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The effect of case management with haemodialysis patients on the health perception and the symptoms: The case of Turkey.

Byline: Bahar Vardar Inkaya and Sezgi Cinar Pakyuz


Objectives: To establish whether case management had an effect on health perceptions and symptom relief in haemodialysis patients.

Methods: The quasi-experimental study was conducted from March to December 2013 in Ankara, Turkey, at three private dialysis centres providing haemodialysis therapy. It comprised chronic haemodialysis patients who were divided into experimental and control groups. In the first interview, the experimental group was provided with extensive training about haemodialysis and a three-month follow-up was conducted through case management. The control group was provided training only in the final interview. Data was collected using the scale for perception of health in haemodialysis patients and the scale for complaints/symptoms in haemodialysis patients. SPSS 20 was used for analysis.

Results: Of the 80 patients, 40(50%) were in each group. There was no significant difference in scale for perception of health in haemodialysis patients scores between first and final interviews (p>0.05), whereas the scale for complaints/symptoms in haemodialysis patients scores were lower in the final interview compared to the first p<0.05). In the control group, the scale for perception of health in haemodialysis patients scores were higher in the final interview compared to first (p0.05) (Table-1). In the experimental group, 25(62.5%) patients stated that they did not receive extensive information about their disease and HD, whereas this ratio was 24(60%) in the control group. It was found that 15(37.5%) subjects in each group received information from the nurse.

In the experimental group, there was no significant difference in SPHHP scores between the first and final interviews (p>0.05), whereas the SC-SHP scores were significantly different (Table-2). In the experimental group, the SC-SHP scores were positively lower in the final interview compared to the first interview (p0.05), whereas the SPHHP scores were significantly different (p0.05), whereas a significant difference was found in the final interview. The scores of the control group were poorer compared with the experimental group in the final interview (p<0.001 and p<0.001) (Table-3).

In the first interview, there was no significant difference in serum phosphorus levels and IDWG between the two groups (p<0.05), whereas sodium, calcium, potassium, and systolic and diastolic blood pressures were significantly different (p<0.05 each). In the first interview, the serum levels of sodium and potassium of the experimental group were higher and the calcium level was lower than the control group (Table-4). In the final interview, there was no significant difference in serum phosphorus levels between the two groups (p<0.05), whereas sodium, calcium, potassium, IDWG, and blood pressures were statistically significantly different (p1.5kg.26 It was revealed that the patients with IDWG >3kg, in particular, had higher mortality risk, and the mortality risk of the patients with IDWG >4kg increased by 28% compared to those with IDWG between 1.5 and 2 kg. It was seen that the sodium level of the experimental group was within normal values according to the KDIGO guideline.27

Considering that the elevated sodium levels cause increased IDWG and therefore hypertension and oedema, it can be said that this is a satisfactory result. Keeping IDWG under control using case management can be expressed as a result that should be considered in terms of avoiding risks. In the study, which was conducted with patients at a dialysis centre regarding the presence, frequency, and severity of the symptoms, the most common complaints of the patients were fatigue, sleep problems, pruritus, skin dryness, drowsiness, and bone pain.25 These complaints resulted from the imbalance in the laboratory findings, such as phosphorus, sodium, and parathormone, which increase the risk level of the patients. Therefore, patient follow-up with case management and laboratory result monitoring can be considered important for improving their motivation and the balance of the values.

Previous studies have established a high correlation between increased dietary potassium intake and high potassium levels. Mortality risk increased relatively in patients with a level of potassium >6 mEq/l.28 Accordingly, it is important to maintain the potassium level within normal limits in terms of mortality risk, and it may be concluded that case management helps achieve the target value at this point. The present study found higher serum levels of calcium and potassium in the experimental group compared to the control group in the final interview. However, such an increase in the serum levels of calcium and potassium was not above the reference values and therefore, does not have much meaning in clinical terms.

In the first interview, there was no significant difference in health perceptions and complaints/symptoms between the experimental and control groups. In the final interview, the experimental group had significantly reduced complaints/symptoms after three month's of case management compared with the control group. In the control group, there was no significant change in complaints/symptoms in the final interview, but the health perception increased negatively. In the experimental group, which was followed-up through case management, a significant reduction was achieved in serum levels of sodium, IDWG, and blood pressures. The main limitation of this study is smaller sample size. The sample could have been larger had it not been for the short duration.


It is recommended that nurses should use case management with a holistic approach to improve health perceptions and the managements of the patients' complaints/symptoms at haemodialysis centres. Additionally, we recommend using SPHHP to evaluate health perceptions and SC-SHP to evaluate complaints and symptoms of the patients.

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.


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Publication:Journal of Pakistan Medical Association
Date:Jul 31, 2018
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