ARTIGO ORIGINAL | ORIGINAL ARTICLE Dyadic Relationship and Quality of Life Patients with Chronic Kidney Disease Relação Diádica e Qualidade de Vida de Pacientes com Doença Renal Crônica Autores ABSTRACT RESUMO Nuno Eduardo Roxo Rodrigues Cravo Barata 1,2 Introduction: Chronic Renal insufficiency Introdução: A Insuficiência Renal Crônica (CRI) and dialysis treatment lead to a (IRC) e o tratamento dialítico provocam uma succession of situations for kidney chronic sucessão de situações para o doente renal 1Universidade do Porto. patient, which compromises his aspect, not crônico, que compromete o seu aspecto, não 2 Universidade Portucalense. only physically, and psychologically, with só físico como psicológico, com repercussões personal, family and social repercussions. pessoais, familiares e sociais. Objetivo: Objective: (1) to verify the existence of (1) verificar a existência de diferenças do differences of dyadic adjustment (DA) relacionamento diádico (RD) de acordo according to renal replacement treatment com o Tratamento Substitutivo Renal (TSR) (RRT) and (2) verify the existence of e (2) verificar a existência de diferenças differences quality of life (QOL) in da qualidade de vida (QDV) de acordo accordance with the RRT. Methods: This com o TSR. Métodos: O presente estudo is a cross-sectional study of a descriptive transversal é de carácter descritivo mediante nature through surveys, exploratory and inquéritos, exploratório e correlacional. A correlational. The sample consisted of amostra é constituída por 125 participantes. 125 participants. Of these, 31 were to Destes, 31 encontravam-se a efectuar TSR be made RRT by automated peritoneal por diálise peritoneal automatizada (DPA) dialysis (APD) and 94 hemodialysis (HD). e 94 por hemodiálise (HD). Os participantes Participants were selected from three foram selecionados de três centros renais: renal centers: (1) Centro Renal da Prelada (1) Centro Renal da Prelada (Porto); (Porto, Portugal), (2) Centrodial (S. João (2) Centrodial (São João da Madeira); e da Madeira, Portugal) and Centro Renal Centro Renal da Misericórdia de Paredes da Misericórdia de Paredes (Paredes, (Paredes). O estudo realizou-se durante 6 Portugal). The study was carried out for 6 meses. Aplicou-se os seguintes instrumentos: months. The following instruments were Questionário Sociodemográfico e clínico applied: Socio-demographic and clinical (QSD&C); Dyadic Adjustment Scale (DAS); questionnaire (SDCQ), Dyadic Adjustment World Health Organization Quality of Life Scale (DAS), World Health Organization (WHOQOL-Bref). Resultados: Os resultados Quality of Life (WHOQOL-Bref). Results: demonstram a existência de diferenças The results demonstrate the existence of estatisticamente significativas entre o tipo statistically significant differences between de TSR e a maioria dos domínios de QDV, the type of RRT and most areas of QOL, bem como, a existência de diferenças as well as the existence of statistically estatisticamente significativas entre as significant differences between the subescalas do Ajuste Diádico avaliadas e o subscales of the DAS evaluated and the tipo de TSR. Conclusão: O presente estudo type of RRT. Conclusion: The present demonstra um maior comprometimento ao Data de submissão: 28/08/2014. Data de aprovação: 05/03/2015. study demonstrates a greater commitment nível da QDV dos indivíduos submetidos in terms of QOL of individuals undergoing a tratamento por HD quando comparados treatment for HD when compared with com os submetidos à DPA. Verifica-se, Correspondência para: those subjected to APD. It turns out, also, igualmente, que o AD é mais fortemente Nuno Eduardo Roxo Rodrigues Cravo Barata. that DA is most strongly perceived by percebido pelos pacientes em DPA do que Universidade Portucalense. Rua D. Pedro V, 113, 5.º W.,Vila patients in APD than with HD. com HD. Nova de Gaia Portugal. CEP: 4400-677. Keywords: quality of life; renal replace- Palavras-chave: ajustamento social; quali- E-mail: [email protected] ment therapy; social adjustment. dade de vida; terapia de substituição renal. DOI: 10.5935/0101-2800.20150051 315 Chronic Kidney Disease INtrODUCTION habits and the continued promotion of behaviors that improve overall health, involving people who also Chronic kidney disease (CKD) and dialysis treatment give assistance to the patient.6 lead to a succession of situations for chronic kidney One can consider, that social support (SS) is the patient, which compromises his aspect, not only result of positive or negative action of the relationships physically, and psychologically, with personal, family perceived by individuals, which meets definitions of and social repercussions. For Riella,1 chronic renal Sarason et al.7 Roughly speaking, it seems apparent patient experiences a sudden change in life, live that the in SS, the dyadic adjustment may function with limitations, with the painful treatment that is as precursor of a better adaptability of individuals hemodialysis, spend time thinking about death, but suffering from CRI, likely to increase optimism coexists with the possibility to undergo a kidney and positivity, as well as the quality of life of these transplant and the expectation of improving their same individuals have strong relationship between quality of life. Consequently, Lima & Gualda2 report everyone, since the renal treatment strongly influence that chronic renal patients end up getting discouraged, the physical and mental level.8 desperate and often, for these reasons or for lack of As noted earlier, it seems appropriate to systemize guidance, eventually abandoning the treatment or do the psychosocial implications inherent in this not give importance to the constant care that should health problem, since people who face CRI suffer a have. It is therefore necessary to stimulate their devastating impact on the social and psychological abilities to adapt positively to new lifestyle and take state, either as a direct consequence of the effects of control of their treatment. the disease and treatments, and either indirectly by All aspects of life are affected by kidney disease the implications of these same effects on personal and its treatment, and the effects extend to all people performance. Recently, the attention of health who have a closer involvement with the patient.3 A professionals began to turn to a therapy aimed at better understanding of the anxieties and concerns improving chronic renal patient QOL as a relevant of patients on a daily basis allows professionals factor in the setting of renal therapy, and not only the who work in Nephrology units responding with extension of his life. appropriate support.4 It has to start as early as In relation to chronic renal patient to achieve possible to avoid problems, both practical and a better QOL, this goal is always present in your material (for example related with employment or everyday life, and its indicator of QOL or wellbeing financial situation) or emotionally (as is the case of is extremely different from an individual considered the problems in personal relations and unnecessary healthy, because their health goals focus on achieving fears prognosis and treatment).3 a level of life/health compatible with a life with dignity So, faced with a crisis or illness, the subject tends and independence.9 It is obvious that in recent decades, to make use of all its resources available, struggling due to the onset of renal replacement treatment (RRT) to promote his self-balance, which was supposed to and adjuvant therapy,9 there have been technological possess and how he feels being threatened. Therefore, advances and considerable therapeutic allowing a it seems more or less clear that the social network of better well-being of these patients, particularly in support is one of the important variables that can racing to his longevity and permanence of some of intervene in a beneficial or malevolent way in a crisis its capabilities (even if it is not possible to enjoy a full or illness.5 It is therefore very important to assess the quality). level of marital relationship and dyadic adjustment The problem of CKD and its influence on QOL (DA) perceived by patients with CRI, providing of individuals can be better understood if Complete relevant information for the knowledge of variations with brief patho-physiological considerations of in terms of psychological well-being related to health CKD framework, therefore, reach a certain level and disease, and also with the quality of life from of health and QOL depends a lot of uncertainties variables such as depression, self-esteem preserved and and fears about the future; family concerns; sleep acceptance of renal substitutive treatment. Given this, disturbance; occupational limitations due to dialysis; it seems clear that the supportive family and friends lack of vitality; too much time spent on treatments; acts as a lever for the maintenance of the balance of dietary restrictions; medicated schemes; technical the patient, taking into account changes of individual J Bras Nefrol 2015;37(3):315-322 316 Chronic Kidney Disease problems with equipment; and fear of complications and people who reach 102 points or more would be during dialysis. Similarly, several authors point to the experiencing a relationship without suffering or well persistence of depressive symptoms, low self-esteem, adjusted. The DAS seeks to measure the following fear of rejection and side effects of renal substitutive dimensions: (a) dyadic consensus, which assesses the therapy, influencing individual’s CKD