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Moderate physical activity is related to reduced mortality in hemodialysis patients. However, most hemodialysis patients have low physical activity levels for complex reasons. This study investigated the determinants of moderate-to-high physical activity levels and whether psychosocial correlates are associated with engagement in moderate-to-high physical activity among hemodialysis patients. A cross-sectional survey was conducted with 134 hemodialysis outpatients, aged 64.7 years, in three hemodialysis centers in Taiwan. Data on sociodemographics, comorbidities, lifestyles, and psychosocial correlates, including perceived benefits, barriers, and self-efficacy of physical activity, were collected. Multiple logistic regression analyses were performed. Results showed that patients with moderate-to-high physical activity levels constituted a significantly lower proportion of current smokers and had fewer perceived physical activity barriers and higher self-efficacy of physical activity compared with those with low levels. After adjusting for potential sociodemographic covariates, current employment, nonsmoking status, and high self-efficacy of physical activity were significantly associated with moderate-to-high physical activity levels. Developing strategies to improve the self-efficacy of physical activity, support employment, and enhance anti-smoking campaigns in hemodialysis patients can help them engage in moderate-to-high levels of physical activity., (© 2024 John Wiley & Sons Australia, Ltd.)

Purpose : In this prospective study, we aimed to examine the sociodemographic factors and clinical factors associated with psychological disorders in chronic kidney disease (CKD) patients receiving unplanned hemodialysis (HD). Methods: We prospectively enrolled 187 CKD stage 5 patients receiving unplanned HD at a tertiary hospital from January 2015 to December 2016. We used structured questionnaires to gather data about participants' anxiety, depression, and sleep disturbance. Generalized linear regression analysis was used to examine the relationships between sociodemographic and laboratory parameters, and severity of psychological distress. Results: The mean age of the participants was 60 years, and the number of men and women was 97 and 90, respectively. We did not find a significant association between anxiety, depression, and sleep disturbance scores and gender, age, marital status, religion status, education levels, and employment status and number of comorbidities. Generalized linear regression analysis showed that a multidisciplinary CKD care program in outpatient clinic disclosed a significant negative association with psychological disorders in participants. Conclusions : CKD patients exhibited psychological distress when receiving unplanned HD, not closely associated with sociodemographic profiles.

Background: Ineffective medical treatment could be avoided if patients had completed advance directives documents in advance. Aims: This study aimed to explore the predictors for the intentions of signing advance directives among dialysis patients. Methods: This cross-sectional study recruited 209 dialysis patients by using structured questionnaires. The Statistical Package for the Social Sciences (Version 17) (SPSS/IBM Inc., Chicago, IL, USA) was used for data analysis. Results: The predictors for the intention of signing the advance directives documents were having information on palliative care, the participants' knowing about the advanced directives documents, and their having more knowledge of advance care plans. Conclusions: Health care workers may strengthen the patient's knowledge of an "advance care plan" by health education during the dialysis treatment and provide information on websites for the patients. Impact statement: Hospital managers should train their staff to provide health teachings for an advance care plan.

Background: Taiwan has the highest incidence and prevalence of dialysis in the world. The literature suggests that severity of depression at the beginning of dialysis treatment is an independent predictor of survival. Depression significantly worsens the condition of chronic renal disease patients, with the adverse consequences of depression including increased mortality and hospitalization rates as well as poor compliance and quality of life. Given the importance of this problem, providing safe and effective information and good nursing care to dialysis patients is urgently needed., Purpose: The purpose of this study was to explore the effects of implementing health promotion education groups on self-perceived depression, hope, and quality of life in dialysis patients., Methods: Dialysis patients who met the study criteria and had provided consent to participate in the health promotion education group were randomly assigned to either the treatment group (20 persons) or the control group (20 persons). In the control group, routine dialysis treatment and nursing care were maintained. In addition to receiving routine dialysis treatment and nursing care, the experimental group participated in health promotion education group activities for 90 minutes, twice a week for a total of 8 sessions. The quantitative data from both groups and the qualitative data analysis of the experimental group were used to assess the effects of the intervention., Results: The results showed that the intervention had significantly improved self-perceived depression, hope, and quality of life in the experimental group. The participants indicated that the health promotion education group had helped them learn to adapt to their physical conditions, change their mindset, learn to regard happiness as the purpose of life, and maintain hope and increase mutual support in the face of difficulties., Conclusions / Implications for Practice: This study demonstrated that the cross-disciplinary integrated care provided through health promotion education groups is able to significantly improve depression, hope, and quality of life in dialysis patients. Thus, health promotion education groups arranged by the case management nurses for dialysis patients have the potential to promote mental health and quality of life in these patients. Therefore, continuing education is recommended to strengthen the awareness and knowledge of dialysis case management nurses with regard to applying integrated cross-disciplinary care in health promotion education groups and to promoting the implementation of these groups in the holistic care of dialysis patients.

Background: Depression is common in dialysis patients, but the clinical impact of this condition is poorly defined., Methods: Out of 57,703 patients starting dialysis during 2000-2007 recorded in the National Health Insurance Research Database of Taiwan, we identified 2,475 patients with a clinical diagnosis of depression, and compared them with 1:5 age- and sex-matched patients without a depression diagnosis (n = 12,375). Patients were followed up for hospitalisation due to severe infections, major adverse cardiovascular events (MACE) and death. Multivariable Cox regression and competing risk analyses (accounting for death when appropriate) were used to estimate risk associations., Results: Patients with depression had a higher frequency of comorbidities. During a mean follow-up of 3.2 years, 1,140 severe infections, 806 MACE, and 1,121 deaths were recorded. Compared to controls, patients with depression were at increased risk of death (adjusted hazard ratio 1.24; 95%CI 1.16-1.33). Patients with depression were also at higher risk of severe (1.14; 1.06-1.22) and fatal infections (death within 30 days, 1.22; 1.09-1.35), attributed mainly to sepsis (1.19; 1.08-1.31), septic shock (1.36; 1.13-1.62) and pneumonia (1.19; 1.07-1.33). Conversely, no association was observed between depression and the MACE risk (1.04; 0.94-1.15)., Conclusion: Dialysis patients with depression are associated with increased risk of infections and death., Competing Interests: The authors have declared that no competing interests exist.

The aim of this study was to explore how hemodialysis patients' quality of life is related to sociodemographic data and depression as predicting variables, and how it is affected by fatigue as a mediating variable. Participants were 405 patients who has been receiving hemodialysis treatment regularly. SPSS Amos path analysis was used to explore the causal relationship and the mediating effect of fatigue among the variables of sociodemographic characteristics, depression, and quality of life. Unstandardized estimates determined that while sociodemographic characteristics were a significant predictor of fatigue, they were not directly related to quality of life. The results showed that depression and fatigue in patients receiving hemodialysis are important factors that affect patients' quality of life to a greater (fatigue) or lesser (depression) extent. Depression can affect patients' quality of life either directly or indirectly via fatigue. In this study, we demonstrated that fatigue plays an important role in the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis. The results of the study further suggest that comprehensive management programs should be applied with patients to reduce their fatigue, and ultimately to improve their quality of life., (© 2018 John Wiley & Sons Australia, Ltd.)

Aim: To explore the association between the sociodemographic factors and the needs of patients undergoing haemodialysis in Taiwan., Background: Concomitant discomfort, including physical and mental aspects, affects the patients' quality of life and their willingness to undergo haemodialysis. Maslow's hierarchy of needs is a well-known tool to assess different levels of human needs., Method: We conducted a small-scale cross-sectional observational study using a structured needs assessment questionnaire on 159 patients from the Taipei Veterans General Hospital haemodialysis unit., Results: The overall mean scores of physical, mental, spiritual, other needs and needs in relation to medical staff care were 4.0 ± 0.8, 3.2 ± 0.8, 2.7 ± 1.0, 3.1 ± 0.9 and 4.1 ± 0.7, respectively. The results showed that the patients' highest need was in relation to medical staff care, followed by physical needs. Further analysis showed that patients who are still employed during the treatment process have higher mental, spiritual and other needs. Patient who is financially supported by their family has higher physical needs. Patients taken care of by paid caregivers have lower spiritual needs and other needs. This is also the same with patients who are religious as opposed to those who are nonreligious. Patients who have attained tertiary education have higher other needs compared with patients who have only achieved up to primary or secondary education., Conclusion: The study is the first in Taiwan to identify and quantify the needs of patients undergoing haemodialysis. When the needs of the patients are identified in relation to their sociodemographic factors, the medical staff can give the appropriate treatment in order to meet the needs and improve the patients' well-being., Relevance to Clinical Practice: Healthcare providers should not only focus on the patients' physiological needs, but should determine and address their other needs in various aspects in order to improve the quality and efficacy of the dialysis care process., (© 2018 John Wiley & Sons Ltd.)

Background: Acceptance of disability (AOD) is a useful construct that assesses the ability of a patient to psychologically cope with chronic diseases, but its effect on long-term outcomes of patients with chronic kidney disease (CKD) remains unclear. This study aimed to evaluate the relation between AOD level and clinical outcomes in a cohort of CKD patients in Taiwan., Methods: 262 CKD patients without dialysis at a hospital in Taiwan were consecutively recruited, from 2010 to 2011, and followed up for 3 years. At enrollment, demographic and clinical data were obtained, including baseline level measurement of AOD, using the Acceptance of Disability Scale-Revised (AODS-R). During follow-up, the authors assessed the effect of AOD on progression to dialysis and all-cause mortality by using Cox proportional hazard regression analysis., Results: Of the patients included in the analyses, 145 (55.3 %) whose total scores of AOD were below the median (86.00) were regarded as having low AOD at enrollment. At the end of 3-year follow-up, 25 have died and 57 initiated dialysis. Participants with low AOD were more likely to have the composite end-point of progression to dialysis or death (adjusted hazard ratios [AHR] = 1.89, 95 % confidence interval [CI]: 1.18-3.20). In addition, CKD stage at IV or above and hemoglobin level were found to be associated with the occurrence of the composite end-point., Conclusion: AOD was associated with an increased risk for poor clinical outcomes, thus suggesting that prompt awareness and management of the psychological reactions may improve clinical outcomes of patients with CKD.

Background: Hemodialysis patients suffer from poor quality of life and survival. A retrospective cohort study was performed to examine the sex differences in self-reported quality of life and mortality in a Taiwanese hemodialysis cohort., Methods: A total of 816 stable hemodialysis patients were included. Patients completed two questionnaires: the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0) to assess health-related quality of life (HRQoL) and the Beck Depression Inventory (BDI, Chinese Version) to assess depressive mood. Mortality outcomes were recorded for a seven-year follow-up period., Results: After adjustment for confounding factors, women had significantly higher BDI scores (P=.003), lower physical functioning (P<.001), bodily pain (P<.001), mental health (P=0007), and physical component scale (PCS) scores (P<.001). There were 284 deaths recorded. In the Cox-proportional hazard model, women had significantly lower mortality than men (P<.001)., Conclusions: Women on hemodialysis had more depression-related symptoms and poor self-reported HRQoL, but better survival than men. The sex difference in psychological and HRQoL issues deserves greater concern because this relates to clinical care and further study.

Background: Hemodialysis (HD) patients have low self-care knowledge, poor self-care behavior, and powerlessness., Purpose: The authors designed this study to, first, understand the current state of first-year HD patients' self-care knowledge, self-care behavior, and powerlessness and, second, assess the effectiveness of an interactive multimedia CD educational intervention., Method: A quasi-experimental, repeated measures design, with intervention and comparison groups, was used. All subjects for this study were recruited from six dialysis centers in southern Taiwan. The three points for outcome testing included baseline, 4 weeks, and 8 weeks. Research tools included an HD self-care knowledge questionnaire, an HD self-care behavioral questionnaire, a powerlessness questionnaire, and an interactive multimedia CD., Results: Results found that participants possessed insufficient knowledge, were incapable of completely achieving or comprehending routine self-care, and were affected by powerlessness. The interactive multimedia CD intervention effectively enhanced self-care knowledge (p < .000) and self-care behavior (p < .000) and improved powerlessness (p < .000). Positive results persisted well after the conclusion of the intervention., Conclusions/implications for Practice: Participants in the intervention group had better self-care knowledge and behaviors and feeling of control over their lives than those in the control group. This illustrates the positive effects of the interactive multimedia CD. Results demonstrate the potential benefits of using the interactive multimedia CD with elderly patients in HD and nursing practice education.

Background: The purpose of this study was to explore the relationship between optimism and life satisfaction among patients with end-stage renal disease who decide to wait or not to wait for kidney transplantation. This cross-sectional, correlation design study was performed from July 2007 to June 2008. Subjects were recruited by purposive sampling in the clinics of kidney transplantation, renal disease, hemodialysis, and peritoneal dialysis. Three hundred fifty questionnaires were distributed, we analyzed the 335 returned including 196 subjects in the waiting group and 139 in the non-waiting group. Parameters included patient basic information, optimism, and life satisfaction scales. Data were analyzed by independent t-student's, chi-square, Pearson correlation, and stepwise multiple regression tests. The subjects in both the waiting and non-waiting groups reported moderate levels of life satisfaction; whereas, the latter reported a greater life satisfaction in general. All participants had good optimism that was positively related to their life satisfaction. Other factors of optimism, age, work ability, waiting transplantation or not, and marriage status were also significantly associated with life satisfaction., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Objective: Depression is common in hemodialysis patients. Reduced DHEA-S levels have been shown to be associated with depression in general population. Abnormalities in hormone production and metabolism are found in hemodialysis patients. However, the association between DHEA-S levels and depression in hemodialysis patients has not been established., Method: We conducted a cross-sectional study, in which 80 patients under regular hemodialysis were studied, and their serum DHEA-S levels were analyzed., Results: The prevalence of depression in our studied hemodialysis population is 37.5% (30/80). The DHEA-S level was 1138.1+/-1216.9 ng/mL in male patients and 502.1+/-389.4 ng/mL in female patients. The levels were not significantly different between patients with or without depression (910.8+/-1127.1 ng/mL vs. 769.3+/-848.3 ng/mL, P=0.533). As compared to the non-depressed patients, the depressed patients were more likely to be male, with lower body mass index, consuming more alcohol, and with more co-morbidity. The prevalence of depression was not associated with age, educational background, smoking, duration of dialysis, hemoglobin, albumin, CRP, ferritin, and urea clearance (Kt/V and URR). The serum DHEA-S levels exhibited significant and independent associations with age, gender, diabetes mellitus, and the levels of serum albumin., Conclusion: The study suggested a lack of association between plasma DHEA-S levels and depression in hemodialysis patients.

This study evaluated the correlations between spiritual beliefs and health-related quality of life (HRQOL) of hemodialysis (HD) patients in Taiwan. Participants had to complete two questionnaires: the 36-item Short Form Health Survey Questionnaire and the Royal Free Interview for Spiritual and Religious Beliefs. They were then divided into three groups according to their strength of spiritual beliefs-having no, weak, or strong beliefs. Demographic, clinical, and laboratory data among groups were compared. Correlations between spiritual beliefs and HRQOL were then determined by the analysis of covariance and the post hoc Scheffe tests. Six hundred thirty-three patients completed the study. There were more women in the group of patients with strong beliefs (P = 0.005) and more less-educated patients in the group of patients with weak beliefs (P = 0.005). Patients with no or with strong spiritual beliefs had higher role physical (P = 0.01) and social functioning (SF) (P = 0.001) scores than patients with weak beliefs. After adjustment for gender, age, marital status, education, comorbidities, and time on dialysis, patients with no or with strong spiritual beliefs were found to have higher SF scores (P = 0.02) than patients with weak beliefs. HD patients with no or strong spiritual beliefs had higher SF HRQOL than those with weak spiritual beliefs.

This study evaluated the associations between economic, social, psychological factors, and health-related quality of life of hemodialysis patients. Cross-sectional study design was used. End-stage renal disease patients who had received maintenance hemodialysis for more than 2 months at 14 centers in northern Taiwan were invited to participate. Demographic, economic, and psychosocial data of patients were collected. Depression was assessed by the Beck Depression Inventory. Health-related quality of life was measured by the Medical Outcomes Study Short-Form 36. Multivariable linear regression analyses were performed. Eight hundred sixty-one patients (373 males, mean age 59.4 +/- 13.2 years) completed the study. Higher monthly income was positively associated with role emotional and mental health (P < 0.05), and so was increased frequency of social activities with social functioning (P < 0.05). The more worries, the stronger the inverse associations with social functioning (P < 0.05) and mental health (P < 0.01). Higher depression scores were associated with lower scores of all Short-Form 36 dimensions (P < 0.01). Higher monthly income and increased social activities are associated with better health-related quality of life, whereas more worries and higher depression scores are associated with worse health-related quality of life of hemodialysis patients.

Background: Sleep disorders are common in hemodialysis (HD) patients. This study examined the relationship between quality of sleep (QoS) and religious/spiritual activity in HD patients., Methods: The study subjects were 861 HD patients from 14 dialysis clinics in Taiwan. QoS and religious/spiritual activity were evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Royal Free Questionnaire respectively., Results: There was no difference in clinical parameters between the good and poor sleepers. Although total scores of religious and spiritual activity did not correlate with global PSQI score, patients who held strong 'spiritual' beliefs reported more problems in 'sleep disturbances', while those who exercised religious beliefs more strongly reported less trouble in 'daytime dysfunction'., Conclusion: There is no significant correlation between QoS and religious/spiritual activity globally. However, the spiritual and religious activity did associate with different components of QoS., (Copyright 2008 S. Karger AG, Basel.)

Aim and Objective: The purpose of this study was to investigate the effects of group intervention on depression, self-efficacy and quality of life in haemodialysis patients., Background: Chronic renal failure and haemodialysis treatment is a long-term process; patients need to have an appropriate adaptive strategy to confront the stress stemming from the disease and subsequent haemodialysis treatment. The application of group intervention for haemodialysis patients has been limited., Design: This study applied an experimental design methodology. Patients were selected at two haemodialysis units of major medical centres in northern Taiwan., Methods: Out of 60 original patients randomly assigned into experimental or control groups, 48 completed the study. Twenty patients in the experimental group received group psychosocial intervention. The therapy ran for two hours per week for two months. Twenty-eight patients in the comparison group received routine unit care and a self-care booklet. Instruments included the Strategies Used by People to Promote Health, the Beck Depression Inventory and the Short Form-36. Data were collected at pretest and one month following the therapy., Results: The findings demonstrated that self-care self-efficacy, depression and quality of life significantly improved statistically for patients in the therapy group, compared with patients in the comparison group., Conclusions: The study indicated that group psychosocial intervention significantly reduced depression, improved self-care self-efficacy and quality of life in haemodialysis patients., Relevance to Clinical Practice: The present study was conducted with a group of outpatients, did not require expensive resources and was not time intensive, making it a viable therapy, clinically suitable for haemodialysis patients.

Background: The prevalence of sexual dysfunction among male haemodialysis patients is high. Sexual dysfunction is composed of both physiological and psychological factors. However, the role of psychological depression is still obscure., Methods: A multicentre cross-sectional study of 411 male haemodialysis patients was conducted to define the determinants of sexual dysfunction. Mid-week pre-dialytic biochemical and haematological parameters were obtained. All patients were required to complete three questionnaires by themselves: (i) the International Index of Erectile Function (IIEF, Chinese version); (ii) the Beck Depression Inventory (BDI, Chinese version) and (iii) the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0)., Results: In total, 154 male patients completed the IIEF questionnaire. Their mean age was 50.2 +/- 10.7 years. A linear multivariable regression analysis demonstrated advanced age, diabetes and the presence of depressive symptoms to be independently associated with sexual dysfunction. Subjects with sexual dysfunction had significantly lower quality of life scores., Conclusions: The presence of depressive symptoms, highly prevalent in haemodialysis patients, is an independent factor of sexual dysfunction in male haemodialysis patients. In a comprehensive approach to the management of sexual dysfunction, a thorough evaluation of psychological depression must be included.

Aims and Objectives: To expand the theoretical understanding of fatigue, this study used in-depth interview to explore the fatigue experience from haemodialysis patients' perspectives., Background: Fatigue is a common symptom experienced by the people with chronic diseases including those with renal failure requiring haemodialysis., Methods: Data were collected in a haemodialysis unit of a hospital in South Taiwan. Purposive samples of 14 participants were interviewed in-depth. Colaizzi's methods were used to analyse transcripts of the interviews., Results: Ten themes were delineated and classified into three domains. The first domain 'physical fatigue' consists of four themes: (1) habitual fatigue, (2) experiencing the uraemic symptoms (3) suffering from sleeping disturbance, (4) insufficient physical energy. The second domain 'affective fatigue' contains three themes: (5) detesting long-term treatment, (6) perceiving depression (7) and feeling exhausted. The third domain 'cognitive fatigue' includes three themes: (8) regretting lost cognition, (9) intentional isolation and (10) coping with fatigue., Conclusions: The findings identify that fatigue is a multi-dimensional concept. By understanding the various aspects of fatigue, nurses may be better able to plan and provide fatigue-relieving strategies for haemodialysis patients., Relevance to Clinical Practice: The results can provide a direction for interventional studies designed to reduce the patients' fatigue.

Background: Quality of life (QOL) is now considered to be an important part of the assessment of dialysis patients. The aim of this study was to develop and assess the reliability, validity and sensitivity of the dialysis module of the World Health Organization Quality of Life - Brief (WHOQOL-BREF) Taiwan version [WHOQOL-BREF(TW)] in patients undergoing regular hemodialysis (HD)., Methods: QOL survey was administered to 283 regular HD patients in metropolitan Taipei. The instruments used included: (1) the proposed module - composed of the core part, the WHOQOL-BREF(TW), and the six specific items; (2) the symptom/problem (S/P) scale - composed of 12 items specific for dialysis patients; (3) the utility measure, which was performed with standard gamble (SG) methods; and (4) the rating scale (RS)., Results: Based on the six criteria of validity, reliability and variance of the items, four HD-specific items were selected. Reliability study showed that Cronbach's alphas, composite reliability, and test-retest reliability (intraclass correlation at an average retest interval of 4-8 weeks) of the four domains of physical, psychological, social relationship and environment, ranged from 0.74-0.82, 0.79-0.84 and 0.61-0.79, respectively. Validity study showed that all the correlations between an item and its corresponding domain were highly significant (r>0.4, p<0.01) and larger than the correlations between the item and other domains. SG and psychometric measures showed relatively low correlations (0.12-0.26). The module showed the same construct as the WHOQOL-BREF(TW) under confirmatory factor analysis, whereas the exploratory factor analysis showed mild variation. Convergent and discriminant validity were good. Global QOL, physical, psychological and environment domains had some sensitivity to differentiate the severity of the condition of patients receiving HD. Clinical validity was demonstrated in global QOL, physical and psychological domains to have significant correlations with S/P scores., Conclusion: Besides broader coverage than the core WHOQOL-BREF(TW), the dialysis module of the WHOQOL-BREF(TW) is a valid, reliable and sensitive QOL instrument for the assessment of HD patients in Taiwan.

The number of patients suffering from end-stage renal disease is increasing rapidly around the world, including in Taiwan. Hemodialysis (HD) patients report fatigue as a major stressor. The purpose of this correlational study with systematic sampling was to explore fatigue and associated physiological, psychological, and situational factors in 119 Taiwanese HD patients. Results indicate that levels of fatigue were mild. Three variables (gender, employment, and depression) had a significant impact on fatigue. Some differences in physiological factors by depression, gender, and employment were found. Stepwise regressions showed that depression, age, and urea reduction ratio were significant predictors for overall fatigue and two of its dimensions. Some relationships from the theory of unpleasant symptoms were supported., (Copyright 2006 Wiley Periodicals, Inc.)

The purpose of this study was to describe the experience of making hemodialysis choices among Taiwanese with end-stage renal disease (ESRD). Using Colaizzi's phenomenological method, 12 ESRD patients provided in-depth, audiotaped interviews that were then transcribed and analyzed. The results of the data analysis revealed three broad categories and ten themes. The first category, confronting the dialysis treatment, included four themes: fear caused by false beliefs, a sense of threat to life, concern about the impairment of self-concept, and fear of physical limitations. The second category, seeking further information, included three themes: getting opinions of family members, seeking professional confirmation, and exploring alternative treatments. The third category, living with dialysis, included three themes: worsening symptoms, support of the family, and law of causation. These categories and themes revealed the difficulties that ESRD patients dealt with and the influence these difficulties and their culture had on the treatment choice.

Background: In 1991, the World Health Organization (WHO) initiated a cross-cultural project to develop a quality-of-life (QOL) questionnaire (WHOQOL); soon after this, the clinically applicable short form was developed and named WHOQOL-BREF, followed by a Taiwanese version (WHOQOL-BREF[TW])., Methods: We first administered the WHOQOL-BREF(TW) and symptom/problem scale to 376 patients with end-stage renal disease on regular hemodialysis therapy in Taiwan. Analysis with multiple stepwise regressions was conducted to study determinants of QOL domains and items., Results: The WHOQOL-BREF(TW) was reliable and valid from various validation studies. The 4 domains (physical, psychological, social relations, and environment) and global items (overall quality of life and general health) of the WHOQOL-BREF(TW) each differentiated symptoms/problems of hemodialysis patients from age-, sex-, and education-matched healthy referents. The 4 domains, except for environment and global items of the WHOQOL-BREF(TW), each differentiated erythropoietin dosage from age-, sex-, and education-matched healthy referents. After adjusting for age, sex, marriage, and education, the prominent associated factors of various QOL domains and items were age, area (Taipei or Keelung), hemoglobin level, normalized protein catabolic rate, and symptom/problem scale., Conclusion: The WHOQOL-BREF(TW) is reliable and valid for long-term study of hemodialysis patients, and hemodialysis had negative impacts on QOL, especially in patients with more severe disease with greater symptom/problem scores, lower hemoglobin levels, and lower normalized protein catabolic rates.

Background/aims: Health-related quality of life (HRQOL) is an important determinant of treatment effectiveness in dialysis patients. To our knowledge, there are no reports evaluating HRQOL of hemodialysis (HD) in Chinese patients. The purpose of this study is to present our results about HRQOL using the 36-Item Short-Form (SF-36) questionnaire on Taiwanese hemodialysis patients., Methods: HRQOL was measured by using the SF-36 questionnaire in 497 HD patients in five hospitals., Results: The following attributes, male gender, age <50 years old, higher education level (HEL), marriage status, employment status (EPS), less comorbid medical condition (CMC), and non-diabetic patients (NDP) were all predicted on a better Physical Component Scale (PCS). Age <50 years old, body mass index >18.5, HEL, EPS and NDP were all predicted on a higher Mental Component Scale (MCS). Scales contributing to a summary measure of physical health, the PCS score was significantly lower in women (35.0 +/- 12.3) than in men (37.9 +/- 12.3). However, there was no difference in the MCS score between women and men. In multivariate analysis, age, CMC, diabetes, serum creatinine (SCr), and erythropoietin responsiveness were significant independent predictors of PCS. Diabetes, educational level, SCr, and erythropoietin responsiveness were significant independent predictors of MCS. All of the individual scales were lower in Taiwanese HD patients than in both the general Taiwanese and US population. Each of the individual scales and MCS scores were substantially lower in the Taiwan HD group than in the US HD cohort. However, the bodily pain of PCS was significantly higher in the Taiwan HD group, although the mean PCS scores for the Taiwan HD group and the US HD study participants were nearly equal at 36.3 and 36.1, respectively., Conclusion: The physical and mental aspects of quality of life are substantially lower for Taiwanese HD patients, except for higher bodily pain tolerance. A number of demographic and clinical characteristics have a significant impact on HRQOL in Taiwanese HD patients.

The purpose of this study is to examine relationships among self-care self-efficacy, depression, and quality of life in 160 patients receiving hemodialysis. The study is a descriptive, correlational design. Measures include Strategies Used by People to Promote Health, the Geriatric Depression Scale, and the Quality of Life Index. Results indicate that self-care self-efficacy and depression are the significant predictors of quality of life after controlling for the effect of age. Self-care self-efficacy explains 47.5% of the variance (beta=0.52, p<0.001) and depression (beta=-0.29, p<0.001) explains an additional 5.5% of variance in quality of life. The study provides important information for health care providers as they design interventions for patients receiving hemodialysis.