Efeitos de uma intervenção baseada em mindfulness na adesão ao tratamento de pessoas em hemodiálise e revisão sistemática de mindfulness e desfechos renais

Abstract

Adaptations of chronic kidney disease (CKD) with hemodialysis and adherence to treatment are complex processes, and can be characterized by changes in lifestyle that involve a series of psychological, social and financial stressors, in addition to dietary and water restrictions. Mortality rates among individuals with CKD remain high, mainly due to non-adherence to dialysis, leading to accumulations of fluids and waste in the body, which help in the development of several comorbidities such as hypertension and diabetes. Mindfulness-based interventions (MBIs) have achieved promising results for several clinical outcomes, and offer complementary options for the treatment of people with chronic diseases, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. In view of scientific gaps and the investigation of non- drug techniques that provide a better experience of undergoing dialysis, the main objective of this study was to evaluate the effects of a MBI on adherence to the treatment of people on hemodialysis. In the theoretical session, a research of the scientific literature on adherence to the treatment of CKD and the effects of MBIs for this population was carried out. The first article was a systematic review in order to investigate the impacts of MBIs on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to assist future research. The searches were carried out in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and varied between the years 2014 to 2019. Significant improvements were found for the symptoms of anxiety, depression, self-efficacy, quality of sleep, and quality of life (n = 3) in the groups that performed the intervention, in addition to physical measures such as blood pressure, frequency heart rate and respiratory rate (n = 1). It was concluded that MBIs offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on the quality of life and physical aspects of the disease. The second article presented in the empirical session, was a randomized controlled trial, with the objective of evaluating the effects of a MBI on adherence to the treatment of people on hemodialysis, through biological markers of potassium, phosphorus, blood pressure and interdialytic weight gain as treatment adherence indicators, together with the assessment questionnaire on the adherence of patients with CKD on hemodialysis (QA - DRC-HD). The analyzes showed significant results for serum potassium levels (p = 0.04) between groups over time, and for systolic blood pressure over time (p = 0.02). Although no significant differences were observed for other outcomes (p> 0.05), we believe that MBIs offer an alternative and integrative tool for the management and adherence to the treatment of CKD, with the intention of decreasing the mortality rate and increasing the quality of life for this population.