.; Bianchi, G.; Ferrier, C.; Cereghetti, C.; Giannini, O. Frequency and severity of pain and symptom distress among patients with chronic kidney disease receiving dialysis. Swiss Med. Wkly. 2013, 143, w13750. [Google Scholar] [CrossRef] [PubMed]
- Kane, P.M.; Vinen, K.; Murtagh, F.E. Palliative care for advanced renal disease: A summary of the evidence and future direction. Palliat Med. 2013, 27, 817–821. [Google Scholar] [CrossRef] [PubMed]
- Hui, D.; Bruera, E. Integrating palliative care into the trajectory of cancer care. Nat. Rev. Clin. Oncol. 2016, 13, 159–171. [Google Scholar] [CrossRef] [Green Version]
- Axelsson, L.; Benzein, E.; Lindberg, J.; Persson, C. Cuidados paliativos y al final de la vida de los pacientes en tratamiento de hemodiálisis de mantenimiento: Un estudio de grupo focal. BMC Palliat. Care 2019, 18, 89. [Google Scholar]
- Davison, S.N.; Jhangri, G.S.; Johnson, J.A. Longitudinal validation of a modified Edmonton symptom assessment system (ESAS) in haemodialysis patients. Nephrol. Dial. Transplant. 2006, 21, 3189–3195. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hannon, B.; Martin, D.; Ashley, P.; Nadia, S.; Subrata, B.; Ernie, M. Modified Edmonton Symptom Assessment System Including Constipation and Sleep: Validation in Outpatients with Cancer. J. Pain Symptom Manag. 2015, 49, 945–952. [Google Scholar] [CrossRef] [PubMed]
- Watanabe, S.M.; Nekolaichuk, C.; Beaumont, C.; Johnson, L.; Myers, J.; Strasser, F. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J. Pain Symptom Manag. 2011, 41, 456–468. [Google Scholar] [CrossRef]
- Valcárcel, A.C.; García, M.M.; Cortés, C.C. Versión española del Edmonton Symptom Assessment Sytem (ESAS): Un instrumento de referencia para la valoración sintomática del paciente con cáncer avanzado. Med. Paliat. 2013, 20, 143–149. [Google Scholar] [CrossRef]
- Alston, H.; Vickerstaff, V.; Low, J.; Beaty, C.; Gane, M.D.S.; Burns, A. Validation of the distress thermometer in a UK renal population. Nephrol. Dial. Transplant. 2015, 30, iii612. [Google Scholar] [CrossRef] [Green Version]
- Holland, J.C.; Bultz, B.D. The NCCN guideline for distress management: A case for making distress the sixth vital sign. J. Natl. Compr. Cancer Netw. 2007, 5, 3–7. [Google Scholar] [CrossRef]
- Damery, S.; Brown, C.; Sein, K.; Nicholas, J.; Baharani, J.; Combes, G. The prevalence of mild-to-moderate distress in patients with end-stage renal disease: Results from a patient survey using the emotion thermometers in four hospital Trusts in the West Midlands, UK. BMJ Open 2019, 9, e027982. [Google Scholar] [CrossRef] [Green Version]
- van de Luijtgaarden, M.W.; Caskey, F.J.; Wanner, C.; Chesnaye, N.C.; Postorino, M.; Janmaat, C.J.; Rao, A.; Torino, C.; Klinger, M.; Drechsler, C.; et al. Uraemic symptom burden and clinical condition in women and men of ≥65 years of age with advanced chronic kidney disease: Results from the EQUAL study. Nephrol. Dial. Transplant. 2020, 34, 1189–1196. [Google Scholar] [CrossRef] [Green Version]
- Murtagh, F.E.; Addington-Hall, J.M.; Edmonds, P.M.; Donohoe, P.; Carey, I.; Jenkins, K.; Higginson, I.J. Symptoms in advanced renal disease: A cross-sectional survey of symptom prevalence in stage 5 chronic kidney disease managed without dialysis. J. Palliat. Med. 2007, 10, 1266–1276. [Google Scholar] [CrossRef]
- Combs, S.A.; Davison, S.N. Palliative and end-of-life care issues in chronic kidney disease. Curr. Opin. Support. Palliat. Care 2015, 9, 14–19. [Google Scholar] [CrossRef] [Green Version]
- Song, M.K.; Paul, S.; Ward, S.E.; Gilet, C.A.; Hladik, G.A. One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis. Am. J. Kidney Dis. 2018, 72, 198–204. [Google Scholar] [CrossRef] [PubMed]
- Amir, R.; Suhl, S.; Alexander, C.M. Renal Evaluation and Protection. Clin. Geriatr. Med. 2020, 36, 431–445. [Google Scholar] [CrossRef] [PubMed]
- Kim, K.M.; Oh, H.J.; Choi, H.Y.; Lee, H.; Ryu, D.R. Impact of chronic kidney disease on mortality: A nationwide cohort study. Kidney Res. Clin. Pract. 2019, 38, 382–390. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zalai, D.; Szeifert, L.; Novak, M. Psychological distress and depression in patients with chronic kidney disease. Semin Dial. 2012, 25, 428–438. [Google Scholar] [CrossRef] [PubMed]
- Drayer, R.A.; Piraino, B.; Reynolds, C.F., III; Houck, P.R.; Mazumdar, S.; Bernardini, J.; Shear, M.K.; Rollman, B.L. Characteristics of depression in hemodialysis patients: Symptoms, quality of life and mortality risk. Gen. Hosp. Psychiatry 2006, 28, 306–312. [Google Scholar] [CrossRef]
- Harwood, L.; Wilson, B.; Locking-Cusolito, H.; Sontrop, J.; Spittal, J. Stressors and coping in individuals with chronic kidney disease. Nephrol. Nurs. J. 2009, 36, 265–276. [Google Scholar]
- Damery, S.; Sein, K.; Nicholas, J.; Baharani, J.; Combes, G. The challenge of managing mild to moderate distress in patients with end stage renal disease: Results from a multi-centre, mixed methods research study and the implications for renal service organisation. BMC Health Serv. Res. 2019, 19, 989. [Google Scholar] [CrossRef]
- Franco, C.; Zatta, T.; Barbosa, A.; Santos, S.; Rosa, D.O. Evaluación de la calidad de vida de pacientes de insuficiencia crónica en dialisis peritoneal. Enferm. Glob. 2011, 23, 158–164. [Google Scholar] [CrossRef]
- Gelfand, S.L.; Schell, J.; Eneanya, N.D. Palliative Care in Nephrology: The Work and the Workforce. Adv. Chronic. Kidney Dis. 2020, 27, 350–355. [Google Scholar] [CrossRef]
- Abdel-Rahman, E.M.; Metzger, M.; Blackhall, L.; Asif, M.; Mamdouhi, P.; MacIntyre, K.; Casimir, E.; Ma, J.Z.; Balogun, R.A. Association between Palliative Care Consultation and Advance Palliative Care Rates: A Descriptive Cohort Study in Patients at Various Stages in the Continuum of Chronic Kidney Disease. J. Palliat. Med. 2020, 24, 536–544. [Google Scholar] [CrossRef]
- Laabar, T.D.; Saunders, C.; Auret, K.; Johnson, C.E. Palliative care needs among patients with advanced illnesses in Bhutan. BMC Palliat. Care 2021, 20, 8. [Google Scholar] [CrossRef] [PubMed]
- Holley, J.L. Palliative Care in End-Stage Renal Disease: Illness Trajectories, Communication, and Hospice Use. Adv. Chronic. Kidney Dis. 2007, 14, 402–408. [Google Scholar] [CrossRef] [PubMed]
- Davison, S.N.; Jhangri, G.S. Impact of pain and symptom burden on the health-related quality of life of hemodialysis patients. J. Pain Symptom Manag. 2010, 39, 477–485. [Google Scholar] [CrossRef] [PubMed]
- Rebollo-Rubio, A.; Morales-Asencio, J.M.; Pons-Raventos, M.E.; Mansilla-Francisco, J.J. Revisión de estudios sobre calidad de vida relacionada con la salud en la enfermedad renal crónica avanzada en España. Nefrología 2015, 35, 92–109. [Google Scholar] [PubMed]
- Yong, D.; Kwok, A.; Wong, D.; Suen, M.; Chen, W.; Tse, D. Symptom burden and quality of life in end-stage renal disease: A study of 179 patients on dialysis and palliative care. Palliat. Med. 2009, 23, 111–119. [Google Scholar] [CrossRef]
- Morton, R.L.; Lioufas, N.; Dansie, K.; Palmer, S.C.; Jose, M.D.; Raj, R.; Salmon, A.; Sypek, M.; Tong, A.; Ludlow, M.; et al. Use of patient-reported outcome measures and patient-reported experience measures in renal units in Australia and New Zealand: A cross-sectional survey study. Nephrology 2019, 25, 14–21. [Google Scholar] [CrossRef] [PubMed]
- Dávalos-Batallas, V.; Mahtani-Chugani, V.; López-Núñez, C.; Duque, V.; Leon-Larios, F.; Lomas-Campos, M.D.L.M.; Sanz, E. Knowledge, Attitudes and Expectations of Physicians with Respect to Palliative Care in Ecuador: A Qualitative Study. Int. J. Environ. Res. Public Health 2020, 17, 3906. [Google Scholar] [CrossRef]
- Seekles, M.; Ormandy, P.; Kamerāde, D. Examining patient distress and unmet need for support across UK renal units with varying models of psychosocial care delivery: A cross-sectional survey study. BMJ Open 2020, 10, e036931. [Google Scholar] [CrossRef]
Scales/Tools | Baseline Mean (SD) | 2-Month Follow-Up Mean (SD) | p-Value |
---|---|---|---|
Edmonton Symptoms | |||
Pain | 4.18 (3.38) | 4.42 (3.17) | 0.108 |
Fatigue | 3.71 (3.12) | 3.83 (2.95) | 0.447 |
Nausea | 1.75 (2.65) | 1.88 (2.59) | 0.328 |
Depression | 3.49 (3.48) | 3.79 (3.28) | 0.061 |
Anxiety | 2.70 (3.13) | 2.63 (3.00) | 0.663 |
Sleepiness | 2.76 (2.94) | 2.92 (2.78) | 0.256 |
Appetite | 2.22 (2.59) | 2.57 (2.36) | 0.050 |
Well-being | 2.18 (2.00) | 3.03 (2.07) | 0.000 |
Dyspnea | 1.26 (2.32) | 1.39 (2.27) | 0.327 |
Difficulty Falling Asleep | 3.27 (3.38) | 3.78 (3.21) | 0.001 |
Itching | 3.13 (3.27) | 3.44 (3.01) | 0.032 |
DT | |||
Practical Problems | 1.42 (1.31) | 1.69 (1.25) | 0.003 |
Family Problems | 0.31 (0.61) | 0.45 (0.69) | 0.001 |
Emotional Problems | 3.45 (2.37) | 3.59 (1.96) | 0.355 |
Physical Problems | 8.39 (4.11) | 8.45 (4.17) | 0.824 |
Total DT Score | 13.57 (6.69) | 14.18 (6.71) | 0.202 |
Scales/Tools | No Disorder Mean (SD) | 1 Disorder Mean (SD) | 2 Disorders Mean (SD) | 3 or More Disorders Mean (SD) | I-Value |
---|---|---|---|---|---|
Edmonton Symptoms | |||||
Pain | 3.82 (3.46) | 4.57 (3.35) | 4.35 (3.39) | 3.39 (3.05) | 0.354 |
Fatigue | 3.34 (3.16) | 4.08 (3.31) | 3.46 (3.01) | 4.28 (2.02) | 0.343 |
Nausea | 1.16 (2.18) | 1.54 (2.58) | 2.80 (3.16) | 2.33 (2.52) | 0.003 |
Depression | 3.13 (3.45) | 3.43 (3.42) | 4.17 (3.94) | 3.39 (2.12) | 0.402 |
Anxiety | 2.37 (2.95) | 2.65 (3.34) | 3.17 (3.27) | 3.00 (2.38) | 0.512 |
Sleepiness | 3.17 (3.11) | 2.55 (2.98) | 2.31 (2.70) | 3.28 (2.56) | 0.281 |
Appetite | 2.06 (2.51) | 2.36 (2.89) | 2.17 (2.26) | 2.33 (2.45) | 0.891 |
Well-being | 2.29 (2.11) | 2.23 (2.07) | 1.91 (1.57) | 2.22 (2.39) | 0.726 |
Dyspnea | 0.74 (1.56) | 1.42 (2.51) | 1.57 (2.63) | 1.83 (2.94) | 0.085 |
Difficulty Falling Asleep | 2.71 (3.43) | 3.52 (3.43) | 3.59 (3.19) | 3.56 (3.48) | 0.336 |
Itching | 2.96 (3.27) | 3.35 (3.32) | 2.63 (3.11) | 4.28 (3.30) | 0.250 |
DT | |||||
Practical Problems | 1.35 (1.27) | 1.40 (1.41) | 1.41 (1.25) | 1.89 (1.60) | 0.468 |
Family Problems | 0.29 (0.62) | 0.32 (0.59) | 0.31 (0.61) | 0.39 (0.70) | 0.947 |
Emotional Problems | 3.10 (2.12) | 3.39 (2.41) | 3.63 (2.54) | 4.78 (2.37) | 0.048 |
Physical Problems | 7.17 (4.11) | 8.26 (3.94) | 9.76 (3.99) | 10.44 (3.60) | 0.000 |
Total DT Score | 11.91 (6.51) | 13.37 (6.51) | 15.11 (6.53) | 17.50 (6.78) | 0.002 |
DT at 2-Month Follow-Up | Age | Number of Concomitant Disorders | Diagnosis Time | Hemodialysis Treatment Time | Estimated Time of Arrival at the Hospital/Clinic | Number of Weekly Sessions (Hemodialysis) | |
---|---|---|---|---|---|---|---|
DT at 2-Month Follow-up | 1.000 | ||||||
Age | 0.106 | 1.000 | |||||
Number of Concomitant Disorders | 0.262 *** | 0.228 *** | 1.000 | ||||
Diagnosis Time | −0.010 | 0.033 | −0.048 | 1.000 | |||
Hemodialysis Treatment Time | 0.144 ** | −0.040 | 0.025 | 0.758 *** | 1.000 | ||
Estimated Time of Arrival at the Hospital/Clinic | 0.052 | 0.025 | 0.008 | −0.126 *** | −0.115 * | 1.000 | |
Number of Weekly Sessions (Hemodialysis) | −0.093 | −0.117 ** | −0.161 ** | 0.030 | −0.003 | −0.068 | 1.000 |
Total Number of Problems at 2-Month Follow-Up (DT) | Model 1 (All Predictors) | Model 2 (Backward Model) |
---|---|---|
Coefficient (95% CI) | Coefficient (95% CI) | |
Age (Centered to 63 Years Old) | 0.000 (−0.07, 0.07) | 0.007 (−0.06, 0.07) |
Gender [Male] | −1.754 (−3.40, −0.11) * | −1.790 (−3.38, −0.20) * |
Marital status [Married] | ||
Separated/Divorced | −0.098 (−2.84, 2.65) | |
Single | 0.555 (−1.60, 2.71) | |
Widowed | 0.433 (−2.05, 2.91) | |
Religion [Catholic] | 0.281 (−2.72, 3.28) | |
Occupational Status [Actively Employed] Not Working/Unemployed Retiree | 2.006 (−0.32, 4.33) 2.000 (−0.52, 4.52) | 2.066 (−0.15, 4.29) 1.881 (−0.54, 4.30) |
Schooling Level [No Studies] | ||
Primary Studies | −6.957 (−13.01, −0.90) * | −6.899 (−12.85, −0.94) * |
Secondary Studies/Technology or Technical | −7.197 (−13.50, −0.89) * | −7.211 (−13.37, −1.05) * |
Third Level/Tertiary/University Studies | −5.021 (−11.41, 1.37) | −5.094 (−11.33, 1.14) |
Diagnosis Time (Years) | −0.162 (−0.39, 0.07) | −0.158 (−0.38, 0.07) |
Hemodialysis Treatment time (Years) | 0.410 (0.13, 0.69) ** | 0.409 (0.13, 0.68) ** |
Number of Weekly Sessions (Hemodialysis) | −1.426 (−6.46, 3.61) | −1.366 (−6.25, 3.52) |
Estimated Time of Arrival at the Hospital/Clinic (Minutes) | 0.003 (−0.01, 0.01) | |
Use of Health Transport [No] | 5.151 (−3.23, 13.53) | |
Hospital/Clinic/Service [Nefroloja] | ||
Isidro Ayora Hospital | −4.315 (−6.63, −2.01) *** | −4.546 (−6.45, −2.44) *** |
Cornelio Samaniego Clinic | −5.168 (−7.29, −3.05) *** | −5.014 (−7.02, −3.01) *** |
Cause of Chronic Kidney Disease [High Blood Pressure] | ||
Type II Diabetes Mellitus | −0.054 (−1.89, 1.78) | |
Type II Diabetes Mellitus and High Blood Pressure | −1.213 (−5.33, 2.90) | |
Other Causes | −2.264 (−5.96, 1.43) | |
Number of Concomitant Disorders | 0.246 (−0.74, 1.23) | 0.382 (−0.51, 1.27) |
Total Number of Problems at 2-Month Follow-Up (DT) | Nefroloja | Isidro Ayora Hospital | Cornelio Samaniego Clinic |
---|---|---|---|
Coefficient (95% CI) | Coefficient (95% CI) | Coefficient (95% CI) | |
Age (Centered to 63 Years Old) | 0.01 (−0.09, 0.11) | 0.04 (−0.09, 0.17) | −0.05 (−0.18, 0.09) |
Gender [Male] | −2.55 (−4.82, −0.29) * | −1.16 (−4.54, 2.22) | −2.42 (−5.93, 1.08) |
Occupational Status [Actively Employed] Not Working/Unemployed Retiree | 2.79 (−0.48, 6.06) 3.72 (−0.08, 7.52) | 3.61 (−0.88, 8.11) 0.11 (−7.67, 7.89) | −0.92 (−5.85, 3.99) −0.39 (−4.84, 4.06) |
Schooling Level [No Studies] | |||
Primary Studies | −4.99 (−13.86, 3.87) | −1.52 (−15.88, 12.83) | −8.95 (−21.92, 4.02) |
Secondary Studies/Technology or Technical | −8.46 (−16.94, 0.02) | 1.47 (−13.06, 15.99) | −9.85 (−23.27, 3.57) |
Third Level/Tertiary/University Studies | −7.70 (−15.89, 0.48) | −1.02 (−15.21, 13.16) | −6.99 (−20.02, 6.04) |
Diagnosis Time (Years) | −0.19 (−3.47, 3.08) | 0.10 (−0.36, 0.57) | −0.19 (−0.62, 0.23) |
Hemodialysis Treatment Time (Years) | 0.36 (−2.92, 3.64) | 0.19 (−0.48, 0.85) | 0.54 (0.03, 1.06) * |
Number of Weekly Sessions (Hemodialysis) | −1.44 (−6.25, 3.36) | ||
Number of Concomitant Disorders | 0.45 (−0.67, 1.58) | 2.07 (−0.24, 4.38) | −1.40 (−3.65, 0.86) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Bonilla-Sierra, P.; Vargas-Martínez, A.M.; Leon-Larios, F.; Arciniega Carrión, J.V.; Jiménez Alverca, T.C.; de las Mercedes Lomas-Campos, M.; González-López, J.R. The Suffering of Advanced Chronic Renal Patients and Their Relationship with Symptoms in Loja, Ecuador. Int. J. Environ. Res. Public Health 2021, 18, 5284. https://doi.org/10.3390/ijerph18105284
Bonilla-Sierra P, Vargas-Martínez AM, Leon-Larios F, Arciniega Carrión JV, Jiménez Alverca TC, de las Mercedes Lomas-Campos M, González-López JR. The Suffering of Advanced Chronic Renal Patients and Their Relationship with Symptoms in Loja, Ecuador. International Journal of Environmental Research and Public Health. 2021; 18(10):5284. https://doi.org/10.3390/ijerph18105284
Chicago/Turabian StyleBonilla-Sierra, Patricia, Ana Magdalena Vargas-Martínez, Fatima Leon-Larios, Joselin Valeria Arciniega Carrión, Tatiana Cecibel Jiménez Alverca, María de las Mercedes Lomas-Campos, and José Rafael González-López. 2021. "The Suffering of Advanced Chronic Renal Patients and Their Relationship with Symptoms in Loja, Ecuador" International Journal of Environmental Research and Public Health 18, no. 10: 5284. https://doi.org/10.3390/ijerph18105284
APA StyleBonilla-Sierra, P., Vargas-Martínez, A. M., Leon-Larios, F., Arciniega Carrión, J. V., Jiménez Alverca, T. C., de las Mercedes Lomas-Campos, M., & González-López, J. R. (2021). The Suffering of Advanced Chronic Renal Patients and Their Relationship with Symptoms in Loja, Ecuador. International Journal of Environmental Research and Public Health, 18(10), 5284. https://doi.org/10.3390/ijerph18105284