nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2004-8-2-61-67nefr-834Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSПСИХОЛОГИЧЕСКИЕ И СОЦИАЛЬНО-ДЕМОГРАФИЧЕСКИЕ АСПЕКТЫ НАРУШЕНИЙ ЛЕЧЕБНОГО РЕЖИМА БОЛЬНЫМИ, НАХОДЯЩИМИСЯ НА ЛЕЧЕНИИ ХРОНИЧЕСКИМ ГЕМОДИАЛИЗОМPSYCHOSOCIAL AND DEMOGRAPHIC ASPECTS OF NON-COMPLIANCE IN CHRONIC HEMODIALYSIS PATIENTSВасильеваИ. А.VasilievaI. A.

г. Петрозаводск, Карелия

РумянцевА. Ш.RumyantsevA. Sh.

г. Петрозаводск, Карелия

МихееваЮ. С.MikheevàYu. S.

г. Петрозаводск, Карелия

Научно-исследовательский институт нефрологии, Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова; Республиканская больницаRussian Federation200410022004826167Copyright © Васильева И.А., Румянцев А.Ш., Михеева Ю.С., 20042004Васильева И.А., Румянцев А.Ш., Михеева Ю.С.Vasilieva I.A., Rumyantsev A.S., Mikheevà Y.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/834

ЦЕЛЬ ИССЛЕДОВАНИЯ. Определить психосоциальные, демографические и клиникобиохимические факторы, влияющие на несоблюдение лечебного режима гемодиализа (ГД). ПАЦИЕНТЫ И МЕТОДЫ. Обследован 51 больной, получавший лечение хроническим ГД. В качестве показателей несоблюдения режима ГД использованы чрезмерная прибавка веса больного в междиализный период, пропуски и сокращение сеансов ГД. Наряду с традиционными показателями нонкомплайенса анализировались курение и злоупотребление алкоголем. Применялись психодиагностические методики для оценки депрессии, тревожности, особенностей личности, качества жизни, жизненных целей и ценностных ориентаций пациентов. РЕЗУЛЬ ТАТЫ. При учете только более строгих критериев нонкомплайенса (относительная междиализная прибавка веса свыше 5,7% от сухого веса больного, пропуски и сокращение сеансов ГД чаще одного раза в месяц) примерно одна треть больных попадает в группу нарушающих лечебный режим хотя бы по одному показателю. Однако если включить в число недисципли нированных всех больных с прибавкой веса в междиализный период свыше 3 кг, группа несоблюдающих режим будет насчитывать свыше половины пациентов. Показано, что курение и злоупотребление алкоголем тесно связаны между собой и со всеми без исключения индикаторами нонкомплайенса. Установлено, что молодой возраст (р=0,004) пациентов достоверно связан с нонкомплайенсом. По результатам рангового корреляционного и факторного анализов, нонкомплайенс связан с такими личностными чертами, как недоверчивость, несоблюдение социальных норм, независимость, сниженный самоконтроль, эмоциональная неустойчивость, экстернальный локус контроля, неудовлетворенность самореализацией, отсутствие жизненной перспективы. Не отмечено достоверных связей индикаторов нонкомплайенса с полом, образованием, наличием работы, семьи, социальной поддержки, психическим состоянием больного, качеством жизни, клиникобиохимическими и анамнестическими показателями. ЗАКЛЮЧЕНИЕ. Установлено, чток факторам, предрасполагающим к нарушениям режима ГД, относятся молодой возраст, «соматическая сохранность» и неблагоприятные особенности личности.

THE AIM of the investigation was to determine psychosocial, demographic and clinicalbiochemical factors influencing non compliance of hemodialysis patients. PATIENTS AND METHODS. Under examinations there were 51 patients on chronic hemodialysis (HD). The excessive gaining of weight of the patients in the periods between dialysis procedures, absence from the procedures, and shortening the HD sessions were used as indices of noncompliance. Smoking and alcohol abuse were analyzed along with traditional indices of noncompliance. Psychodiagnostic techniques were used for the assessment of depression, anxiety, personal peculiarities, life quality, life aims and value orientations of the patients. RESULTS. Only stricter criteria of noncompliance (relative gaining weight over 5.7% of the patient’s dry weight, absence from and shortening HD sessions more than once a month) included about one third of the patients into the group of noncompliance patients even if by one index. However if the group of undisciplined patients could include all patients with weight gain more than 3 kg in the period between the HD sessions, the group of non compliance would include more than half patients. It was shown that smoking, alcohol abuse and all other indices of noncompliance are closely interconnected. Younger age of the patients (p=0.004) was found to be reliably connected with noncompliance. The rank correlation and factor analyses have shown that noncompliance is associated with such features as mistrustfulness, nonobservance of social norms, independence, low selfcontrol, emotional instability, external locus of control, dissatisfaction with selfrealization, absence of life perspectives. No reliable relationships of noncompliance indicators with gender, education, job, family, social supporting, mental state of the patient, life quality, clinicalbiochemical and anamnestic indices were revealed. CONCLUSION. It was found that the factors predisposing to noncompliance are young age, «somatic safety» and unfavorable personal features.

несоблюдение лечебного режима (нонкомплайенс)гемодиализпсихосоциальные переменныеособенности личностиnon-compliancehemodialysispsychosocial variablespersonal peculiaritiesReferencesArici M, Altun B, Usalan C. Compliance in hemodialysis patients. Unanticipated monitoring of biochemical indices. Blood Purif 1998; 16: 274276Arici M, Altun B, Usalan C. Compliance in hemodialysis patients. Unanticipated monitoring of biochemical indices. Blood Purif 1998; 16: 274276Curtin RB, Svarstad BL, Andress D et al. Differences in older versus younger hemodialysis patients’ noncompliance with oral medications. Geriatr Nephrol Urol 1997; 7 (1): 3544Curtin RB, Svarstad BL, Andress D et al. Differences in older versus younger hemodialysis patients’ noncompliance with oral medications. Geriatr Nephrol Urol 1997; 7 (1): 3544Pang SK, Ip WY, Chang AM. Psychosocial correlates of fluid compliance among Chinese haemodialysis patients. J Adv Nurs 2001; 35 (5): 691698Pang SK, Ip WY, Chang AM. Psychosocial correlates of fluid compliance among Chinese haemodialysis patients. J Adv Nurs 2001; 35 (5): 691698Safdar N, Baakza H, Kumar H, Naqvi SA. Noncompliance to diet and fluid restrictions in haemodialysis patients. J Pakistan Med Assoc 1995; 45 (11): 293295Safdar N, Baakza H, Kumar H, Naqvi SA. Noncompliance to diet and fluid restrictions in haemodialysis patients. J Pakistan Med Assoc 1995; 45 (11): 293295Sciarini P, Dungan JM. A holistic protocol for management of fluid volume excess in hemodialysis patients. ANNA J 1996; 23: 298302Sciarini P, Dungan JM. A holistic protocol for management of fluid volume excess in hemodialysis patients. ANNA J 1996; 23: 298302Vives T, Pujolar N, Junyent E et al. Adherence to treatment and personality in renal failure. Edtna Erca J 1999; 25 (3): 13 14, 18Vives T, Pujolar N, Junyent E et al. Adherence to treatment and personality in renal failure. Edtna Erca J 1999; 25 (3): 13 14, 18Kimmel PL, Peterson RA, Weihs KL et al. Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 1998; 54 (1): 245254Kimmel PL, Peterson RA, Weihs KL et al. Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 1998; 54 (1): 245254Leggat JE Jr, Orzol SM, HulbertShearon TE et al. Noncompliance in hemodialysis: predictors and survival analysis. Am J Kidney Dis 1998; 32 (1): 139145Leggat JE Jr, Orzol SM, HulbertShearon TE et al. Noncompliance in hemodialysis: predictors and survival analysis. Am J Kidney Dis 1998; 32 (1): 139145Bleyer AJ, Hylander B, Sudo H. et al. An international study of patient compliance with hemodialysis. J Am Med Assoc 1999; 281: 12111213Bleyer AJ, Hylander B, Sudo H. et al. An international study of patient compliance with hemodialysis. J Am Med Assoc 1999; 281: 12111213Kutner NG, Zhang R, McClellan WM et al. Psychosocial predictors of noncompliance in haemodialysis and peritoneal dialysis patients. Nephrol Dial Transplant 2002; 17: 9399Kutner NG, Zhang R, McClellan WM et al. Psychosocial predictors of noncompliance in haemodialysis and peritoneal dialysis patients. Nephrol Dial Transplant 2002; 17: 9399Baines LS, Jindal RM. Noncompliance in patients receiving haemodialysis: an indepth review. Nephron 2000; 25 (1): 17Baines LS, Jindal RM. Noncompliance in patients receiving haemodialysis: an indepth review. Nephron 2000; 25 (1): 17Rahman M, Fu P, Sehgal AR, Smith MC. Interdialytic weight gain, compliance with dialysis regimen, and age are independent predictors of blood pressure in hemodialysis patients. Am J Kidney Dis 2000; 35 (2): 257266Rahman M, Fu P, Sehgal AR, Smith MC. Interdialytic weight gain, compliance with dialysis regimen, and age are independent predictors of blood pressure in hemodialysis patients. Am J Kidney Dis 2000; 35 (2): 257266Morduchowicz G, Sulkes J, Aizic S et al. Compliance in hemodialysis patients: a multivariate regression. Nephron 1993; 64: 365368Morduchowicz G, Sulkes J, Aizic S et al. Compliance in hemodialysis patients: a multivariate regression. Nephron 1993; 64: 365368Zung WWK. A selfrating depression scale. Arch Gen Psychiat 1965; (12): 6370Zung WWK. A selfrating depression scale. Arch Gen Psychiat 1965; (12): 6370Spielberger CD et al. Manual for the State Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press, 1983.Spielberger CD et al. Manual for the State Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press, 1983.Ware JE, Snow KK, Kosinski M, Gandek B. SF 36 Health Survey Manual and Interpretation Guide. Boston, 1993: 122Ware JE, Snow KK, Kosinski M, Gandek B. SF 36 Health Survey Manual and Interpretation Guide. Boston, 1993: 122Cattell RB, Cattell AK, Cattell HE. Sixteen Personality Factor Questionnaire, Fifth edition. Champaign, IL: Institute for Personality and Ability Testing, 1993Cattell RB, Cattell AK, Cattell HE. Sixteen Personality Factor Questionnaire, Fifth edition. Champaign, IL: Institute for Personality and Ability Testing, 1993Леонтьев ДА. Тест смысложизненных ориентаций (СЖО). «Смысл», М, 1992:16Леонтьев ДА. Тест смысложизненных ориентаций (СЖО). «Смысл», М, 1992:16Avram MR, Pena C, Berrell D et al. Hemodilaysis and elderly patients: potential advantages as to quality of life, urea generation, serum creatinine, and less interdialytic weight gain. Am J Kidney Dis 1990; 16: 342345Avram MR, Pena C, Berrell D et al. Hemodilaysis and elderly patients: potential advantages as to quality of life, urea generation, serum creatinine, and less interdialytic weight gain. Am J Kidney Dis 1990; 16: 342345Sherman RA, Cody RP, Matera JJ et al. Deficiencies in delivered hemodialysis therapy due to missed and shortened treatment. Am J Kidney Dis 1994; 24: 921923Sherman RA, Cody RP, Matera JJ et al. Deficiencies in delivered hemodialysis therapy due to missed and shortened treatment. Am J Kidney Dis 1994; 24: 921923Kimmel PL, Peterson RA, Weihs KL et al. Aspects of quality of life in hemodialysis patients. J Am Soc Nephrol 1995; 6: 14181426Kimmel PL, Peterson RA, Weihs KL et al. Aspects of quality of life in hemodialysis patients. J Am Soc Nephrol 1995; 6: 14181426Bernardini J, Piraino B. Compliance in CAPD and CCPD patients measured by supply inventories during home visits. Am J Kidney Dis 1998; 31: 100103Bernardini J, Piraino B. Compliance in CAPD and CCPD patients measured by supply inventories during home visits. Am J Kidney Dis 1998; 31: 100103Bremer BA, Haffly D, Foxx RM, Weaver A. Patients’ perceived control over their health care: an outcome assessment of their psychological adjustment to renal failure. Am J Med Qual 1995; 10 (3): 149154Bremer BA, Haffly D, Foxx RM, Weaver A. Patients’ perceived control over their health care: an outcome assessment of their psychological adjustment to renal failure. Am J Med Qual 1995; 10 (3): 149154Kimmel PL. Psychosocial factors in adult endstage renal disease patients treated with hemodialysis: correlates and outcomes. Am J Kidney Dis 2000; 35 [Suppl 1]: S132S140Kimmel PL. Psychosocial factors in adult endstage renal disease patients treated with hemodialysis: correlates and outcomes. Am J Kidney Dis 2000; 35 [Suppl 1]: S132S140Taylor SE, Helgeson VS, Reed GM et al. Selfgenerated feelings of control and adjustment to physical illness. J Soc Issues 1991; 47: 91109Taylor SE, Helgeson VS, Reed GM et al. Selfgenerated feelings of control and adjustment to physical illness. J Soc Issues 1991; 47: 91109Васильева ИА. Психическая адаптация больных с хронической почечной недостаточностью к лечению гемо диализом. Автореф дисс канд психол наук. СПб., 1992: 120Васильева ИА. Психическая адаптация больных с хронической почечной недостаточностью к лечению гемо диализом. Автореф дисс канд психол наук. СПб., 1992: 120Bame SI, Petersen N, Wray NP. Variation in hemodialysis patients compliance according to demographic characteristics. Soc Sci Med 1993; 37: 10351043Bame SI, Petersen N, Wray NP. Variation in hemodialysis patients compliance according to demographic characteristics. Soc Sci Med 1993; 37: 10351043Furr LA. Psychosocial aspects of serious renal disease and dialysis: a review of the literature. Soc Work Health Care 1998; 27: 9599Furr LA. Psychosocial aspects of serious renal disease and dialysis: a review of the literature. Soc Work Health Care 1998; 27: 9599Cummings KM, Becker MH, Kirscht JP et al. Psychosocial factors affecting adherence to medical regimens in a group of hemodialysis patients. Med Care 1982; 20: 567 580Cummings KM, Becker MH, Kirscht JP et al. Psychosocial factors affecting adherence to medical regimens in a group of hemodialysis patients. Med Care 1982; 20: 567 580Friend R, Hatchett L, Schneider MS et al. A comparison of attributions, health beliefs and negative emotions as predictors of fluid adherence in renal dialysis patients: a prospective analysis. Ann Behav Med 1998; 19: 344347Friend R, Hatchett L, Schneider MS et al. A comparison of attributions, health beliefs and negative emotions as predictors of fluid adherence in renal dialysis patients: a prospective analysis. Ann Behav Med 1998; 19: 344347Vourlekis BS. Psychosocial problems in dialysis and transplant: the U.S experience. Unpublished Thesis, University of Maryland, Baltimore Country 1998Vourlekis BS. Psychosocial problems in dialysis and transplant: the U.S experience. Unpublished Thesis, University of Maryland, Baltimore Country 1998Christensen AJ, Smith TW, Turner CW et al. Family support, physical impairment and adherence in hemodialysis: an investigation of main and buffering effects. J Behavior 1992 15: 313325Christensen AJ, Smith TW, Turner CW et al. Family support, physical impairment and adherence in hemodialysis: an investigation of main and buffering effects. J Behavior 1992 15: 313325DeOreo PB. Hemodialysis patientassessed health status predicts continued survival, hospitalization, and dialysis attendance compliance. Am J Kidney Dis 1997; 30 (2): 204212DeOreo PB. Hemodialysis patientassessed health status predicts continued survival, hospitalization, and dialysis attendance compliance. Am J Kidney Dis 1997; 30 (2): 204212Kimmel PL, Peterson RA, Weihs KL et al. Psychologic functioning, quality of life and behavioral compliance in patients beginning hemodialysis. J Am Soc Nephrol 1996; 7 (10): 2152 2159Kimmel PL, Peterson RA, Weihs KL et al. Psychologic functioning, quality of life and behavioral compliance in patients beginning hemodialysis. J Am Soc Nephrol 1996; 7 (10): 2152 2159

The authors declare that there are no conflicts of interest present.