Avaliação da ativação de pacientes com Doença Renal Crônica em tratamento dialítico

Abstract

Introduction: The quality of self-care in patients with chronical kidney disease (CKD) is important to improve life quality, raise the survival time and reduce complications. The selfcare can be evaluated by measuring the activation of these patients. Objectives: Evaluate the activation in patients’ health with CKD in haemodialysis, comparing whether there is statistical difference in the activation of patients with CKD in relation of a normative group and identifying the social, demographic and clinical determinants associated to self-care and selfmanagement that associate with the activation in health from patients with CKD and from a normative group. Methode: Cross-sectional study, of analytical and descriptive nature, of quantifying approach, approved by the local ethics committee. Held in a public institution and a private haemodialysis clinic. Took part patients with CKD in haemodialysis (study group) and healthy subjects (normative group). All of them answered the Questionnaire of sociodemographic and clinical characterization and the instrument Patient Activation Measure (PAM 13). Results were presented as absolute or relative frequency or as average, standard error, minimum, maximum and the median. To the comparison of the groups profile, the dichotomized data was used the Chi-square Test of Independence. To the continuous data, nonmatched, the Mann-Whitney’s test was utilized. Regarding the evaluation of the linear effect of the profile variables from PAM 13, we used the multiple linear regression, including the assessment of both groups and independently (only for the KDC patients). In order to obtain the thriftier model, we applied the backward variable selection method, based on the model exclusion criterion at probability of less than 10%. Significance level adopted of 0.05. Results: Took part on the study 100 patients with CKD, in haemodialysis and 100 people of the normative group. As for the characteristics of the study group, there was predominance of the male gender (59%). 68% referred educational level as “incomplete secondary school” and 55% referred not having a conjugal live. Most of them (53%) was originated on private institution and 57% referred having some complication due CKD. Due the evaluation of the activation, the scores of activation did not varied between the two groups (Chi-square = 1.64; p = 0.649, g.l. = 3; p = 0.885) and the scores of activation, from both groups, corresponded to level 3 of activation (p>0.05). In relation to the influence of the social, demographical and clinical variables on activation, the formal teaching time (Bi = 5.38, p = 0.002), performing physical activity (Bi = 4.2; p = 0.019) and the number of people living with someone (Bi = -2.22; p = 0.001) had positively influenced in the activation in both groups. Regarding the independent evaluation (study group), the variables that had influenced in the activation were gender (Bi = -4.69; p = 0.050); education (Bi = 6.55; p = 0.008); medical clinic of origin (Bi = -5.48; p = 0.02) and the presence of complications (Bi = 6.55; p = 0.026) Conclusion: The scores of activation did not differ from the both evaluated groups. Regarding to the social demographic and clinical variables, performing physical activity and number of person who live with the subject, there was influence in both groups. In the activation of the study group, though, the variables were gender, education, medical clinic origin and the existence of complications.