Study On The Related Factors Of Thirst And Clinical Significances Of Intervention In Maintenance Hemodialysis Patients

PartⅠ:Study on the Related Factors of Thirst and Xerostomia in Maintenance Hemodialysis PatientsObjective:Some maintenance hemodialysis(MHD) patients suffer from thirst(the urge to drink) and xerostomia(the feeling of a dry mouth). High fluid intake through beverages and food would result in high interdialytic weight gain(IDWG) between dialysis sessions.Long-term non-compliance to the fluid-restricted diet can induce severe complications,such as hypertension,acute pulmonary oedema,congestive heart failure and cardiovascular comorbidity.The aim of this study was to analyse the clinical significances and related factors of thirst and xerostomia through cross-sectional study.Methods:42 MHD patients were enrolled in the study.Sensations of thirst and xerostomia were assessed by 100-mm visual analog scales(VAS),dialysis thirst inventory(DTI) and xerostomia inventory(XI).Unstimulated whole saliva(UWS) was measured. At the same time,IDWG,dry weight,body mass index and blood pressure were recorded.The IDWG was expressed as daily IDWG,daily IDWG%.The parameters of biochemistry,for example,potassium,sodium,chlorine, Kt/V,nPCR,plasma osmotic pressure and routine blood test etc.were determined.Zung self-rating depression scale(SDS) was used to assess depression.Thirst was defined as DTI≥16 points.Hyposalivation was defined as UWS≤0.16ml/min.Residual urine output was defined as urine during 24 hours≥100ml.The patients were assigned to two groups by DTI, UWS,urine,gender and age etc.for comparison.Then correlations of related factors were analyzed.Results:The average DTI and VAS_thirst score of the 42 MHD patients was 10.36±5.90 and 33.67±30.99 respectively.MHD patients with thirst were 8 cases,accounting for 19.05%.The mean XI and VAS_xerostomia score of the patients were 19.45±7.90 and 34.10±27.81 respectively.The mean UWS was 0.26±0.21ml/min,in which hyposalivation was 19 cases,accounting for 45.24%.①Compared with patients in low DTI score group,high DTI score group had significant higher scores of VAS_thirst, XI,VAS_xerostomia.The UWS had no difference between the two groups.②There were no significant differences in VAS_thirst,DTI,VAS_xerostomia and XI between different groups stratified with UWS.③Compared with patients in residual urine output group,without residual urine output group had significant higher scores of VAS_thirst,DTI,VAS_xerostomia and XI,while there were no difference in UWS.④XI score was higher in women than in men.⑤No significant differences in UWS,DTI,VAS_thirst,XI and VAS_xerostomia were observed with regard to age,dialysis months,and diabetics.⑥DTI,VAS_thirst,XI and VAS_xerostomia correlated with each other.⑦Daily IDWG correlated positively with VAS_thirst,DTI.Daily IDWG%correlated positively with VAS_thirst,DTI, VAS_xerostomia and XI.⑧Residual urine output correlated negatively with DTI, VAS_xerostomia and XI.⑨Dry weight correlated negatively with DTI,VAS_xerostomia and XI.⑩SDS scores correlated positively with VAS_thirst,DTI,VAS_xerostomia and XI.UWS was negatively with VAS_xerostomia.Multiple linear regression analyses revealed that XI,VAS_xerostomia and Daily IDWG%were independent determinants for VAS_thirst and DTI.Conclusion:Some MHD patients in this study suffered from thirst and xerostomia.Thirst was correlated with Daily IDWG,Daily IDWG%,SDS,residual urine output and dry weight.PartⅡ:Study on the relationships between Thirst and quality of life in Maintenance Hemodialysis PatientsObjective:To investigate the relationships of thirst,xerostomia and quality of life in MHD Patients through cross-sectional study.Methods: 42 MHD patients were recruited in the study.Addition to the parameters determined in the PartⅠ,KDQOL-SF^TM1.3 scale was used to survey quality of life.KDQOL-SF^TM Versionl.3 Scoring Program(V3.0) provided by the Kidney Disease Quality Of Life(KDQOL^TM) Working Group was used to collect registering data.The relationships of DTI,VAS_thirst,XI,VAS_xerostomia and quality of life were analyzed.The major factors impacting on quality of life in MHD patients were investigated by multiple regression analysis.Results:The mean score of KDQOL-SF was 61.75±14.36.The mean score of SF-36 and Kidney Disease Target Area(KDTA) were 60.79±22.54 and 62.40±10.66 respectively.Compared with patients in high DTI score group, low DTI score group had significant higher scores in many items of KDQOL-SF. These items were Symptom/problem list(SPL),Burden of kidney disease (EKD),Burden of kidney disease(BKD),Overall health(OH),Physical function(PF),Role limitations-physical(RLP),General health(GH), Emotional well-being(EWB),Social function(SOCIALF),Energy/Fatigue(EF), SF-12 Physical Composite(SF12PH),SF-12 Mental Composite(SF12MH),SF-36, KDTA,KDQOL-SF.VAS_thirst was negatively with KDQOL-SF,SF-36,KDTA,SPL, EKD,OH and EWB.DTI was negatively with KDQOL-SF,SF-36,KDTA,SPL,EKD, BKD,OH,GH,EWB,SOCIALF,EF,SF12PH and SF12MH.VAS_xerostomia was negatively with KDQOL-SF,SF-36,KDTA,SPL,EKD,BKD,OH,GH,EWB,SOCIALF,EF,SF12PH and SF12MH.XI was negatively with KDQOL-SF,SF-36,KDTA,SPL,EKD,BKD, OH,GH,EWB,SOCIALF,EF,SF12PH and SF12MH.Multiple linear regression analyses revealed that XI,SDS and age are independent determinants for KDQOL.Conclusion:Thirst and xerostomia were negatively with many aspects of KDQOL-SF.Therefore thirst and xerostomia affected the quality of life in MHD patients.PartⅢ:Study on the intervention of Thirst and Xerostomia in Maintenance Hemodialysis PatientsObjective:Stimulants or saliva substitutes could potentially be used to alleviate thirst and xerostomia in MHD patients and then to decrease IDWG. The aim of this study was to explore measures to alleviate thirst in MHD patients.Methods:This was a clinical crossover study,enrolling 11 MHD patients.After the use of chewing gums or straws to restrict fluid for 2 weeks,a wash-out period of 2 weeks was introduced and thereafter the other regimen was carried out.Thirst and xerostomia were assessed at baseline and after each treatment period,as were IDWG,blood pressure, UWS and paraffin chewing-stimulated whole saliva(PC-SWS).The IDWG was expressed as daily IDWG,daily IDWG%,IDWG2d,IDWG3d.Results:Compared with basis,chewing gum decreased DTI from19.27±3.41 to 14.27±4.84, VAS_thirst from 70.72±17.08 to 61.09±22.00,XI from 32.18±9.39 to 27.27±11.71,VAS_xerostomia from 54.55±19.57 to 44.55±20.03,IDWG2d from 2.78±0.66kg to 2.43±0.70kg and IDWG3d from 3.17±0.89kg to 2.88±0.65kg respectively.Restricting fluid by using of straws decreased DTI to 15.64±5.32,VAS_thirst to 59.36±21.74,and IDWG3d to 2.94±0.71kg respectively.UWS,PC-SWS and blood pressure were unchanged.Comparing the using of chewing gum with straws during the crossover trial,the former intervention significant decreased VAS_xerostomia.Comparing the two interventions each other,there were no differences in DTI,VAS_thirst,XI, UWS,PC-SWS,IDWG and blood pressure.Conclusion:Chewing gum could alleviate thirst and xerostomia.Restricting fluid by straws could also alleviate thirst.Both of them could decrease IDWG.