Dialysis-Related Factors Affecting Activities of Daily Living in Patients on Hemodialysis in Erbil City

  • Sideeq Sadir Ali Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq
  • Vian Afan Naqshbandi Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq
  • Shihab Ahmed Sedeeq Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq
Keywords: Activities, Daily living, Hemodialysis patient, Complication, Independency, Dependency


Background and objective: Hemodialysis procedure is one of the important replacement therapies for patients with renal failure, Maintenance hemodialysis associated with the many complications that have a significant role on activity of daily living. The aim of the present study is to find out the factors affecting activities of daily living among patients with maintenance hemodialysis in Erbil City.

Methods: This cross-sectional study was conducted on 268 patients on maintenance hemodialysis for more than 2 months and at least 2 time per a week at 2 dialysis centers in Erbil City from Decembers 2019 to April 2020, Activity of Daily Living and complications from hemodialysis procedure questionnaires was used for collecting data then analyzed through descriptive statistical approach, involved descriptive statistics, including frequency, percentage and chi-square tests.

Results: Majority of the study sample their age was above 51 years old, male, able to read and write, middle income and lives from urban area. Concerning the chronic diseases, most of them had hypertension. Majority of the study sample had complications associated with hemodialysis like: headache and hypotension and half percentage of them had back pain. Highly significant association was found between dependent activity daily living and some socio economic and clinical variables, as well as a significant association was found between dependent activity daily living and some hemodialysis complications with (p<0.001).

Conclusion: depending on the result of the present study the researchers concluded that the Hemodialysis patients were complained from other chronic diseases, hemodialysis complications and low level of activities of daily living. The complications of hemodialysis treatment were significantly affected on dependency of Activity of Daily Living. So the patients need to more education and nursing care to improve their activity and free from complications.




[1] Smeltzer SO, Bare BG. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 10th ed. Philadelphia: JB Lippincott; 2003. P. 1289.
[2] Rhoades, RA, Tanner, GA. Medical Physiology. 2nd ed. Lippincott-Raven. Part VI Renal Physiology and Body Fluids, Chapter 23, Kid-ney Function; 2003. P.378.
[3] Shabila NP, Alhagbaker JM, Ali SS. Daily living activities among geriatric residents at geriatric homes in Erbil and Sulaimaniyah cities, Kurdistan Region. Zanco Journal of Medical Sciences. 2017; 21(1):1619-28. Available from: https://doi.org/10.15218/zjms.2017.012.
[4] Mlinaca ME, Fengb MC. Assessment of Activities of Daily Living, Self-Care, and Independence. Archives of Clinical Neuro-psychology. 2016;506–516. Available from: DOI:10.1093/arclin/acw049.
[5] Williams LS, Hopper PD. Understanding Medical-Surgical Nursing. 2nd ed. USA, Philadelphia: F.A. Davis Company Publish-ing; 2003. p. 645-7.
[6] Kopple JD, Kim JC, Shapiro BB, Zhang M, Li Y, Porszasz J et al. Factors affecting daily physical activity and physical performance in maintenance dialysis patients. Journal of Renal Nutrition. 2018; 25(2): 217–22. Available from: DOI:10.1053/j.jrn.2014.10.017.
[7] Atashpeikar S, Jalilazar T, Heidarzadeh M. Self-care ability in hemodialysis patients. Journal of Caring Sciences. 2012 May; 1(1): 31-5.
[8] Johansen KL, Chertow GM, Ng AV, Mulligan K, Carey S, Schoenfeld PY, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney International. 2000 1st June; 57(6):2564-70. Available from: DOI: 10.1046/j.1523-1755.2000.00116.x.
[9] Shukla B, Kaur A. Study to assess knowledge and attitude regarding self-care among patients undergoing hemodialysis in selected hospital of Punjab, India. JARS International Research Journal. 2012; 2 (1): 3-4.
[10] Feinstein AR, Josephy BR, Wells CK. Scientific and clinical problems in indexes of functional disability. Annals of Internal Medicine. 1986 Sep 1; 105 (3):413-20.
[11] Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969 1st October; 9 (3): 179-86.
[12] Singh S, Multani NK, Verma SK. Development and validation of geriatric assessment tools: A preliminary report from Indi-an population. Journal of Exercise Science and Physiotherapy. 2007 Dec; 3 (2):103.
[13] Watanabe T, Kutsuna T, Yoneki K, Harada M, Shimoda T, Matsunaga Y, et al. Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis. Renal Replacement Therapy. 2018 Dec 1; 4 (1): 1-8. Available from: DOI 10.1186/s41100-018-0146-y.
[14] Kutsuna T, Isobe Y, Watanabe T, Matsunaga Y, Kusaka S, Kusumoto Y, et al. Comparison of difficulty with activities of daily living in elderly adults undergoing hemodialysis and community-dwelling individuals: a cross-sectional study. Renal Replacement Therapy. 2019 Dec 1; 5 (1):50. Available from: https://doi.org/10.1186/s4110-019-0250-7.
[15] Jagannathan R, Ziolkowski SL, Weber MB, Cobb J, Pham N, Long J, et al. Physical activity promotion for patients transitioning to dialysis using the “Exercise is Medicine” framework: a multi-center randomized pragmatic trial (EIM-CKD trial) protocol. BMC Nephrology. 2018 Dec 1; 19 (1): 230. Available from: https://doi.org/10.1186/s12882-018-1032-0.
[16] Anding K, Bär T, Trojniak-Hennig J, Kuchinke S, Krause R, Rost JM, et al. A structured exercise programme during hemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence. BMJ Open. 2015 Aug 1; 5 (8):e008709. Available from: DOI:10.1136/bmjopen-2015-008709.
[17] Kutner NG, Zhang R, Allman RM, Bowling CB. Correlates of ADL difficulty in a large hemodialysis cohort. Hemodialysis International. 2014 Jan; 18 (1):70-7. Available from: DOI:10.1111/hdi.12098.
[18] Julius M, Hawthorne VM, Carpentier-Alting P, Kneisley J, Wolfe RA, Port FK. Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates. American Journal of Kidney Diseases. 1989 Jan 1; 13 (1):61-9.
[19] Painter P, Marcus RL. Assessing physical function and physical activity in patients with CKD. Clinical Journal of the American Society of Nephrology. 2013 May 7; 8 (5):861-72. Available from: DOI: 10.2215/CJN.06590712.
[20] Cook WL, Jassal SV. Functional dependencies among the elderly on hemodialysis. Kidney International. 2008 Jun 1; 73 (11):1289-95. Available from: DOI:10.1038/ki.2008.62.
[21] Mohamed SK, El-Fouly YA, El-Deeb MA. Im-pact of a designed self-care program on selected outcomes among patients undergoing hemodialysis. International Journal of Research in Applied. 2016; 4 (5):73-90.
[22] Timby BK, Smith NE. Introductory medical-surgical nursing. 10th ed. Lippincott Williams & Wilkins: 2010; P. 931.
[23] Rahimi F, Oskouie F, Naser O, Sanandji ME, Gharib A. The effect of self-care on patients undergoing hemodialysis in the Sanandaj Hospitals affiliated to Kurdistan University of Medical Sciences in 2016. Bali Medical Journal. 2017 Jan 1; 6 (3):684-9. Available from: DOI:10.15562/bmj.
[24] McCaleb A, Cull VV. Sociocultural influ-ences and self-care practices of middle adolescents. Journal of Pediatric Nursing. 2000 Feb 1; 15(1):30-5.
[25] Caplin B, Kumar S, Davenport A. Patients' perspective of hemodialysis-associated symptoms. Nephrology Dialysis Transplantation. 2011 1st August;26(8):2656-63. Available from: DOI: 10.1093/ndt/gfq763.
[26] Singh RG, Singh S, Rathore SS, Choudhary TA. Spectrum of intradialytic complications during hemodialysis and its management: a single-center experience. Saudi Journal of Kidney Diseases and Transplantation. 2015 Jan 1; 26 (1):168.
[27] Gela D, Mengistu D. Self-management and associated factors among patients with end-stage renal disease undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia. International Journal of Nephrology and Renovascular Disease. 2018; 11:329. Available from: http://dx.doi.org/10.2147/IJNRD.S184671.
[28] Minn WW. Enhancing patient safety in hemodialysis nursing care practice among nurses in the renal unit at the Defence Services General Hospital: a best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports. 2014 Sep 1; 12 (9):467-88. Available from: DOI: 10.11124/jbisrir-2014-1368.
[29] Xue H, Ix JH, Wang W, Brunelli SM, Lazarus M, Hakim R, et al. Hemodialysis access usage patterns in the incident dialysis year and associated catheter-related complications. American Journal of Kidney Diseases. 2013 Jan 1; 61(1):123-30. Available from: http://dx.doi.org/10.1053/j.ajkd.2012.09.006.
[30] Johansen KL, Chertow GM, Kutner NG, Dalrymple LS, Grimes BA, Kaysen GA. Low level of self-reported physical activity in ambulatory patients new to dialysis Kidney International. 2010 Dec 1; 78(11):1164-70. Available from: DOI:10.1038/ki.2010.312.
[31] Stack AG, Murthy B. Exercise and limitations in physical activity levels among new dialysis patients in the United States: an epidemiologic study. Annals of Epidemiology. 2008 Dec 1; 18 (12):880-8.
[32] Na L, Streim JE. Psychosocial well-being associated with activity of daily living stages among community-dwelling older adults. Gerontology and Geriatric Medicine. 2017 Mar 21; 3 (1): 1-13. Available from: doi.10.1177/23337214177000.
[33] Yu F, Chen Y, Mathiason MA, Wan Q, Lin FV. Cognitive and physical factors affecting daily function in Alzheimer's disease: A cross-sectional analysis. Nursing & Health Sciences. 2019 Mar; 21(1):14-20. Available from: DOI: 10.1111/nhs.12426.
[34] Aucella F, Battaglia Y, Bellizzi V, Bolignano D, Capitanini A, Cupisti A. Physical exercise programs in CKD: lights, shades and perspectives: a position paper of the “Physical Exercise in CKD Study Group” of the Italian Society of Nephrology. Journal of Nephrology. 2015 Apr 1;28 (2):143-50. Available from: DOI 10.1007/s40620-014-0169-6.
[35] Mollaoglu M. Fatigue in people undergoing hemodialysis. Dialysis & Transplantation. 2009 Jun; 38 (6):216-20.
[36] Muehrer RJ, Schatell D, Witten B, Gangnon R, Becker BN, Hofmann RM. Factors affecting employment at initiation of dialysis. Clinical Journal of the American Society of Nephrology. 2011 Mar 1; 6 (3):489-96. Available from: DOI: 10.2215/CJN.02550310.
[37] Hallab A, Wish JB. Employment among patients on dialysis: An unfulfilled promise. Clinical Journal of the American Society of Nephrology. 2018 January 18; 13 (1): 1-2. Available from: DOI: 10.2215/CJN.13491217.
[38] Bağ E, Mollaoğlu M. The evaluation of self-care and self-efficacy in patients undergoing hemodialysis. Journal of Evaluation in Clinical Practice. 2010 Jun; 16 (3):605-10. Available from:DOI:10.1111/j.1365-2753.2009.01214.x.
[39] Kamble DS, Shinde MB. Factors Affecting Quality of Life among Hemodialysis Patients. International Journal of Science and Research. 2015; 6(1):572-6.
[40] Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Primary care: Clinics in office practice. 2008 Jun 1; 35 (2):329-44. Available from: DOI:10.1016/j.pop.2008.01.008.
[41] Algarni RS. Exploring the Concept of Health-related Quality of Life for Patients with End-stage Renal Disease on Haemodialysis in the Eastern Region of Saudi Arabia. (Doctoral dissertation). The University of Manchester (United Kingdom)). 2014. Ac-cessed: 10th February 2020. Available from: https://www.semanticscholar.org/paper/Exploring-the-concept-of-health-related-quality-of-Algarni/ef304884f6e87594bf6c00509c3b10d5d3b1e4a2
[42] Gutman, RA, Stead, WW, Robinson, RR. Physical activity and employment status of patients on maintenance dialysis. New England Journal of Medicine. 1981 Feb 5; 304 (6):309-13.
[43] Anees M, Hameed F, Mumtaz A, Ibrahim M, Saeed KM. Dialysis-related factors affecting quality of life in patients on hemodialysis. Iranian Journal of Kidney Diseases. 2011 Jun; 5 (1):329-44.
[44] Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney International. 2000 Jul 1; 58 (1):353-62.
[45] Mousa I, Ataba R, Al-Ali K, Alkaiyat A, Sa’ed HZ. Dialysis-related factors affecting self-efficacy and quality of life in patients on hemodialysis: a cross-sectional study from Palestine. Renal Replacement Thera-py. 2018 Dec; 4 (1):21. Available from: https://doi.org/10.1186/s41100-018-0162-y.
[46] Morfin JA, Fluck RJ, Weinhandl ED, Kansal S, McCullough PA, Komenda P. Intensive hemodialysis and treatment complications and tolerability. American Journal of Kidney Diseases. 2016 Nov 1; 68 (5):S43-50. Available from: http://dx.doi.org/10.1053/j.ajkd.2016.05.021.
[47] Schrier RW. Diseases of the Kidney & Uri-nary Tract. 8th ed. Volume 1. Lippincott Williams & Wilkins; 2007. Chapter 100. P. 2649-69.
[48] Alhajim SA. Assessment of the quality of life in patients on hemodialysis in Iraq. Eastern Mediterranean Health Journal. 2017 Jan 1; 23 (12):815-20. Available from: https://doi.org/10.26719/2017.23.12.815
[49] Davenport A. Intradialytic complications during hemodialysis. Hemodialysis International. 2006 Apr; 10 (2):162-7.
[50] Asgari MR, Asghari F, Ghods AA, Ghorbani R, Motlagh NH, Rahaei F. Incidence and severity of nausea and vomiting in a group of maintenance hemodialysis patients. Journal of Renal Injury Prevention. 2017; 6 (1):49. Available from: DOI: 10.15171/jrip.2017.09.
[51] Mehmood Y, Ghafoor S, Ashraf MI, Riaz H, Atif SR, Saeed M. Intradialytic complications found in patients at a tertiary care hospital. Austin Journal of Pharmacology and Therapeutics. 2016; 4 (1):107.
How to Cite
Ali, S., Naqshbandi, V., & Sedeeq, S. (2021). Dialysis-Related Factors Affecting Activities of Daily Living in Patients on Hemodialysis in Erbil City. Erbil Journal of Nursing and Midwifery, 4(1), 1 - 14. https://doi.org/10.15218/ejnm.2021.01
Original Articles