| Abstract | Uvod: Vrlo se rijetko bavimo činjenicom da bolesnici na hemodijalizi često pate od boli: akutna ili kronična, bol je itekako prisutna u njihovom svakodnevnom životu. Ovim istraživanjem želi se utvrditi postojanje kronične boli na lokomotornom sustavu koji nastaje zbog poremećaja metabolizma elektrolita i minerala, prvenstveno kalcija i fosfora, kao i dugotrajnog liječenja hemodijalizom/peritonejskom dijalizom.
Cilj: Glavni cilj ovog istraživanja je utvrditi prisutnost kronične boli kod dijaliziranih bolesnika, procijeniti njen intenzitet, lokaciju i opis boli, te istražiti je li ta bol posljedica dugotrajnog liječenja dijalizom i pojave koštano zglobne bolesti kao komplikacije kronične bubrežne bolesti.
Metode rada: Istraživanje je provedeno na Zavodu za hemodijalizu KBC“ Sestre milosrednice“, 2015. godine anketom koju su ispitanici samostalno ispunjavali ili uz pomoć anketara. U istraživanju su sudjelovali bolesnici na kroničnom programu liječenja dijalizom ukupno 79, od čega je na hemodijalizi 59, peritonejskoj dijalizi 10, a kombinacija koja je prvo liječena peritonejskom, zatim hemodijalizom je 10 ispitanika. Korišten je upitnik sa sociodemografskim pitanjima i onima vezanim uz dijalizu, te upitnik za procjenu boli (McGill pain questionaire).
Rezultati: S obzirom na vrstu dijalize ispitanici su podijeljeni u tri skupine: oni koji su liječeni samo hemodijalizom (prosječna dob 65,37±14,08), peritonejskom dijalizom (60,20±15,77) i one koji su prvo liječeni peritonejskom, a zatim hemodijalizom (68,40±8,18), ta skupina nazvana je kombinacija. Bol je prisutna (VAS≥3) kod čak 57 od ukupno 79 ispitanika (72,1%), od čega je najzastupljenija lokacija ramena (p< 0,001), te kralježnice (p< 0,001) koja je ujedno češća lokacija boli kod žena. Zatim slijede lokacije šake (p= 0,042) i kukova (p= 0,005), što odgovara kliničkoj slici zglobno koštane bolesti. Dobivena je statistička značajnost za dob u kategoriji najjača bol unazad 4 tjedna (p= 0,010) i prosječnoj boli unazad 4
tjedna (p= 0,023), što je očekivano (populacija je prosječno starija od 65 godina). Za stručnu spremu u kategoriji najjača bol unazad 4 tjedna (p= 0,025) i prosječna bol unazad 4 tjedna (p= 0,042) neočekivano je statistički značajna (moguće je da ima veze sa socijalnom dimenzijom doživljaja boli). Spearmanovim korelacijskim koeficijentima procijenjena je povezanost razine PTH s vrstama i intenzitetom boli te trajanjem liječenja hemodijalizom, bez uočene statistički značajne razlike.
Zaključak: Pretpostavka da je mineralno koštani poremećaj jedan od glavnih uzroka kronične boli od strane lokomotornog sustava, u ovom istraživanju je potvrđena, s obzirom da su najčešće i statistički značajne lokacije boli upravo one koje odgovaraju kliničkoj slici mineralno koštanog poremećaja. Zglobno koštana bolest je česta komplikacija kod bolesnika i posljedica je dugotrajnog liječenja peritonejskom/hemodijalizom, iako u ovom istraživanju nije dobivena statistički značajna razlika između duljine trajanja dijalize i prisutnosti boli. |
| Abstract (english) | Introduction: We rarely deal with the fact that patients on dialysis suffer from pain: acute or chronic, pain is very much present in their everyday life. The aim of this study is to determine the existance of chronic pain of the locomotor system which occurs due to metabolic disorders of electrolites and minerals, primarly calcium and phosphorus, as well as long-term hemodyalisis/ peritonael dialysis treatment.
Aim: The main goal of this study is to determine the presence of chronic pain in dialysis patients, to estimate its intensity, location and description of pain, and to investigate wheather this pain is the consequence of the long term dialysis treatment and the occurance of bone and joint diseases as complication of chronic kidney disease.
Methodology: This research was conducted at the Department of hemodialysis „KBC Sestre Milosrdnice“ in 2015 by survey which respondents fulfilled individualy or with the interviewer help. The research involved patients on chronic dialysis treatment program, a total of 79, of whome 59 is on hemodialysis, 10 on the peritoneal dialysis, and 10 is the combination, where patients were first treated by peritoneal dialysis and then by hemodialysis. The questionnaire used in the research contained socio-demografic questions and questions related to dialysis, and pian assessing questionnaire (McGill pain questionnaire).
Results: Considering the type of dialysis, respondents were divided into three groups: ones which were treated only by hemodialysis (the average age is 65,37±14,08), peritoneal dialysis (the average age is 60,20±15,77) and those who were first treated with peritoneal dialysis and then with hemodialysis (the average age is 68,40±8,18), and that group was called combination. The pain is present (VAS>3) in 57 out of 79 patients (72,1%), of which the most common location is shoulder (p<0,001) and spine (p<0,001), which is also more common site of pain in women. They are followed by the location of the hand (p=0,042) and hips (p=0,005), corresponding to clinical
picture of the articulated bone disesase. Statistical significance was obtained for age in category the strongest pain in the last four weeks (p=0,010), and average pain in the last four weeks (p=0,023), what was expected (the population is on average of over 65 years old). For the professional qualification in category the strongest pain reversing four weeks (p=0,025) and average pain reversing four weeks (p=0,042) is unespectedly statisticaly significant (it is possible that this has to do with social dimension of pain). The interconnection of the level of PTH with the types and intensity of the pain and with duration of hemodialysis treatment were estimated using Spearman correlation coefficients and there was no statistically significant difference observed.
Conclusion: The assumption that the mineral-bone disorder is one of the main causes of chronic pain of locomotor system is confirmed by this research, considering that the most common and statistically significant locations of pain are exactly those which correspond to the clinical picture of mineral-bone disorder. The articulated bone disease is an often complication in patients and is the result of the long-term peritoneal or hemodialysis treatment, although in this research statisticaly significant difference between the duration of the dialysis and the presence of pain wasn't obtained. |
