z Demographic
The demographic characteristics of subjects are shown in Table 4-1 and Table 4-2. There were 348 patients in the final study sample. The response rate was 93.05%. Mean age of population was 60.47 ± 13.92 years (range, 20.17 to 92.33).
The proportion of female was 52.3%. Sixty-six patients had never gone to school.
The education levels, 124 patients (35.63%) graduated from elementary school, 57 patients (16.38%) graduated from junior high school, 64 patients (18.39%) graduated from high school, and 37 patients (10.64%) graduated from collage or above.
The marital status, they were 264 married (76.3%), 36 widow or widower (10.4%), and 14 separated or divorced (4.1%). The proportion of occupational status of subjects without work was 78.9 %, with part-time work was 8.5%, with full daytime work was 11.7%, and with full nighttime work was 0.9%. The family income (NT$ thousand) were less than or equal to 30 (37.46%), between 30 to 60 or equal to 60 (40.25%), between 60 to 90 or equal to 90 (12.07%), between 90 to 120 or equal to 120 (6.5%), and greater to 120 (3.72%). In personal habits, 14.8% of cases were smokers, and 14% of patients had caffeine consumption lifestyle. Similar to Taiwanese religion distribution, most of patients were Buddhist and Taoist (76.3%), none of religion (19.6%), Christian and Catholic (3.5%), and others (0.6%).
z Etiology of ESRD and Co-morbidity
The most prevalent end stage renal disease was chronic glomerulonephritis
(41.95%). The other causes of ESRD were DM (33.6%), hypertension (9.77%), PKD (2.01%), and SLE (1.44%). Other or unknown etiology of ESRD accounted for 11.2% of patients. The co-morbidity was distributed as HT (35.9%), DM (17.9%), chronic hepatitis (10.8%), and HF (4.6%). The proportion of sum of co-morbidity number as following: none was 33.5 %, one was 46 %, two was 16.38
%, and ≧ 3 was 4.6 %..
z Clinical Parameters
The ESRD patients have been treated on maintenance dialysis for a mean of 4.68 ± 4.27 years (range, 0.2 to 22 years). Forty-four percent of the patients dialyzed in the morning, 42.4% of the patients dialyzed in the afternoon, and 13.8 % of the patients dialyzed at night. Most of HD patients (96.3%) dialyzed 3 times per week.
Only 3.7% dialyzed two or four times per week. Most of the each HD session was between 3.5 to 4 hours (73.5%). There were 19% of patients received each HD session greater than 4 hours. The average Pre-HD/Post-HD weight of subjects was 61.1/58.36 Kg. The average ultrafiltration rate per HD session was 2.78 Kg. The average blood pressure (SBP/DBP) before HD was 138.63/77.61 mmHg. The heart rate was between 59 and 102 beats per minute. The respiratory rate ranged from 12 to 22 times per minute.
z Biochemical and Hematologic Parameters
The serum albumin level varied from 2.4 g/dl to 5.3 g/dl with mean of 3.9 (±0.4) g/dl. Pre-HD BUN ranged from 34 mg/dl to 134.7 mg/dl with mean of 73.47 (±19.05) mg/dl. Mean and SD of urea reduction rate was 71.19 ± 6.83% and the range from 35% to 95%. The Kt/V (Daugirdas) ranged from 0.73 to 2.04 with average of 1.48. The mean of pre-HD creatinine level was 10.86 ± 2.79 mg/dl (range from 3.8 to 24.1) mg/dl. The serum uric acid had a range of 3-12.4 mg/dl with average of 7.39 mg/dl. Total cholesterol varied from 65 mg/dl to 526 mg/dl
with average of 177.73 ± 46.93 mg/dl. Triglyceride was between 32 mg/dl and 1040 mg/dl with mean of 161.37 ± 123.04 mg/dl.
The serum sodium measured from 128 meq/L to 147 meq/L with mean of 138.29 ± 3.47 meq/L. The serum potassium varied from 2.8 meq/L to 7.2 meq/L and mean of 4.71 ± 0.78 meq/L. The mean of total serum calcium was 9.54 ± 0.86 mg/dl and range from 12.8 mg/dl to 6.8 mg/dl. The serum phosphate checked from 1.4 to 12.4 mg/dl and the mean was 5.1 ± 1.62 mg/dl. The calcium phosphate product was between 11.9 and 109.1 with mean of 49.07 ± 16.14. The intact parathyroid hormone varied from 0.5 pg/ml to 1687.7 pg/dl and average of 235.86 ± 290.98 pg/dl. The GOT value was 6 IU/L to 242 IU/L with mean of 24.92 ± 21.17 IU/L.
The GPT leveled from 2.4 IU/L to 154 IU/L with mean of 23.61±20.43 IU/L.
The serum ferritin ranged from 3.8 ng/ml to 6755ng/ml with mean of 596.8 ± 615.06 ng/ml. The serum iron varied from 2 ug/dl to 239 ug/dl with mean of 78.22 ± 39.35 ug/dl. The TIBC was between 44.1 ug/dl and 432 ug/dl and average of 224.28
± 49.07 ug/dl. The red blood cells observed 1.99 million per milliliter to 9.2 million per microliter with mean of 3.46±0.8 million per microliter. The hemoglobin measured was 6.4 g/dl to 15.7 g/dl with mean of 10.51 ± 1.4 g/dl. The white blood cells ranged from 2.6 to 20.8 thousand per milliliter and average of 6.54 ± 2.21 thousand per milliliter. The hematocrit checked between 19% and 47% with mean of 31.48 ± 4.06%.
There were 48.7 % of patients that had used sleep medications. The percentage of patients used two or more sleep medications were 4.5%. Only three patients had never received the erythropoitin (EPO). The dosage of EPO used for patients and the percentage of patients were less than 10000 (25.95%), 10000 to 18000 (32.65), 18000 to 26000 (26.53%), and greater than 26000 (14%) units per month. There were 17.7% of patients that had received 100 mg ferrous injection per month. Six
percent of patients had received 400 mg ferrous injection per month. Only 3.18% of patients had received more than 400 mg iron supply per month.
z Quality of Sleep
The PSQI global score of study patients had a range of 0-21 points with mean of 8.49 ± 4.64 points. For the individual components, each observed ranges were 0-3 points. The subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction had mean of 1.34 ± 0.88, 1.79 ± 0.98, 1.03 ± 1.08, 1.03 ± 1.21, 1.36 ± 0.63, 1.14 ± 1.34, and 0.79
± 0.80.
z RLS and Depression
The restless legs syndrome rating scale revealed a range of 0 to 40 points with mean and SD of 14.25 ± 11.48 in HD patients. There were 26.93 % of the ESRD patients on mild severity of RLS symptom. Nine percent of the ESRD patients had moderate symptom of RLS. On severe and very severe symptom, there were 8.05%
and 7.43% of the ESRD patients. The total Beck depression inventory (BDI-II) score of 0-13 were 57.47% of the ESRD patients. The mean and SD of the BDI-II scores were 7.05 ± 8.62. There were 14.94 % of subjects with score of 14-19 points in the BDI-II that were considered mild depression. Sixteen percent of cases had BDI-II score of 20-28 points that were regarded as moderate depression, 12.07% of patients greater than 28 points as severe depression.