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Previous issue date: 2006 / Introdução: A prevalência da doença renal crônica tem aumentado nos últimos
anos, tornando-se um problema de saúde pública no mundo. O tratamento
dialítico, empregado na fase mais avançada da doença, aumenta a sobrevida
dos pacientes e é necessário que essa tenha boa qualidade. Alterações no
estado de humor parecem ser muito comuns nos pacientes hemodialisados e
permanecem sub-diagnosticadas nesse grupo de pacientes. O estado
depressivo parece prejudicar a qualidade de vida e a função sexual.
Objetivos: O objetivo geral foi de avaliar parâmetros relacionados ao estado
emocional, sexualidade e qualidade de vida em doentes portadores de doença
renal crônica recebendo tratamento de hemodiálise. Os objetivos específicos
foram estabelecer se há alteração do humor; identificar possível disfunção
erétil; avaliar qualidade de vida nesses pacientes; correlacionar alteração do
humor com a qualidade de vida referida; correlacionar alteração do humor e
disfunção erétil.
Métodos: Quarenta e sete pacientes adultos, masculinos, submetidos ao
procedimento de hemodiálise há mais de seis meses, foram avaliados em
relação ao estado de humor, empregando-se a escala de depressão de
Hamilton. A qualidade de vida foi avaliada utilizando o questionário Kidney
Disease and Quality of Life Short Form (KDQOL-SF™) e a função sexual o
Índice Internacional de Função Erétil (IIEF). Dados clínico-laboratoriais como
hemoglobina, hematócrito, albumina, ferritina e dose de diálise (Kt/v) foram
obtidas nos prontuários dos pacientes. As análises estatísticas foram
realizadas pelo teste exato de Fisher para comparação entre freqüências e o
teste de correlação de Spearman para analisar as correlações entre as
pontuações obtidas na escala de Hamilton, nos domínios do KDQOL-SF™ e do
IIEF. O nível de significância de p<0.05 foi adotado.
Resultados: Em relação à escala de depressão de Hamilton, 32 (68 %)
pacientes tinha alteração no humor (escore ≥ 7) e 15 (32 %) não apresentaram
esta alteração. (escore ≤ 6). Encontramos correlação, significativa e negativa,
entre o escore de depressão de Hamilton e os seguintes parâmetros da escala
KDQOL-SF™: Lista de “sintomas e problemas” (rs=-0.399, p=0.005) “qualidade
da interação social” (rs= -0.433, p = 0.002), “sono” ( rs= -0.585,p = 0.000),
“saúde geral” (rs= -0.475,p = 0.000), “bem-estar emocional” (rs= -0.582, p =
0.000), “função social” (rs= -0.354,p = 0.015) e “energia/fadiga” (rs= -0.518,p =
0.000). Os valores obtidos na Escala de Hamilton não apresentaram
correlações significativas com os domínios do IIEF (p>0.05). Os escores
obtidos nos domínios do IIEF mostraram correlações positivas e significativas
com os seguintes domínios do KDQOL-SF™: A função erétil correlacionou-se
com “efeitos da doença renal” (rs=0.340,p=0.019), com a “qualidade da
interação social” (rs= 0.328, p=0.024), com a “função sexual
“(rs=0.583,p=0.000), com “sono” (rs=0.343,p=0.018), com o “funcionamento
físico” (rs=0.391,p=0.006), com “saúde geral “ (rs=0.362,p=0.012), com a
“função emocional” (rs=0.286,p=0.005) e com a “energia/fadiga”
(rs=0.365,p=0.011). A função orgástica apresentou correlações com a
“sobrecarga da doença renal” (rs=0.321,p=0.028), com “função sexual”
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(rs=0.508,p=0.000), com “funcionamento físico” (rs=0.384,p=0.007) com a
“função física” (rs=0.363,p=0.012) com a “saúde geral” (rs=0.349,p=0.016),
com o “bem-estar emocional” (rs=0.324,p=0.026), com “função emocional”
(rs=0.321,p=0.028) e com “energia/fadiga” (rs= 0.281,p=0.005). O domínio
desejo sexual do IIEF apresentou correlação com “ efeitos da doença renal”(rs=
0.312,p=0.033), com “função sexual” (rs= 0.394,p= 0.006), com “sono” (rs=
0.393,p=0.006), com “funcionamento físico” (rs=0.422,p=0.003), com “saúde
geral” (rs= 0.302,p=0.038), com “bem-estar emocional” (rs=0.422,p=0.003) e
com “energia e fadiga” (rs=0.398,p=0.005). O domínio satisfação na relação
sexual do IIEF apresentou correlação significativa e positiva com “lista de
sintomas e problemas” (rs=0.326,p=0.025), com “efeitos da doença renal” (rs=
0.369,p=0.010), com “função sexual”(rs= 0.696,p=0.000), com “funcionamento
físico”( rs=0.414,p=0.003), com “saúde geral” (rs=0.412,p=0.004), com “ bemestar
emocional” (rs=0.334,p=0.022), com “função emocional” (rs= 0.299,p=
0.041) e com “energia/fadiga” (rs=0.370,p=0.010). O domínio satisfação com a
vida sexual do IIEF apresentou correlações positivas e significativas com “ lista
de sintomas e problemas” (rs= 0.403,p=0.005), com “efeitos da doença renal”
(rs=0.345,p=0.017), com “sobrecarga da doença renal” (rs=0.343,p=0.018) ,
com “qualidade da interação social”(rs=0.302,p=0.039), com “função sexual”
(rs=0.695,p=0.000), com o “sono”(rs=0.288,p=0.049), com “funcionamento
físico” (rs=0.331,p=0.023), com “saúde geral” (rs=0.444,p=0.001) , com “bemestar
emocional” (rs=0.306,p=0.036) , com “energia e fadiga”
(rs=0.314,p=0.032). A soma da pontuação de todos os domínios do IIEF
refletindo a função sexual como um todo apresentou correlações positivas e
significativas com a “lista de sintomas e problemas” (rs=0.329,p=0.024), com
“efeitos da doença renal” (rs=0.369,p=0.010), com “qualidade de interação
social” (rs=0.288,p=0.049), com a “função sexual” (rs=0.670,p=0.000) , com o
“sono”(rs= 0.336,p=0.21), com “funcionamento físico”(rs=0.429,p=0.002), com a
“saúde geral” (rs=0.454,p=0.001) , com o “bem-estar emocional” (rs=0.371 ,
p=0.010), com a”função emocional”(rs=0.302,p= 0.039), e com “energia/fadiga”
( rs= 0.405,p= 0.004)
Utilizando o domínio erétil do IIEF observou-se que 38 dos 47 pacientes
apresentaram disfunção erétil (80,8%). Apesar do grande número de pacientes
que apresentaram disfunção erétil e alteração no estado de humor pela escala
de Hamilton, não houve associação entre depressão e disfunção erétil. (p>
0.05, Teste exato de Fisher)
Conclusões: Observamos alto índice de alteração do estado de humor e de
disfunção sexual nos pacientes em hemodiálise crônica. As pontuações obtidas
na escala de Hamilton apresentaram correlações negativas com vários
domínios do questionário de qualidade de vida relacionada à saúde (KDQOLSF
™), sugerindo que o estado depressivo está associado com menores
escores de qualidade de vida nos pacientes hemodialisados. Por outro lado, a
função sexual, avaliada pelos diferentes domínios do questionário internacional
de função erétil (IIEF) apresentou correlações positivas com diferentes
domínios do KDQOL-SF™, sugerindo que a disfunção sexual está
correlacionada com escores mais baixos de qualidade de vida nos pacientes
estudados. Os principais domínios do KDQOL-SF™ que apresentaram
relações mais fortes e significativas com a função sexual avaliada pelo IIEF
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foram: função sexual, sono, funcionamento físico, saúde geral, bem estar -
emocional e energia/fadiga. Podemos concluir que os pacientes com
insuficiência renal crônica, em hemodiálise, apresentam: alto índice de
alteração do humor, a maioria na faixa de depressão leve e distimia; alto índice
de disfunção erétil e deterioração da qualidade de vida. Devemos encorajar
novos estudos que busquem quantificar a presença de alterações do estado de
humor e da disfunção sexual nos pacientes com insuficiência renal crônica,
buscando realizar intervenções que visem atenuar esses fatores, tendo em
vista as possíveis influências que estas alterações provocam na qualidade de
vida dos indivíduos, contribuindo para maior morbidade e mortalidade. ____________________________________________________________________________________ ABSTRACT / Introduction: The prevalence of chronic renal disease has increased in recent
years,and disease has become a public health issue worldwide. The dialysis
treatment, used in the most advanced stage of the disease, increases the
patients’ life expectancy and improves their quality of life. Patients under
hemodialysis treatment commonly have mood swings, but these changes are
not properly diagnosed. Depressive appears to affect their quality of life and
sexual function.
Objectives: The general objective was to evaluate parameters related to
emotional state, sexuality and quality of life in chronic renal disease patients
receiving hemodialysis treatment. The specific objectives were: to determine if
there were mood swing; to identify possible erectile dysfunction; to evaluate
quality of life in these patients; to correlate mood shift with quality of life; and to
correlate mood swings with erectile dysfunction.
Methods: Forty seven adult male patients who underwent hemodialysis
procedure for over six months were evaluated in relation to mood state, using
the Hamilton depression scale. The life quality was evaluated using the
questionnaire “Kidney Disease and Quality of Life Short Form” (KDQOL-SF™)
questionnaire, and the sexual function was assessed using the “International
Index of Erectile Function” (IIEF). Laboratorial data, such as hemoglobin,
hematocrit, albumin, ferritin and dialysis dose of (Kt/v), were obtained from the
patients files. Statistical analyses were conducted using Fisher’s test for
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comparison frequencies, and the Spearman’s correlation test was used to
evaluate the correlation among the results obtained from Hamilton scale over
the KDQOL-SF™ and the IIEF domains. The significance level p<0.05 was
adopted
Results: Based on the Hamilton Depression Scale, 32 (68%) patients had
mood shifts and swings (score ≥ 7) and 15 (32%), didn’t (score ≤ 6). We found
significant negative correlations among the scores obtained from theHamilton
Depression Scale and the following parameters of KDQOL-SF™ scale: “list of
symptoms and problems” (rs=-0.399 , p=0.005) “quality of social interaction”
(rs= -0.433, p = 0.002), “sleep” (rs= -0.585, p = 0.000), “general health” (rs= -
0.475, p = 0.000), “emotional well-being” (rs= -0.582, p = 0.000), “social
function” (rs= -0.354, p = 0.015 ) and “energy/fatigue” (rs= -0.518, p = 0.000).
We did not find a significant correlation between the score obtained from the
Hamilton Depression Scale and the IIEF domains (p>0.05). However, we found
a significant positive among IIEF domains and the following KDQOL-SF™
domains: erectile function was correlated with "effects of renal disease" (rs=
0.340, p=0.019), with "quality of social interaction" (rs= 0.328, p=0.024), with
"sexual function" (rs=0.583, p=0.000), with "sleep" (rs=0.343, p=0.018), with
"physical functioning" (rs=0.391, p=0.006), with "general health "(rs=0.,362, p=
0.012), with "emotional function" (rs=0.286, p=0.005) and with "energy/fatigue"
(rs=0.365, p=0.011). The orgasmic function showed correlations with "overload
of renal disease" (rs=0.321, p=0.028), with "sexual function" (rs= 0.508,
p=0.000), with "physical functioning" (rs=0.384, p=0.007) with "physical
function" (rs=0.363, p=0.012) with "general health" (rs=0.349, p=0.016), with
XVI
"emotional well-being” (rs=0.324, p=0.026), with "emotional function" (rs= 0.321,
p=0.028) and with "energy/fatigue" (rs= 0.281, p=0.005). The sexual domain
desire of the IIEF was correlated with "effect of renal disease" (rs= 0.312,
p=0.033), with "sexual function" (rs= 0.394 , p= 0,006), with "sleep" (rs= 0.393,
p=0.006), with "physical functioning" (rs= 0.422, p=0.003), with "general health"
(rs= 0.302, p=0.038), with "emotional well-being" (rs= 0.422, p=0.003), and with
"energy/fatigue" (rs= 0.398, p=0.005). The satisfaction in the sexual intercourse
domain of the IIEF showed a significant positive correlation with "list of
symptoms and problems" (rs= 0.326, p=0.025), with "effect of renal disease"
(rs= 0.369 , p=0.010), "sexual function" (rs= 0.696, p=0.000), "physical
functioning" (rs=0.414, p=0.003),"general health" (rs=0.412, p=0.004),
"emotional well-being" (rs=0.334, p=0.022), "emotional function" (rs= 0.299, p=
0.041) and with "energy /fatigue" (rs=0.370, p=0.010). The satisfaction with
sexual life domain of the IIEF had significant positive correlations with "list of
symptoms and problems" (rs= 0.403, p=0.005 ), "effect of renal disease"
(rs=0.345, p=0.017), “overload of the renal disease" (rs=0.343, p=0.018),
"quality of the social interaction" (rs=0.302, p=0.039), "sexual function"
(rs=0.695, p=0.000), "sleep" (rs= 0.288, p=0.049), "physical functioning"
(rs=0.331, p=0.023), "general health" (rs=0.444, p=0.001), "emotional wellbeing"
(rs=0.306, p=0.036), and with "energy/fatigue" (rs=0.314, p=0.032). The
IIEF total score reflecting the sexual function as a whole had significant positive
and correlations with the "list of symptoms and problems" (rs=0.329, p=0.024),
"effect of renal disease" (rs= 0.369, p=0.010), "quality of social interaction"
(rs=0.288, p=0.049), "sexual function" (rs=0.670, p=0.000), "sleep" (rs= 0.336,
p=0.21), "physical functioning" (rs=0.,429, p=0.002), "general health" (rs=
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0.454, p=0.001), "emotional well-being" (rs=0.371, p=0.010), " emotional
function" (rs=0.302, p= 0.039), and with "energy/fatigue" (rs= 0.405, p= 0.004).
The erectile domain of the IIEF showed that 38 of the 47 patients (80.8%) had
erectile dysfunction. Although most patients presented erectile dysfunction and
mood shift and swings according to the Hamilton Scale, no correlation between
depression and erectile dysfunction was found. (p> 0.05, accurate Fisher ‘s
test).
Conclusions: We found a high index of mood shift and sexual dysfunction in
patients with chronic renal disease under hemodialysis treatment. The scores
obtained in the Hamilton Scale showed a negative correlations with some
domains of the questionnaire of quality of life related to health (KDQOL-SF™).
This suggests that the depressive is associated with a lower score in quality of
life for patients under hemodialysis treatment. In contrast sexual function,
evaluated by different domains of the international questionnaire of erectile
function (IIEF), showed positive correlations with different domains of the
KDQOL-SF™, suggests that the sexual dysfunction is correlated with lower
scores in quality of life of the patients studied. The main domains of the
KDQOL-SF™ that showed stronger correlations with the mood state were:
sleep, general health, emotional well-being and energy /fatigue. The main
domains of the KDQOL-SF™ that had stronger and more significant
correlations with the sexual function evaluated by the IIEF were: sexual
function, sleep, physical functioning, general health, emotional well-being and
energy/fatigue We can conclude that the patients with chronic renal
XVIII
insufficiency, under hemodialysis treatment, present: high index of mood shifts,
and swings, most having mild depression and dysthymia; high index of erectile
dysfunction and poor life quality. These data suggest that these patients life
quality is negatively affected by depression.
Further studies should be encouraged to measure the degree of conditions
such as mood shifts and swings and sexual dysfunction in the patients with
chronic renal insufficiency. Well-thought-of interventions seeking to minimize
patients’ morbidity and-mortality, may be to minimize the harmful effects of
those conditions and consequently improve the patients’ quality of life.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unb.br:10482/3474 |
| Date | January 2006 |
| Creators | Garcia, Thales Weber |
| Contributors | Motta, Luiz Augusto Casulari Roxo da |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | Portuguese |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UnB, instname:Universidade de Brasília, instacron:UNB |
| Rights | info:eu-repo/semantics/openAccess |
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