Subjective Well-Being Measures of Hemodialysis Patients

In recent years the frequency of intra-dialytic symptoms has been decreasing, improving the patient well-being during treatment sessions. This has mainly been due to technical advances, such as more reliable monitoring devices, better water quality, physiological bicarbonate-based dialysate and machines to control ultrafiltration. Nowadays during hemodialysis (HD), patients suffer less from hypotension, cramps, headache, dizziness, nausea and vomiting (Himmelfarb & Ikizler, 2010; Al-Hilali et al., 2004). However, instead of well-being during dialysis, this chapter examines the well-being of patients between sessions, in their daily lives, focusing on how they perceive their quality of life (QOL). Unfortunately, technical advances in HD have not brought changes in the characteristics of renal replacement therapy: severe dietary restrictions, lost time, dependence on a machine, common occurrence of clinical complications and high mortality. Treatment of end-stage renal disease (ESRD) with HD is thus inherently distressing, causing social and family changes, and interferes profoundly in patients’ well-being (Cukor et al., 2007; Tsutsui et al., 2009; Low et al., 2008). ESRD treated with HD should be highlighted among other chronic diseases concerning its treatment, evolution and life consequences. Treatment depends not only on polypharmacy, but also on artificial replacement of kidney function by a machine – still a deficient method that cannot prevent various complications: ostheodystrophy, atherosclerotic disease and risk for infections. This inefficacious replacement of kidney function causes these patients to have a twenty-fold higher chance of death than in the general population (Parmar, 2002). HD patients must adhere to a very restricted diet with controlled ingestion of water. In conventional HD, the patient is submitted to sessions of dialysis for approximately four hours three times a week in a renal unit (plus the time spent commuting to and from the renal unit), a time loss that influences employment, leisure and relationships. It is not surprising, then, that ESRD treated with HD affects QOL more intensely than heart failure, diabetes, chronic lung disease, arthritis and cancer (Mittal et al., 2001). Therefore dialytic therapy is associated with powerful stressors. The literature shows that successful adaptation to dialysis depends more on personal stress modulators than on objective treatment variables (Tsay et al., 2005; Curtin & Mapes, 2001). Personal modulators are mainly subjective, due to psychology, personality and behaviour (Cukor et al., 2007). These subjective factors cannot be discovered by traditional medical measures like physical signs, laboratory and radiological data. The assessment of these