| Abstract | Cilj istraživanja: Ispitati razlike u razinama depresije, obrana ega, kvalitete sna i dnevne pospanosti, laboratorijskih varijabli i općih obilježja u uzorku HD bolesnika prema razinama aleksitimije; ispitati razlike u razinama upale, elektrolita, urata i PTH prema razinama kvalitete sna i depresivnih simptoma HD bolesnika i prema tipu krvožilnog pristupa. Nacrt studije: presječno istraživanje. Bolesnici i metode: Istraživanje je provedeno na ukupno 170 HD bolesnika u ustanovama KBC Osijek, OŽB Vinkovci i Domu zdravlja Županja u razdoblju od veljače 2019. do travnja 2021. godine. Kod ispitanika su bilježena opća obilježja, razine aleksitimije, depresije, obrana ega, kvalitete sna i dnevne pospanosti. Neposredno prije liječenja dijalizom određene su laboratorijske vrijednosti CRP - a, leukocita, urata, PTH i elektrolita; kod bolesnika su mjereni međudijalizni donos mase i prosječne vrijednosti krvnog tlaka. Rezultati: Aleksitimični HD bolesnici imaju značajno niže razine serumskog fosfora (p = 0,005), više razine dnevne pospanosti (p < 0,001), depresivnih simptoma (p = 0,009) i nezrelih obrana ega (p < 0,001) u odnosu na HD bolesnike bez aleksitimije. Za svaki postignuti bod na TAS - 26 upitniku više, HD bolesnici imaju 1% niže vrijednosti serumskog fosfora (p < 0,001). Pozitivni prediktivni čimbenici aleksitimije u modelu s drugim somatskim i mentalnim čimbenicima su depresija (OR = 1,09 p = 0,02) i nezreli mehanizmi obrane ega (OR = 1,87 p = 0,004). HD bolesnici s lošijom kvalitetom sna imaju više razine CRP - a (p = 0,02) i urata (p = 0,02) u odnosu na dobre spavače, a HD bolesnici s AVF imaju i značajno više vrijednosti PTH (p = 0,03) u odnosu na dobre spavače s AVF. HD bolesnici s izraženom dnevnom pospanosti imaju granično značajno niži međudijalizni donos mase (p = 0,05). Nismo uspjeli dokazati prediktivan odnos varijabli somatskog i mentalnog zdravlja na preživljenje HD bolesnika. Zaključak: Aleksitimični HD bolesnici značajno više koriste nezrele obrane ega, imaju više razine dnevne pospanosti, niže razine serumskog preddijaliznog fosfora i višu razinu depresivnih simptoma u odnosu na HD bolesnike bez aleksitimije. Značajni prediktivni čimbenici aleksitimije su depresija i nezreli mehanizmi obrane od kojih su nezrele obrane prediktivnije. |
| Abstract (english) | Objectives: To test differences in levels of depression, ego defense mechanisms, sleep quality, daytime sleepiness, laboratory values and basic findings in a sample of HD patients according to the level of alexithymia; to test differences in levels of inflammation, electrolytes, uric acid and PTH according to levels of sleep quality and depression symptoms and according to vascular approach. Study design: Cross - sectional study. Patients and methods: The survey was run on a sample of 170 HD patients in Osijek Clinical Hospital Centre, Vinkovci General County Hospital and Županja Health Centre in the period between February 2019 and April 2021. Basic socio - demographic findings, levels of alexithymia, depression, ego defense mechanisms, sleep quality and daytime sleepiness were measured. Before hemodialysis sessions, we measured laboratory values of CRP, leukocytes, uric acid, PTH and electrolytes; interdialytic weight gain and average blood pressure were also measured. Results: Alexithymic HD patients have significantly lower levels of serum phosphorus (p = 0.005), higher levels of daytime sleepiness (p < 0.001), depressive symptoms (p = 0.009) and immature ego defense mechanisms (p < 0.001) compared to HD patients without alexithymic traits. For every point on a TAS - 26 questionnaire, HD patients have 1% lower values of serum phosphorus (p < 0.001). Positive predictors of alexithymia in a model with other somatic and mental variables are depression (OR = 1.09 p = 0.02) and immature ego defense mechanisms (OR = 1.87 p = 0.004). HD patients with lower sleep quality have higher levels of uric acid (p = 0,02) and CRP (p = 0,02) compared to good sleepers, and HD patients with an AVF have significantly higher values of PTH (p = 0.03) compared to good sleepers with an AVF. HD patients with high levels of daytime sleepiness have borderline significantly lower interdialytic weight gain (p = 0.05). We did not prove a predictive influence of variables of somatic and mental health on survival of HD patients. Conclusion: Alexithymic HD patients exhibit significantly higher levels of immature ego defenses, higher levels of daytime sleepiness, lower levels of phosphorus and higher levels of depression compared to HD patients without alexithymia. Significant predictive factors of alexithymia are depression and immature defense mechanisms, with immature defenses having higher predictive influence. |
