Benefits of spirituality and/or religiosity in patients with Chronic Kidney Disease: an integrative review

Bravin, Ariane Moysés; Trettene, Armando dos Santos; Andrade, Luis Gustavo Modelli de; Popim, Regina Célia

doi:10.1590/0034-7167-2018-0051

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 72 (2) • Mar-Apr 2019 • https://doi.org/10.1590/0034-7167-2018-0051 copy

Benefits of spirituality and/or religiosity in patients with Chronic Kidney Disease: an integrative review

Beneficios de la espiritualidad y/o religiosidad en pacientes renales crónicos: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Identify and analyze existing evidence regarding the benefits of spirituality and / or religiosity in patients with Chronic Kidney Disease.

Method:

Integrative review carried out through consultation of databases: Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online, US National Library of Medicine and Scopus. The following descriptors were used: chronic kidney disease, spirituality and religion. Primary articles published by December 2017 were included.

Results:

Twenty-six articles were selected, from which four thematic categories emerged: benefits as a modality of coping, perception of quality of life, mental health and improvement of renal function after transplantation.

Conclusion:

Benefits included those related to situational coping modalities, such as the strengthening of hope, social support and coping with pain; those related to mental health, such as the lower risk of suicide and fewer depressive symptoms; improvement in the perception of quality of life and in renal function after transplantation.

Descriptors:
Chronic Kidney Disease; Spirituality; Religion; Religion and Medicine; Patient-Centered Care

Article title	Authors/Country/ Publication year	Study design/ Level of Evidence	Main results/ Recommendations
Adjustment, spirituality, and health in women on hemodialysis⁽¹⁶16 Tanyi RA, Werner JS. Adjustment, spirituality, and health in women on hemodialysis. Clin Nurs Res[Internet]. 2003[cited 2018 Jan 20];12(3):229-45. Available from: http://journals.sagepub.com/doi/pdf/10.1177/1054773803253163 http://journals.sagepub.com/doi/pdf/10.1... ⁾.	Tanyi RA, Werner JS. USA. 2003.	Descriptive and correlational study (n=65 patients). Level IV.	The relationships between adjustment, spiritual well-being and self-perception of health in women with end-stage renal disease under hemodialysis were evidenced.
Religious beliefs and quality of life in an American inner-city haemodialysis population⁽¹⁷17 Ko B, Khurana U, Spencer J, Scott B, Hahn H, Hammes M. Religious beliefs and quality of life in an American inner-city haemodialysis population. Nephrol Dial Transplant[Internet]. 2007[cited 2018 Jan 20];22(10):2985-90. Available from: https://academic.oup.com/ndt/article/22/10/2985/1831289 https://academic.oup.com/ndt/article/22/... ⁾.	Ko B, Khurana A, Spencer J, Scott B, Hahn M, Hammes M. USA. 2007.	Cross-sectional study (n=112 patients). Level IV.	Patients under hemodialysis use religious/spiritual beliefs to give themselves hope, meaning and life purpose.
Spirituality in African American and Caucasian women with end-stage renal disease on hemodialysis treatment⁽¹⁸18 Tanyi RA, Werner JS. Spirituality in African American and Caucasian women with end-stage renal disease on hemodialysis treatment. Health Care Women Int[Internet]. 2007[cited 2018 Jan 20];28(2):141-54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17364977 https://www.ncbi.nlm.nih.gov/pubmed/1736... ⁾.	Tanyi RA, Werner JS. USA. 2007.	Cross-sectional study (n=58 patients). Level IV.	Benefits of religious well-being were evidenced.
Women's experience of spirituality within end-stage renal disease and hemodialysis⁽¹⁹19 Tanyi RA, Werner JS. Women's experience of spirituality within end-stage renal disease and hemodialysis. Clin Nurs Res[Internet]. 2008[cited 2018 Jan 20];17(1):32-49. Available from: http://journals.sagepub.com/doi/pdf/10.1177/1054773807311691 http://journals.sagepub.com/doi/pdf/10.1... ⁾.	Tanyi RA, Werner JS. USA. 2008.	Qualitative study (n=16 patients). Level IV.	Spirituality is of great importance and should be used to improve holistic care.
Religion and spirituality: the experience of families of children with Chronic Renal Failure⁽²⁰20 Paula ES, Nascimento LC, Rocha SM. Religião e espiritualidade: experiência de famílias de crianças com Insuficiência Renal Crônica. Rev Bras Enferm[Internet]. 2009 Jan-Feb [cited 2018 Jan 20];62(1):100-6. Available from: http://www.scielo.br/pdf/reben/v62n1/15.pdf http://www.scielo.br/pdf/reben/v62n1/15.... ⁾.	Paula ES, Nascimento LC, Rocha SM. Brazil. 2009.	Qualitative study (n=14 participants). Level IV.	Health professionals should understand the religion and spirituality of the family in the process of illness, with a view to their work in promoting health.
Existential and religious dimensions of spirituality and their relationship with health-related quality of life in chronic kidney disease⁽²¹21 Davison SN, Jhangri GS. Existential and religious dimensions of spirituality and their relationship with health-related quality of life in chronic kidney disease. Clin J Am Soc Nephrol[Internet]. 2010[cited 2018 Jan 20];5 (11):1969-76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001767/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾.	Davison SN, Jhangri GS. Canada. 2010.	Quantitative study (n=253 patients). Level IV.	The existential domain of spirituality had a greater impact on quality of life compared to measures of religiosity.
Religious/spiritual coping in people with chronic kidney diseaseundergoing hemodialysis⁽²²22 Valcanti CC, Chaves EC, Mesquita AC, Nogueira DA, Carvalho EC. Religious/spiritual coping in people with chronic kidney disease undergoing hemodialysis. Rev Esc Enferm USP[Internet]. 2012[cited 2018 Jan 20];46(4):838-45. Available from: http://www.scielo.br/pdf/reeusp/v46n4/08.pdf http://www.scielo.br/pdf/reeusp/v46n4/08... ⁾.	Valcanti CC, Chaves ECL, Mesquita AC, Nogueira DA, Carvalho EC. Brazil. 2012.	Descriptive and cross-sectional study (n=123 patients). Level IV.	Patients use coping positivelyreligious/spiritual as a coping strategy.
Religious beliefs and practices in end-stagerenal disease: implications for clinicians⁽²³23 Elliott BA, Gessert CE, Larson P, Russ TE. Religious beliefs and practices in end-stage renal disease: implications for clinicians. J Pain Symptom Manage[Internet]. 2012 Sep [cited 2018 Jan 20];44(3):400-9. Available from: https://www.sciencedirect.com/science/article/pii/S0885392412001662 https://www.sciencedirect.com/science/ar... ⁾.	Elliott BA, Gessert CE, Larson P, Russ TE. USA. 2012.	Qualitative study (n=31 patients). Level IV.	Religious beliefs brought meaning to life. The importance of religious practices (prayer, liturgy and traditions) was highlighted to keep them connected to God. Receiving visits from church members and clergy offered support.
Religiousness, mental health, and quality of life in Brazilian dialysis patients⁽²⁴24 Lucchetti G, Almeida LG, Lucchetti AL. Religiousness, mental health, and quality of life in Brazilian dialysis patients. Hemodial Int[Internet]. 2012[cited 2018 Jan 20];16(1):89-94. http://onlinelibrary.wiley.com/doi/10.1111/j.1542-4758.2011.00623.x/epdf http://onlinelibrary.wiley.com/doi/10.11... ⁾.	Lucchetti G, Almeida LG, Lucchetti AL. Brazil. 2012.	Descriptive and cross-sectional study (n=133 patients).Level IV.	Religiousness was associated with fewer depressive symptoms and better quality of life.
Investigating the action and interaction strategies that patients use to cope with peritoneal dialysis⁽²⁵25 Santos FK, Valadares GV. Investigating the action and interaction strategies that patients use to cope with peritoneal dialysis. Esc Anna Nery [Internet]. 2013[cited 2018 Jan 20];17(3):423-31. Available from: http://www.scielo.br/pdf/ean/v17n3/en_1414-8145-ean-17-03-0423.pdf http://www.scielo.br/pdf/ean/v17n3/en_14... ⁾.	Santos FK, Valadares GV. Brazil. 2013.	Qualitative study (n=8 patients). Level IV.	When knowing the strategies used in coping with DP, it will be up to the nurse to participate in this process in which the client gives meaning to this method.
The relationship between spirituality, psychosocial adjustment to illness, and health-related quality of life in patients with advanced chronic kidney disease⁽²⁶26 Davison SN, Jhangri GS. The relationship between spirituality, psychosocial adjustment to illness, and health-related quality of life in patients with advanced chronic kidney disease. J Pain Symptom Manage[Internet]. 2013[cited 2018 Jan 20];45(2):170-8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(12)00265-5 https://linkinghub.elsevier.com/retrieve... ⁾.	Davison SN, Jhangri GS.Canada. 2013.	Descriptive and cohort study (n=253 patients).Level IV.	The importance of directing psychosocial adjustment to disease and spirituality as ways of preserving or improving the quality of life of pre-dialysis and dialysis patients was evidenced.
Spiritual coping, religiosity and quality of life: a study on Muslim patients undergoing haemodialysis⁽²⁷27 Saffari M, Pakpour AH, Naderi MK, Koenig HG, Baldacchino DR, Piper CN. Spiritual coping, religiosity and quality of life: a study on Muslim patients undergoing haemodialysis. Nephrology[Internet]. 2013 [cited 2018 Jan 20];18(4):269-75. Available from: http://onlinelibrary.wiley.com/doi/10.1111/nep.12041/epdf http://onlinelibrary.wiley.com/doi/10.11... ⁾.	Saffari M, Pakpour AH, Naderi MK, Koenig HG, Baldacchino DR, Piper CN. Iran. 2013.	Descriptive cohort study (n=362 patients).Level IV.	Spiritual resources may contribute to a better quality of life and health status among patients under hemodialysis.
Quality of life/spirituality, religion and personal beliefs of adult and elderly chronic kidneypatients under hemodialysis⁽²⁸28 Rusa SG, Peripato GI, Pavarini SC, Inouye K, Zazzetta MS, Orlandi F. Quality of life/spirituality, religion and personal beliefs of adult and elderly chronic kidney patients under hemodialysis. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2018 Jan 20];22(6):911-7. Available from: http://www.scielo.br/pdf/rlae/v22n6/0104-1169-rlae-3595-2495.pdf http://www.scielo.br/pdf/rlae/v22n6/0104... ⁾.	Rusa SG, Peripato GI, Pavarini SCI, Inouye K, Zazzetta MS, Orlandi FS. Brazil. 2014.	Descriptive cross-sectional study (n=110 patients).Level IV.	Patients presented high quality of life scores, specifically in the dimensions related to spirituality, religion and personal beliefs.
Religious Wellbeing as a Predictor for Quality of Life in IranianHemodialysis Patients⁽²⁹29 Taheri Kharame Z, Zamanian H, Foroozanfar S, Afsahi S. Religious wellbeing as a predictor for quality of life in Iranian hemodialysis patients. Glob J Health Sci[Internet]. 2014 [cited 2018 Jan 20];6(4):261-9. Available from: http://www.ccsenet.org/journal/index.php/gjhs/article/view/34855/20449 http://www.ccsenet.org/journal/index.php... ⁾.	Taheri Kharame Z, Zamanian H, Foroozanfar S, Afsahi S. Iran. 2014.	Cross-sectional study (n=95 patients). Level IV.	Religious well-being should be considered as an important predictive factor for better quality of life in patients under hemodialysis.
Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study⁽³⁰30 Ottaviani AC, Souza ÉN, Drago NC, Mendiondo MS, Pavarini SC, Orlandi FS. Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study. Rev Latino-Am Enfermagem[Internet]. 2014[cited 2018 Jan 20];22(2):248-54. Available from: http://www.scielo.br/pdf/rlae/v22n2/0104-1169-rlae-22-02-00248.pdf http://www.scielo.br/pdf/rlae/v22n2/0104... ⁾.	Ottaviani AC, Souza EN, Drago NC, Mendiondo MSZ, Pavarini SCI, Orlandi FS. Brazil. 2014.	Descriptive, cross-sectional study (n=127 patients). Level IV.	Hope and spirituality should be considered in health care.
How do thai patients receiving haemodialysis cope with pain?⁽³¹31 Yodchai K, Dunning T, Savage S, Hutchinson AM, Oumtanee A. How do Thai patients receiving haemodialysis cope with pain? J Ren Care[Internet]. 2014 Sep [cited 2018 Jan 20];40(3):205-15. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jorc.12073/pdf http://onlinelibrary.wiley.com/doi/10.11... ⁾	Yodchai K, Dunning T, Savage S, Hutchinson AM, Oumtanee A. USA. 2014.	Qualitative study (n=20 patients). Level IV.	The study made it possible to understand how patients deal with pain and the importance of cultural beliefs and coping strategies and appropriate management of pain.
Relationship between mental health and spiritual wellbeing among hemodialysis patients: a correlation study⁽³²32 Martínez BB, Custódio RP. Relationship between mental health and spiritual wellbeing among hemodialysis patients: a correlation study. São Paulo Med J[Internet]. 2014 [cited 2018 Jan 20];132(1):23. Available from: http://www.scielo.br/pdf/spmj/v132n1/1516-3180-spmj-132-01-00023.pdf http://www.scielo.br/pdf/spmj/v132n1/151... ⁾.	Martínez BB, Custódio RP. Brazil. 2014.	Descriptive cross-sectional study (n= 150 patients). Level IV.	Poor mental health was associated with lower spiritual well-being.Spiritual well-being has been negatively related to stress, sleep disorders, psychosomatic complaints, and mental health.
Relation between quality of life and spirituality in chronic renal patients who conduct hemodialysis⁽³³33 Malaguti I, Manfrim PB, Santos TM, Santos DCN, Napoleão LL, Silva RCR, et al. Espiritualidade em Pacientes que realizam Hemodiálise. Medicina (Ribeirão Preto) [Internet]. 2015 [cited 2018 Jan 20];48(4):367-79. Available from: http://www.scielo.br/pdf/rlae/v22n2/pt_0104-1169-rlae-22-02-00248.pdf http://www.scielo.br/pdf/rlae/v22n2/pt_0... ⁾.	Malaguti I, Manfrim PB, Santos TM, Santos DCN, Napoleão LL, Silva RCR, et al. Brazil. 2015.	Descriptive cross-sectional study (n= 100 patients). Level IV.	Spirituality was positively related to the improvement in quality of life.
Family experience in the kidney transplant process from a living donor⁽³⁴34 Cruz JP, Colet PC, Alquwez N, Inocian EP, Al-Otaibi RS, Islam SM. Influence of religiosity and spiritual coping on health-related quality of life in Saudi haemodialysis patients. Hemodial Int[Internet]. 2017[cited 2018 Jan 20];21(1):125-32. Available from: http://onlinelibrary.wiley.com/doi/10.1111/hdi.12441/epdf http://onlinelibrary.wiley.com/doi/10.11... ⁾.	Cruz MG, Daspett C, Roza BA, Ohara CV, Horta AL. Brazil. 2015.	Qualitative study (n=4 families).Level IV.	Live donor kidney transplantation involves aspects of physical and emotional care of all involved, where spirituality is a contributing factor.
Religião no tratamento da doença renal crônica: comparação entre médicos e pacientes⁽³⁵35 Souza Jr EA, Trombini DSV, Mendonça ARA, Atzingen ACV. Religion in the treatment of chronic kidney disease: a comparison between doctors and patients. Rev Bioét [Internet]. 2015 [cited 2018 Jan 20];23(3):615-22. Available from: http://www.scielo.br/pdf/bioet/v23n3/en_1983-8034-bioet-23-3-0615.pdf http://www.scielo.br/pdf/bioet/v23n3/en_... ⁾.	Souza Júnior EA, Trombini DSV, Mendonça ARA, Von Atzingen AC. Brazil. 2015.	Qualitative study (n= 20 participants, being 10 patients and 10 doctors). Level IV.	The meaning of religion in their lives was distinct among the groups analyzed; however, both agree that religion is a beneficial factor in the patient's life.
Quality of life and associated factors in patients withchronic kidney disease on hemodialysis⁽³⁶36 Fukushima RL, Menezes AL, Inouye K, Pavarini SC, Orlandi FS. Quality of life and associated factors in patients with chronic kidney disease on hemodialysis. Acta Paul Enferm [Internet]. 2016 [cited 2018 Jan 20];29(5):518-24. Available from: http://www.scielo.br/pdf/ape/v29n5/en_1982-0194-ape-29-05-0518.pdf http://www.scielo.br/pdf/ape/v29n5/en_19... ⁾.	Fukushima RL, Menezes AL, Inouye K, Pavarini SC, Orlandi FS. Brazil. 2016.	Descriptive cross-sectional study (n= 101 patients). Level IV.	Socio-demographic and clinical factors, including spirituality, are important for improving the care of patients with Chronic Kidney Disease under hemodialysis.
Religiosity and health-related quality of life: a cross-sectional study on filipino christian hemodialysis patients⁽³⁷37 Cruz JP, Colet PC, Qubeilat H, Al-Otaibi J, Coronel EI, Suminta RC. Religiosity and health-related quality of life: a cross-sectional study on Filipino Christian hemodialysis patients. J Relig Health[Internet]. 2016 [cited 2018 Jan 20];55:895-08. Available from: https://link.springer.com/content/pdf/10.1007%2Fs10943-015-0103-9.pdf https://link.springer.com/content/pdf/10... ⁾.	Cruz JP, Colet PC, Qubeilat H, Al-Otaibi J, Coronel EI, Suminta RC. Philippines. 2016.	Descriptive cross-sectional study (n=100 patients). Level IV.	The holistic approach in treating patients under hemodialysis, with an emphasis on spiritual care, was encouraged in order to improve health as a whole.
The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand⁽³⁸38 Yodchai K, Dunning T, Savage S, Hutchinson AM. The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand. Scand J Caring Sci[Internet]. 2017 June [cited 2018 Jan 20];31(2):359-367. Available from: http://onlinelibrary.wiley.com/doi/10.1111/scs.12355/epdf http://onlinelibrary.wiley.com/doi/10.11... ⁾.	Yodchai K, Dunning T, Savage S, Hutchinson AM. USA. 2017.	Qualitative study (n=20 patients). Level IV.	Religion and spirituality provided powerful coping strategies.
Influence of spirituality on renal function of kidney transplant patients⁽³⁹39 Bravin AM, Trettene AS, Cavalcante RS, Banin VB, Padula NA, Saranholi TL, et al. Influence of spirituality on renal function of kidney transplant patients. Acta Paul Enferm[Internet]. 2017 [cited 2018 Jan 20];30(5):504-11. Available from: http://www.scielo.br/pdf/ape/v30n5/en_0103-2100-ape-30-05-0504.pdf http://www.scielo.br/pdf/ape/v30n5/en_01... ⁾.	Bravin AM, Trettene AS, Cavalcante RS, Banin VB, Padula NA, Saranholi TL, et al. Brazil. 2017.	Descriptive cross-sectional study (n=81 patients). Level IV.	More spiritual patients had better renal function during the course of a year of transplantation. This effect was independent.
Factors associated with the quality of life of patients undergoing hemodialysis⁽⁴⁰40 Gesualdo GD, Menezes ALC, Rusa SG, Napoleão AA, Figueiredo RM, Melhado VR, et al. Factors associated with the quality of life of patients undergoing hemodialysis. Texto Contexto Enferm[Internet]. 2017 [cited 2018 Jan 20];26(2):e05600015. Available from: http://www.scielo.br/pdf/tce/v26n2/0104-0707-tce-26-02-e05600015.pdf http://www.scielo.br/pdf/tce/v26n2/0104-... ⁾.	Gesualdo GD, Menezes ALC, Rusa SG, Napoleão AA, Figueiredo RM, Melhado VR, et al. Brazil. 2017.	Descriptive cross-sectional study (n=101 patients). Level IV.	Religiousness, among others, had a positive influence on health-related quality of life.
The influence of spirituality and religiousness on suicide risk and mental health of patients undergoing hemodialysis⁽⁴¹41 Loureiro ACT, Coelho MCR, Coutinho FB, Borges LH, Lucchetti G. The influence of spirituality and religiousness on suicide risk and mental health of patients undergoing hemodialysis. Compr Psychiatry[Internet]. 2017[cited 2018 Jan 20];80:39-45. Available from: https://www.sciencedirect.com/science/article/pii/S0010440X17301955 https://www.sciencedirect.com/science/ar... ⁾.	Loureiro ACT, Rezende Coelho MC, Coutinho FB, Borges LH, Lucchetti G. Brazil. 2017.	Descriptive cross-sectional study (n=264 patients). Level IV.	In short, spiritual beliefs were associated with lower risk of suicide and better mental health among patients under hemodialysis.

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[1] Corresponding Author: Armando dos Santos Trettene E-mail: armandotrettene@usp.br