Kidney

Improve the Psychological and Physical Health of Dialysis Patients with Mindfulness

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Improve the Psychological and Physical Health of Dialysis Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“We found that by engaging in mindfulness meditation, our patients have significantly decreased their anxiety, especially at the beginning of a treatment as they are connected to the dialysis machine,” – Thang Trey Ng

 

End-stage renal disease (ESRD) is a serious and all too common medical problem that results from a total and permanent failure of the kidneys. As a result, the body retains fluid and harmful wastes build up. Treatment, usually dialysis, is required to replace the work of the failed kidneys. Kidney dialysis uses a machine to filter harmful wastes, salt, and excess fluid from your blood. This restores the blood to a normal, healthy balance. Without dialysis or a kidney transplant the ESRD patient cannot survive It is estimated that ESRD occurs in more than 650,000 patients per year in the United States and is increasing by 5% per year. Those who live with ESRD are 1% of the U.S. Medicare population but account for 7% of the Medicare budget. Worldwide there are an estimated 2 million ESRD patients.

 

End-stage renal disease (ESRD) is frequently accompanied by a number of other serious diseases, such as cardiovascular disease and diabetes. Making matters worse is the fact that ESRD patients often experience psychological distress including depression. It is possible that mindfulness training may be helpful as it has been found be helpful for patients with kidney disease, to help relieve depression and improve the patients ability to effectively deal with stress.

 

In today’s Research News article “The effect of mindfulness program on general health of patients undergoing hemodialysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009148/ ), Nejad and colleagues recruited patients with End-stage renal disease (ESRD) on dialysis and randomly assigned them to receive 8 1.5 hour weekly sessions of either a mindfulness training program or an End-stage renal disease (ESRD) education program. They were measured before and after training and 1 month later for physical health, anxiety, depression, sleep disturbance, and social problems.

 

They found that in comparison to baseline and to the education control group the patients who received mindfulness training had significant improvements in all measured variables including significantly lower levels of anxiety, depression, sleep disturbance, and social problems and significantly higher levels of physical health. Importantly, these improvements were still present 1 month after the completion of training. This suggests that the benefits are enduring. A strength of this study is that the control condition was an active control which eliminates many sources of bias and contamination.

 

The study thus indicates that mindfulness training produces substantial physical and psychological benefits for patients with End-stage renal disease (ESRD) who are on dialysis. It remains for future research to clarify exactly how mindfulness training may be helping the patients. It is possible that the improved emotion regulation or ability to cope with the physical and psychological effects of stress produced by mindfulness training were responsible for the benefits for these patients. Regardless, training in mindfulness helps relieve at least some of the burden on these patients.

 

So, improve the psychological and physical health of dialysis patients with mindfulness.

 

“Meditation could be a valuable, low-cost, nonpharmacologic intervention for reducing blood pressure and adrenaline levels in patients with chronic kidney disease” – Kurtis Pivert

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Moosavi Nejad, M., Shahgholian, N., & Samouei, R. (2018). The effect of mindfulness program on general health of patients undergoing hemodialysis. Journal of Education and Health Promotion, 7, 74. http://doi.org/10.4103/jehp.jehp_132_17

 

Abstract

INTRODUCTION:

Patients undergoing hemodialysis have a low level of health and mindfulness technique in mind-body medicine is used to help patients with chronic illness. Therefore, this clinical trial was conducted to determine the effect of the mindfulness program on the general health of patients undergoing treatment with hemodialysis.

METHODS:

Sixty hemodialysis patients were selected through the convenient method and randomly divided into experimental and control groups. Both groups completed demographic information questionnaire and general health questionnaire. Then, the experimental group received 8 sessions of mindfulness training and the control group received 8 sessions of education in relation to end-stage renal disease and hemodialysis. Educational sessions were performed for both groups in the second 30 min after hemodialysis for 1 h in six individual sessions and two 1.5 h group sessions. Immediately after and 1 month after the intervention, the General Health Questionnaire was completed by both groups.

RESULTS:

Analysis of the findings showed no significant differences between the mean score of general health disorder and its subscales before the intervention in to two groups (P > 0.05). Nevertheless, after intervention in the experimental group, the mean of general health disorder score decreased from 44.17 ± 12.32 to 21.9 ± 6.4 and 1 month after the intervention, the mean score of this score was 23.6 ± 6.2. The mean score of physical symptoms, anxiety and sleep disorder, social functioning deficiency, and depression were also significantly lower in the experimental group immediately after intervention and 1 month after the intervention; however, there were no significant differences between the mean of this score immediately and 1 month after the intervention. In addition, the mean score of general health disorder changes immediately and 1 month after the intervention in the experimental group was significantly more than the control group. In the control group, there was no significant difference between the mean score of general health disorder and its subscales before, immediately, and 1 month after the intervention (P > 0.05).

CONCLUSIONS:

The results of this research showed that mindfulness has been effective in reducing physical and anxiety symptoms, sleep disorder, social dysfunction, and depression symptoms. Therefore, the use of mindfulness as a complementary treatment can improve the general health level in these patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009148/

 

Improve Psychological and Physical Health in End Stage Renal Disease with Mindfulness

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Improve Psychological and Physical Health in End Stage Renal Disease with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Meditation could be a valuable, low-cost, nonpharmacologic intervention for reducing blood pressure and adrenaline levels in patients with chronic kidney disease” –  Kurtis Pivert

 

End-stage renal disease (ESRD) is a serious and all too common medical problem that results from a total and permanent failure of the kidneys. As a result, the body retains fluid and harmful wastes build up. Treatment, usually dialysis, is required to replace the work of the failed kidneys. Kidney dialysis uses a machine to filter harmful wastes, salt, and excess fluid from your blood. This restores the blood to a normal, healthy balance. Without dialysis or a kidney transplant the ESRD patient cannot survive It is estimated that ESRD occurs in more than 650,000 patients per year in the United States and is increasing by 5% per year. Those who live with ESRD are 1% of the U.S. Medicare population but account for 7% of the Medicare budget. Worldwide there are an estimated 2 million ESRD patients.

 

End-stage renal disease (ESRD) is frequently accompanied by a number of other serious diseases, such as cardiovascular disease and diabetes. Making matters worse is the fact that ESRD patients often experience psychological distress including depression. It is possible that mindfulness training may be helpful as it has been found be helpful for patients with kidney disease and help relieve depression.

 

In today’s Research News article “Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875579/ ), Sohn and colleagues conducted and uncontrolled pilot study to investigate the effectiveness of group based Cognitive Behavioral Therapy that includes mindfulness training for improving the psychological health or 7 patients with End-Stage Renal Disease (ESRD) undergoing dialysis and suffering from depression.

 

The therapy included muscle relaxation, meditation, and cognitive therapy to uncover automatic thinking regarding their emotions and was conducted once a week for 12 weeks. The participants were measured before, at 8 weeks and after treatment for the biochemical variables of albumin, serum creatinine, calcium/phosphorus, and interdialytic weight gain and for the psychological variables of quality of life, anxiety, depression, perceived stress. They found that compared to baseline the participants had significant increases in quality of life, and significant decreases in albumin, serum creatinine, anxiety, depression, perceived stress.

 

Hence, after Cognitive Behavioral Therapy with mindfulness training the patients psychological and physical states were greatly improved. These are intriguing results that must be interpreted cautiously as this was an uncontrolled pilot study with just 7 patients. But, the findings clearly justify conducting a large randomized controlled trial with an active control condition. These patients suffer greatly and identifying a safe and effective therapy to relieve their psychological distress and improve their physical well-being is sorely needed.

 

So, improve psychological and physical health in end stage renal disease with mindfulness.

 

“Not only did mindfulness meditation decrease the anxiety related to dialysis, many patients also used this technique to assist relaxation and improve sleep at home.” – Raymond Chang

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sohn, B. K., Oh, Y. K., Choi, J.-S., Song, J., Lim, A., Lee, J. P., … Lim, C. S. (2018). Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients. Kidney Research and Clinical Practice, 37(1), 77–84. http://doi.org/10.23876/j.krcp.2018.37.1.77

 

Abstract

Background

Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers.

Methods

We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF), the Beck Depression Inventory II (BDI-II), the Hamilton Rating Scale for Depression (HAM-D), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT.

Results

The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period.

Conclusion

In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875579/

 

Improve Diseased Kidney Function with Yoga

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By John M. de Castro, Ph.D.

 

“Yoga combines both physical and spiritual elements which helps restores the body and revitalizes the mind. Some of the poses in yoga can improve the over health of the kidney and improve kidney function. This is an important step for preventing kidney problems and for slowing the progression of kidney disease.” – National Kidney Foundation

 

Chronic Kidney Disease (CKD) is a serious and all too common medical problem that involves a gradual loss of kidney function over time. As a result, the body retains fluid and harmful wastes build up. This leads to feelings of fatigue, trouble concentrating, poor appetite, trouble sleeping, muscle cramps, swollen feet and ankles, puffiness around your eyes, dry, itchy skin, and need to urinate more often. It is not unusual for people to not realize that they have chronic kidney disease until their kidney function is down to 25% of normal. CKD can eventually lead to complete kidney failure requiring dialysis, to replace the work of the failed kidneys, or a kidney transplant. It is estimated that CKD is present in more than 26 million Americans. Without effective treatment, CKD can lead to heart disease and reduced longevity. There are, however, no cures for CKD and treatment focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause.

 

Yoga practice has been found to be effective with treating a number of conditions that can lead to Chronic Kidney Disease (CKD). These include hypertension, diabetes, and artherosclerosis. So, it would seem reasonable to test yoga practice as a treatment for CKD. In today’s Research News article “Effects of 6 months yoga program on renal functions and quality of life in patients suffering from chronic kidney disease.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/pb.627681673922429.-2207520000.1480152606./1393155440708378/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2017;volume=10;issue=1;spage=3;epage=8;aulast=Pandey

Pandy and colleagues recruited patients with Chronic Kidney Disease (CKD) and randomly assigned them to receive either treatment as usual or 6-months of yoga practice. The practice consisted of 15-20 minutes of poses, 10-15 minutes of breathing exercises, and 20 minutes of relaxation. Before and over the 6-months of treatment they measured the patients’ quality of life, blood pressure, blood urea, sodium, potassium, and creatinine levels. They found that at the end of 6-months of yoga practice there was a significant reduction of blood pressure, nonsignificant reduction in blood urea and serum creatinine, and significant improvement in physical and psychological quality of life in comparison to the treatment as usual group. In addition, there was a reduction in the need for dialysis in the yoga practice group.

 

These are encouraging results and suggest that yoga practice may be a safe and effective treatment for Chronic Kidney Disease (CKD).  The study, however, examined only a small number of patients and sufficient statistical power was not present to detect many possible effects. So, the study needs to be replicated with a larger sample of CKD patients. Also, it needs to be recognized that the study lacked a group who performed another light exercise over the treatment period. So, it cannot be determined if yoga practice is necessary for the benefits or if any light exercise would produce similar benefits. Regardless, it appears that the practice of yoga can help improve kidney function in patients with Chronic Kidney Disease (CKD).

 

So, improve diseased kidney function with yoga.

 

“Yoga has been around for more than two millennia and has helped people everywhere overcome their medical conditions the natural way. While it is an effective method of keeping your kidneys healthy, yoga should not be used as a substitute for any medications that your doctor might have prescribed.” – India Times

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Pandey RK, Arya TV, Kumar A, Yadav A. Effects of 6 months yoga program on renal functions and quality of life in patients suffering from chronic kidney disease. Int J Yoga [serial online] 2017 [cited 2016 Nov 23];10:3-8. Available from: http://www.ijoy.org.in/text.asp?2017/10/1/3/186158

 

Abstract

Aim: To study the effect of 6 months yoga program in patients suffering from chronic kidney disease (CKD).
Materials and Methods: Fifty-four patients with CKD were studied and divided into two groups (yoga group and control group) to see the effect of yoga in CKD. Patients in the yoga group were offered yoga therapy along with other conventional treatment modalities, while the control group was only on conventional treatment. Subjects in yoga group were trained to perform specific yogic asanas for at least 5 days a week for 40-60 min a day. Regular monitoring of blood pressure, renal function, requirement of a number of dialysis, and quality of life (QOL) indicators were done. Fifty patients (yoga – 25; control-25) completed 6 months follow-up.
Results: In yoga group, a significant reduction of systolic and diastolic blood pressure, significant reduction in blood urea and serum creatinine levels, and significant improvement in physical and psychological domain of the World Health Organization QOL (as assessed by BREF QOL scores) were seen after 6 months. In control group, rise of blood pressure, deterioration of renal function, and QOL were observed. Poststudy comparison between the two groups showed a statistically significant reduction of blood pressure, nonsignificant reduction in blood urea and serum creatinine, and significant improvement in physical and psychological domain of QOL in yoga group as compared to control group. For subjects in yoga group, the need for dialysis was less when compared to control group although this difference was statistically insignificant. Except for inability of some patients to perform certain yogic asanas no adverse effect was found in the study.
Conclusion: Six months yoga program is safe and effective as an adjuvant therapy in improving renal functions and QOL of CKD patients.

http://www.ijoy.org.in/article.asp?issn=0973-6131;year=2017;volume=10;issue=1;spage=3;epage=8;aulast=Pandey

Improve Physical Condition in Dialysis Patients with Tai Chi

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By John M. de Castro, Ph.D.

 

“One of the best features of tai chi and qi gong is that they can be adapted to fit just about any fitness level. The gentle flowing low-impact movements are easy on your joints if you have arthritis. You can even do them seated or in a wheelchair if needed.” – Jodi Helmer

 

End-stage renal disease (ESRD) is a serious and all too common medical problem that results from a total and permanent failure of the kidneys. As a result, the body retains fluid and harmful wastes build up. Treatment, usually dialysis, is required to replace the work of the failed kidneys. Kidney dialysis uses a machine to filter harmful wastes, salt, and excess fluid from your blood. This restores the blood to a normal, healthy balance. Without dialysis or a kidney transplant the ESRD patient cannot survive It is estimated that ESRD occurs in more than 650,000 patients per year in the United States and is increasing by 5% per year. Those who live with ESRD are 1% of the U.S. Medicare population but account for 7% of the Medicare budget. Worldwide there are an estimated 2 million ESRD patients.

 

End-stage renal disease (ESRD) is frequently accompanied by a number of other serious diseases, such as cardiovascular disease and diabetes. Making matters worse is the fact that ESRD patients are most often sedentary. Moderate exercise, by improving cardiovascular performance and lowering insulin resistance, can be very helpful in preventing or coping with these comorbidities. But, great care must be used with exercise for the compromised ESRD patients.

 

Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It has been shown to have psychological and physical benefits particularly for the elderly. Because it is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for individuals with compromising conditions such as ESRD. So, it would seem that tai chi practice would be well suited as an exercise for dialysis patients.

 

In today’s Research News article “Evaluation of Exercise Tolerance in Dialysis Patients Performing Tai Chi Training: Preliminary Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1337845682906021/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980525/

Dziubek and colleagues provided dialysis patients with tai chi training for 60 minutes, twice a week for 6-months. They were closely monitored during all sessions for blood pressure. Heart rate was also measured to insure it was maintained at 50% or less of the maximal heart rate appropriate for the patients age. At the beginning and end of training a 6-minute walk test was performed on a treadmill and a stress test for oxygen uptake was performed on an exercise bicycle.

 

They found that after tai chi training the patients walked significantly further and reported less fatigue on the 6-minute treadmill walk and lasted longer on the bicycle stress test with no differences in heart rate or blood pressure. Hence, tai chi training appeared to improve the physical condition of the patients. It should be noted that there wasn’t a comparison condition or control group. So, it is not known if the patients would have improved without training and if other forms of exercise might be superior. Further research is needed to clarify these issues. The results though show that tai chi training is a safe and effective exercise for ESRD patients on dialysis. This is important as the exercise is needed to help maintain the health of these compromised patients.

 

So, improve physical condition in dialysis patients with tai chi.

 

“Tai chi is often described as “meditation in motion,” but it might well be called “medicationin motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems.” – Harvard Health Blog

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Dziubek, W., Bulińska, K., Kusztal, M., Kowalska, J., Rogowski, Ł., Zembroń-Łacny, A., … Woźniewski, M. (2016). Evaluation of Exercise Tolerance in Dialysis Patients Performing Tai Chi Training: Preliminary Study. Evidence-Based Complementary and Alternative Medicine : eCAM, 2016, 5672580. http://doi.org/10.1155/2016/5672580

 

Abstract

Introduction. Patients with end-stage renal disease (ESRD) have poor physical performance and exercise capacity due to frequent dialysis treatments. Tai Chi exercises can be very useful in the area of rehabilitation of people with ESRD. Objectives. The aim of the study was to assess exercise capacity in ESRD patients participating in 6-month Tai Chi training.

Patients and Methods. Twenty dialysis patients from Wroclaw took part in the training; at the end of the project, 14 patients remained (age 69.2 ± 8.6 years). A 6-minute walk test (6MWT) and spiroergometry were performed at the beginning and after 6 months of training.

Results. After 6 months of Tai Chi, significant improvements were recorded in mean distance in the 6MWT (387.89 versus 436.36 m), rate of perceived exertion (7.4 versus 4.7), and spiroergometry (8.71 versus 10.08 min).

Conclusions. In the ESRD patients taking part in Tai Chi training, a definite improvement in exercise tolerance was recorded after the 6-month training. Tai Chi exercises conducted on days without dialysis can be an effective and interesting form of rehabilitation for patients, offering them a chance for a better quality of life and fewer falls and hospitalisations that are the result of it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980525/