Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review

Razzera, Bruno Nunes; Adamoli, Angélica Nickel; Ranheiri, Maitê Freitas; Oliveira, Margareth da Silva; Feoli, Ana Maria Pandolfo

doi:10.1590/2175-8239-JBN-2021-0116

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Brazilian Journal of Nephrology

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Review Articles • Braz. J. Nephrol. 44 (1) • Jan-Mar 2022 • https://doi.org/10.1590/2175-8239-JBN-2021-0116 copy

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies.

Methods:

We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936).

Results:

Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1).

Conclusions:

MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.

Keywords:
Chronic Kidney Failure; Renal Dialysis; Chronic Kidney Failure; Mindfulness

			Participants		Intervention	Control
Main (year)	author	Outline	No of participants and no. of participants per group	Mean age and SD (years)	Format (group por individual), Frequency, program duration	Format (group or individual), frequency, duration	Post-treatment assessment	Measures/Instruments	Main results
Thomas (2017)³⁷37 Thomas Z, Novak M, Platas SGT, Gautier M, Holgin AP, Fox R, et al. Brief mindfulness meditation for depression and anxiety symptoms in patients undergoing hemodialysis. Clin J Am Soc Nephrol. 2017 Dec;12(12):2008-15. DOI: https://doi.org/10.2215/CJN.03900417 https://doi.org/10.2215/CJN.03900417...	et al.	ECR	21 (GI)	66 ± 13 (GI)	Siegal, Williams & Teasdale MBCT, 8 weeks, 3 times a week, lasting between 10-15 minutes, individually next to bed. The participants were encouraged to practice at home in between sessions.	Usual hemodialysis treatment	No follow up	1. Viability:	1.1. 71% retention.
			20 (GC)	64 ± 14 (GC)				1.1 Registration.	1.2. 82% Frequency of all sessions offered.
								1.2 Frequency.	1.3. Good-tolerability meditation, score of 8 on the Likert scale.
								1.3. Tolerability.
								2. Depression (PHQ-9).	2. With no significant difference between the groups (p = 0.45)
								3. Generalized anxiety disorder (GAD-7)
									3. With no significant difference between the groups (p = 0.91)

Reilly-Spong (2015)⁴⁵45 Reilly-Spong M, Reibel D, Pearson T, Koppa P, Gross CR. Telephone-adapted mindfulness-based stress reduction (tMBSR) for patients awaiting kidney transplantation: Trial design, rationale and feasibility. Contemp Clin Trials [Internet]. 2015 May. 42:169-84. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1551714415000683 https://linkinghub.elsevier.com/retrieve...	et al.	ECR with active control	31 (GI)	51.7 ± 12.1 (GI)	tMBSR based on the MBSR program from Kabat-Zinn, Weekly in person group for 5 hours on weeks 1 and 8, and 90-minute teleconferences throughout weeks 2-7, ending with one day of mindfulness retreat on week 8. The participants were encouraged to practice at home between the sessions.	Structured support group, adapted for telephone, facilitated by a life trainer and kidney transplant receiver, teleconference in 90-minute groups, in person, on weeks 1 and 8, and 1 hour throughout weeks 2-7, development of skills with homework included between the sessions.	No follow-up	1.Viability:	1.1. Presence in 84% of the intervention group and 88% in the support group (p = 0,472). With no significant difference between the groups in terms of presence (p = 0.472) and commitment (p > 0.05).
			32 (GC)	53.8 ± 11.4 (GC)				1.1 Presence and commitment
								1.2 Treatment preference
								1.3 Satisfaction
								1.4 Benefit expectation	1.2 Without significant difference in treatment preference (p = 0.340)
								1.5 Treatment loyalty
									1.3 High satisfaction in the intervention group (8.83) and control group (8.07). With no significant difference between the groups (p = 0.17)



									1.4 Expectation of higher benefits in the intervention group (p = 0.005).

									1.5 All the sessions were held in both groups with small adjustments.

Gross (2017)³⁸38 Gross CR, Reilly-Spong M, Park T, Zhao R, Gurvich OV, Ibrahim HN. Telephone-adapted mindfulness-based stress reduction (tMBSR) for patients awaiting kidney transplantation. Contemp Clin Trials [Internet]. 2017 Jun. 57:37-43. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1551714416305018 https://linkinghub.elsevier.com/retrieve...	et al.	ECR with active control	27 (GI)	52,6 (GI)	tMBSR program based on the MBSR by Kabat-Zinn, 8 weeks, in-person 3-hour workshop on weeks 1 and 8, and 1.5h group teleconference on weeks 2-7. Final 3-hour retreat called “One day of mindfulness”. The participants were encouraged to practice at home between the sessions.	Support group (tSupport) structured, led by a moderator, and designed with the format of the book used by the tMBSR group. Two 1.5-houer workshops and six one-hour weekly workshops. The participants held homework in between the meetings.	6-month follow-up	1. Ansiedade (STAI);	1. No significant difference between the groups after (p = 0.18) and upon the 6-month follow-up (p = 0.55). .
			28 (GC)	54,6 (GC)				2. Depressão (CES-D);
			28 (GC)	54,6 (GC)				3. Qualidade do sono (PSQI);
								4. Energia/exaustão (PROMIS)	2. Significant difference after (p = 0.05), and no significant difference on the 6-month follow-up (p = 0.86)
								5. Qualidade de vida (MCS e PCS do SF-12)
								6. Dor (SF-12)
									3. No significant difference after (p = 0.59) and upon the 6-month follow-up (p = 0.65).
									4. No significant difference after (p = 0.54) and on the 6-month follow-up (p = 0.96).

									5. No significant difference for MCS after (p = 0.34), significant difference for the 6-month follow-up (p = 0.01). No significant difference for PCS after (p = 0.29) and upon the 6-month follow-up (p = 0.96).


									6. No significant difference after (p = 0.99) and upon the 6-month follow-up (p = 0.94).
Solati (2019)³⁶36 Solati K, Mardani S, Ahmadi A, Danaei S. Effect of mindfulness-based cognitive therapy on quality of life and self-efficacy in dialysis patients. J Ren Inj Prev [Internet]. 2019;8(1):28-33. Available from: http://journalrip.com/Abstract/jrip-541 http://journalrip.com/Abstract/jrip-541... ECR	et al.	ECR	10 (GI)	57 ± 8.32 (GI)	MBCT program from Siegal, Williams and Teasdale, group intervention with 2 to 2.5 hours in each session. The program also includes 45 minutes of daily practice, formal and informal exercises, the participants sometimes record their observations.	Usual treatment of the hemodialysis environment	No follow-up	1. Quality of life (SF-36)	1. Quality of life increased in the GI (p < 0.01). No significant difference between the groups (p > 0.05).
			20 (GC)	60 ± 9.87 (GC)				2. Self-efficacy- General self-efficacy scale

									2. Significant difference for both groups separately (p < 0.01). No significant difference between the groups (p > 0.05).


Nejad (2018)⁴⁴44 Nejad M, Shahgholian N, Samouei R. The effect of mindfulness program on general health of patients undergoing hemodialysis. J Educ Health Promot [Internet]. 2018 Jun; [cited 2021 Apr 21]; 7:74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009148/ https://www.ncbi.nlm.nih.gov/pmc/article...	et al.	ECR	30 (GI)	55.45 ± 11.6 (Did not specify the age of the groups)	8 mindfulness training sessions; 2 of them in 1.5h sessions and the Other 6 are individual sessions, 30 minutes after the hemodialysis for 1 hour.	8 educational group sessions associated with CKD and hemodialysis, 2 of them were 1.5h group sessions and 6 individual sessions, 30 minutes after hemodialysis for 1 hour.	1 month follow-up	1. General health questionnaire (GHQ-28):	1. Significant difference between the average score in the intervention group after the intervention and on the 1-month follow-up (p < 0.05) for all the GHQ-28 domains. With no significant difference among the groups for all the GHQ-28 domains (p > 0.05).
			30 (GC					1. General health questionnaire (GHQ-28):
								1.1 Physical symptoms
								1.2 Anxiety and sleep disorder symptoms
								1.3 Social functioning failures
								1.4 Signs of depression
								1.5 General health
Park (2014)³⁹39 Park J, Lyles RH, Bauer-Wu S. Mindfulness meditation lowers muscle sympathetic nerve activity and blood pressure in African-American males with chronic kidney disease. Am J Physiol Integr Comp Physiol. 2014 Jul;307(1):R93-101. DOI: http://www.physiology.org/doi/10.1152/ajpregu.00558.2013 http://www.physiology.org/doi/10.1152/aj...		ECR, crossover	15	58.7 ± 1.4	The participants heard a prerecorded 14-minute MM using one MP3 player and earphones. The standard recording of the guided meditation included various basic components of mindfulness. There were two to three visits in the early morning.	The participants were submitted to 14 minutes of AP education, listening to a recording on the diagnosis and treatment of hypertension, using the same MP3 player and earphones, in a total of two to three visits in the early morning.	With no follow-up	1. Blood pressure (BP)	1. Significant reduction during MM: SBP (p = 0,004) DBP (p = 0,004) MAP (p = 0,001)
								2. Heart rate (HR)
								3. Muscle neural sympathetic activity (MNSA)	2. Significant heart rate reduction during the mindfulness meditation (p < 0.001)
								4. Controlled breathing (CB)
								5. Respiratory rate (RR)	3. Significant MNSA reduction during MM (p = 0.001)
									3. Significant MNSA reduction during MM (p = 0.001)
									4. The CB alone did not reduce the BP, HR or MNSA (p = 0.012)

									5. Significant RR reduction during the MM (p < 0.001)
									5. Significant RR reduction during the MM (p < 0.001)

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[1] Correspondence to:
Bruno Nunes Razzera. E-mail: brunorazzera@gmail.com