Efeito da intervenção educativa sobre os cuidados ao paciente com doença renal crônica em hemodiálise

Abstract

Chronic Kidney Disease is considered a worldwide public health problem and arterial stiffness is an important subclinical marker of cardiovascular risk and a strong predictor of mortality in patients with this disease. Objectives To analyze and correlate the adequacy of hemodialysis treatment, the effects of kidney disease, sociodemographic and clinical factors with arterial stiffness and to investigate the effect of an educational nursing intervention on the care of chronic renal patients on hemodialysis and to associate it with arterial stiffness. Methods This is a descriptive, before-and-after, non-randomized, cross-sectional study carried out in two stages. The first was carried out from August 2016 to July 2017, with 149 chronic renal failure patients undergoing hemodialysis at a teaching hospital in the northwest of São Paulo, and the second stage was from January to June 2020 with 52 patients out of the 149 who were still undergoing treatment. of hemodialysis. The Dyna-MAPA® device was used to measure arterial stiffness. The data collection instruments used were: semi-structured interview, Morisky-Green test and the specific questionnaire to assess the quality of life Kidney Disease Quality of Life Questionnaire Short Form-KDQOL-SFTM before and after the nursing educational intervention. This intervention was carried out through an educational leaflet in january 2020, in march the guidelines of the educational leaflet were reinforced by telephone and in june 2020 they were reassessed. The intervention comprised individual guidance, clarifying the care that patients should have during hemodialysis treatment in chronic kidney disease. Statistical analysis was descriptive and multivariate linear regression tests and Student's t-correlation and chi-square tests were applied to relate arterial stiffness with the variables studied before and after the intervention. Results Most patients were of working age, professionally inactive, male, in a stable relationship, undergoing water and food restriction, with less than 48 months of dialysis treatment; 36.9% of patients had arterial stiffness, creatinine, urea and phosphorus biomarkers were increased; hematocrit and hemoglobin were decreased, mean interdialytic weight was 2.34 ± 1.4 kg and most Kt/V was inadequate. As for the effects of kidney disease, statistical significance was observed with those enrolled in the transplant list, longer treatment time and increased creatinine. Of the 149 patients studied in the first stage of the research, only 52 patients participated in the educational nursing intervention. The results of the analysis before and after the educational nursing intervention showed a significant association with arterial stiffness: in self-care of controlled pressure, in adherence to drug treatment and in the dimensions of sleep and social function of health-related quality of life. Regarding arterial stiffness and findings before and after the intervention, the educational intervention had a positive impact on controlled blood pressure, adherence to drug treatment and on the dimensions of quality of life, sleep and social function. As for lifestyle habits, there were no significant differences. Conclusion The sociodemographic and clinical profile of chronic kidney patients are in accordance with the national literature and the effects of kidney disease, creatinine, treatment time and those enrolled in the kidney transplant list had a positive impact on arterial stiffness. Systolic blood pressure was the only clinical variable that showed statistical significance in relation to arterial stiffness. The results of this study showed that the intervention was effective and effective in improving medication adherence and that the presence of arterial stiffness significantly decreases the patient's quality of life in relation to sleep and social function. These results can provide subsidies for the multidisciplinary team to carry out actions of therapeutic and educational interventions in the prevention and combat of cardiovascular morbidity and mortality in these patients.