Document Type : Original Article
Authors
1 Department of Nursing, School of Nursing and Midwifery, Tehran Medical Branch, Islamic Azad University, Tehran
2 Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Hemodialysis patients have lower quality of life and one of the ways to improve
their quality of life is providing self‑care education to them using some models including self‑care
model. This study aimed to determine and evaluate the effects of using self‑care model on
health and quality of life outcomes in hemodialysis patients. Materials and Methods: This was
a quasi‑experimental study conducted in 2012 on the patients who were referred to a military
hospital in Tehran, Iran to be treated with hemodialysis. All 32 patients referred to this hospital in
2012 were selected and studied. Required data were collected using the Short Form‑36 (SF‑36)
standard questionnaire and a researcher‑made questionnaire. The educational intervention was
implemented using self‑care model. Collected data were analyzed using SPSS for Windows
version 18.0 and some statistical tests including paired samples t‑test, Wilcoxon and McNemar
tests. Results: The results showed that the mean and standard deviation (SD) of patients’
parameters including weight and blood pressure improved significantly after the educational
intervention compared to before the intervention (P < 0.001). Also, all dimensions of the quality
of life of hemodialysis patients, including physical function, role physical, bodily pain, general
health, vitality, social function, mental health, and role emotional improved compared to those
before the intervention (P < 0.001). Conclusion: Implementing the self‑care model increased
the quality of life of hemodialysis patients. Therefore, the use of this model in hemodialysis
patients is recommended.
Keywords
1. Burrows‑Hudson S. Chronic kidney disease: An overview: Early
and aggressive treatment is vital. Am J Nurs 2005;105:40‑9.
2. Mahdavi‑Mazdeh M, Heidary Rouchi A, Norouzi S, Aghighi M,
Rajolani H, Ahrabi S. Renal replacement therapy in Iran. Urol J
2007;4:66‑70.
3. Modi G, Jha V. The incidence of end‑stage renal disease in India:
A population‑based study. Kidney Int 2006;70:2131‑3.
4. Seck SM. Issues of renal replacement therapy in elders living
low‑income African countries. Nephrourol Mon 2012;4:648‑9.
5. Smyth A. End‑stage renal disease and renal replacement therapy
in older patients. Nephrourol Mon 2012;4:425‑30.
6. Lessan‑Pezeshki M, Rostami Z. Contributing factors in health‑related
quality of life assessment of ESRD patients: A single center study.
Int J Nephrol Urol 2009;1:129‑136.
7. Maffei S, Savoldi S, Triolo G. When Should Commence
Hemodialysis: Focusing on the Prehemodialysis Condition.
Nephrourol Mon 2013;5:723‑7.
8. Bruce MA, Beech BM, Crook ED, Sims M, Griffith DM, Simpson SL,
et al. Sex, Weight Status, and Chronic Kidney Disease Among
African Americans: The Jackson Heart Study. J Investig Med
2013;61:701‑7.
9. Ricardo AC, Madero M, Yang W, Anderson C, Menezes M,
Fischer MJ, et al. Adherence to a healthy lifestyle and all‑cause
mortality in CKD. Clin J Am Soc Nephrol 2013;8:602‑9.
10. Levey AS, Coresh J. Chronic kidney disease. Lancet
2012;379:165‑80.
11. Aghighi M, Mahdavi‑Mazdeh M, Zamyadi M, Heidary Rouchi A,
Rajolani H, Nourozi S. Changing epidemiology of end‑stage renal
disease in last 10 years in Iran. Iran J Kidney Dis 2009;3:192‑6.
12. Fauci AS. Harrison’s principles of internal medicine. New York:
McGraw‑Hill Medical Publication; 2008.
13. Pounds LL, TeodorescuVJ. Chronic kidney disease and hemodialysis
access in women. J Vasc Surg 2013;57:49S‑53.
14. Fukuhara S, Lopes AA, Bragg‑Gresham JL, Kurokawa K, Mapes DL,
Akizawa T, et al. Health‑related quality of life among hemodialysis
patients on three continents: The Hemodialysis Outcomes and
Practice Patterns Study. Kidney Int 2003;64:1903‑10.
15. Moreiras‑Plaza M, Blanco‑García R, Cossio‑Aranibar CR,
Rodriguez‑Goyanes G. Assessment of health‑related quality of
life: The cinderella of peritoneal hemodialysis? Int J Nephrol
2011;2011:1‑8
16. Mapes DL, Lopes AA, Satayathum S, Mccullough KP, Goodkin DA,
Locatelli F, et al. Health‑related quality of life as a predictor of
mortality and hospitalization: The Hemodialysis Outcomes and
Practice Patterns Study (DOPPS). Kidney Int 2003;64:339‑49.
17. Sørensen V, Mathiesen E, Watt T, Bjorner J, Andersen MV,Feldt‑Rasmussen B. Diabetic patients treated with hemodialysis:
Complications and quality of life. Diabetologia 2007;50:2254‑62.
18. Allender JA, Spradley BW. Community health nursing: Promoting
and protecting the public’s health: Lippincott williams and wilkins;
2005. p 1‑945.
19. Cohen JJ. Collaborative care: A new model for a new century. Acad
Med 2000;75:107‑12.
20. Dwight CA, Bispham BZ, Callen LJ, Brady K, Chonchol M,
Spiegel DM. A collaborative practice model for the care of
hemodialysis patients: Assessment of outcomes. Hemodial
Transplant 2002;31:287.
21. Mohammadi I. Designing a Collaborative care model for the control
of high blood pressure. Tehran: Tarbiat Modares University; 2002.
22. Merkus MP, Jager KJ, Dekker FW, Boeschoten EW, Stevens P,
Krediet RT. Quality of life in patients on chronic hemodialysis:
Self‑assessment 3 months after the start of treatment. Am J Kidney
Dis 1997;29:584‑92.
23. Manns B, Johnson J, Taub K, Mortis G, Ghali W, Donaldson C.
Quality of life in patients treated with hemodialysis or peritoneal
hemodialysis: What are the important determinants? Clin Nephrol
2003;60:341‑51.
24. Malkian L. The study of self care self efficacy and its relationship to
quality of life in hemodialysis patients of pastor hospital in the city
of Bam 2013. Iran, Kerman: Kerman University of Medical Sciences;
2013.
25. Heidarzadeh M, Atashpeikar S, Jalilazar T. Relationship between
quality of life and self‑care ability in patients receiving hemodialysis.
Iran J Nurs Midwifery Res 2010;15:71.
26. Masoudi R, Mohammadi A, Nabavi M, Ahmadi F. The effect of
self‑care program based on Orem’s model on physical dimension
of quality of life in multiple sclerosis patients. J Shahrekord Univ
Med Sci 2008;10:21‑9.
27. Tsay SL, Lee YC. Effects of an adaptation training programme for
patients with end-stage renal disease. J Adv Nurs 2005;50:39‑46.
28. Tsay SL, Healstead M. Self‑care self‑efficacy, depression, and quality
of life among patients receiving hemodialysis in Taiwan. Int J Nurs
Stud 2002;39:245‑51.
29. Baraz S, Mohammadi E, Broumand B. The effect of self‑care
educational program on decreasing the problems and improving
the quality of life of hemodialysis patients. Hayat 2005;11:63‑70.
30. Pakpour AH, Saffari M, Yekaninejad MS, Panahi D, Harrison AP,
Molsted S. Health‑related quality of life in a sample of Iranian
patients on hemodialysis. Iran J Kidney Dis 2010;4:50‑9.
31. Moattari M, Ebrahimi M, Sharifi N, Rouzbeh J. The effect of
empowerment on the self‑efficacy, quality of life and clinical
and laboratory indicators of patients treated with hemodialysis:
A randomized controlled trial. Health Qual Life Outcomes
2012;10:115.
32. Klang B, Björvell H, Clyne N. Prehemodialysis education helps
patients choose hemodialysis modality and increases diseasespecific knowledge. J Adv Nurs 1999;29:869‑76.
33. Corbin JM, Strauss A. A nursing model for chronic illness
management based upon the trajectory framework. Res Theory
Nurs Pract 1991;5:155‑74.
34. Kristjanson LJ, Tamblyn R, Kuypers JA. A model to guide
development and application of multiple nursing theories. J Adv
Nurs 2006;12:523‑9.
35. Sweeney NM. A concept analysis of personal knowledge:
Application to nursing education. J Adv Nurs 2008;20:917‑24.
36. Azadi F, Mohammadi E. Evaluation of partnership care model
on quality of life in patients with coronary disease. Nurs Surv J
2007;1:23‑9.
37. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short
Form Health Survey (SF‑36): Translation and validation study of
the Iranian version. Qual Life Res 2005;14:875‑82.
38. Ware Jr JE, Gandek B. Overview of the SF‑36 health survey and
the international quality of life assessment (IQOLA) project. J Clin
Epidemiol 1998;51:903‑12.
39. Osthus TB, von der Lippe N, Ribu L, Rustøen T, Leivestad T.
Health‑related quality of life and all‑cause mortality in patients with
diabetes on dialysis. BMC Nephrol 2012;13:78.
40. Maor Y, King M, Olmer L, Mozes B. A comparison of three measures:
The time trade‑off technique, global health‑related quality of life and
the SF‑36 in hemodialysis patients. J Clin Epidemiol 2001;54:565‑70.
41. King CR, Hinds PS. Quality of life: From nursing and patient
perspectives. United States: Jones and Bartlett Learning; 2011.
42. Rostami Z, Einollahi B, Lessan‑Pezeshki M, Soleimani Najaf Abadi A,
Mohammadi Kebar S, Shahbazian H, et al. Health‑Related Quality
of Life in Hemodialysis Patients: An Iranian Multi‑Center Study.
Nephrourol Mon 2013;5:901‑12.
43. Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development
of the kidney disease quality of life (KDQOLTM) instrument. Qual
Life Res 1994;3:329‑38.
44. Mau LW, Chiu HC, Chang PY, Hwang SC, Hwang SJ. Health‑related
quality of life taiwanese hemodialysis patients: Effects of
hemodialysis modality. Kaohsiung J Med Sci 2008;24:453‑60.
45. Cleary J, Drennan J. Quality of life of patients on haemohemodialysis
for end-stage renal disease. J Adv Nurs 2005;51:577‑86.
46. Molsted S, Prescott L, Heaf J, Eidemak I. Assessment and clinical
aspects of health‑related quality of life in hemodialysis patients
and patients with chronic kidney disease. Nephron Clin Pract
2007;106:c24‑33.
47. Fujisawa M, Ichikawa Y, Yoshiya K, Isotani S, Higuchi A, Nagano S,
et al. Assessment of health‑related quality of life in renal transplant
and hemodialysis patients using the SF‑36 health survey. Urology
2000;56:201‑6.
48. Diaz‑Buxo JA, Lowrie EG, Lew NL, Zhang H, Lazarus JM. Quality‑of‑life
evaluation using Short Form 36: Comparison in hemodialysis and
peritoneal dialysis patients. Am J Kidney Dis 2000;35:293‑300.
49. Brunner LS, Smeltzer SCC, Bare BG, Hinkle JL, Cheever KH. Brunner
and Suddarth’s Textbook of Medical‑surgical Nursing: Lippincott
williams and wilkins;2010. p 1‑2240.
50. Iliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM,
Singer MA, et al. Quality of sleep and health-related quality of life
in haemodialysis patients. Nephrol Dial Transplant 2003;18:126‑32.
51. Sadeghi H, Azizzadeh Forouzi M, Haghdust AA, Mohammad AS.
Effect of implementing continuous care model on sleep quality of
hemodialysis patients. Crit Care Nurs 2009;3:13‑8.
52. Braz S. Comparison two methods of verbal and non verbal education
on quality of life in hemodyialisis patients. Tehran: Tarbiat Modares
University; 2004.
53. Lugon JR. Uremic pruritus: A review. Hemodial Int 2005;9:180‑8.
54. Jennen C, Uhlenbruck G. Exercise and life‑satisfactory‑fitness:
Complementary strategies in the prevention and rehabilitation of
illnesses. Evid Based Complement Alternat Med 2004;1:157‑65.
55. Salehi S. Effect of self‑care education on labratory indicators and
Overweight in two dialysis sessions. Tehran: Iran University of
Medical Sciences; 2002.
56. Sarafi M. The effect of self‑care education on knowledge, attitude
and pphysical conditions of patients treated with hemodialysis.
Tehran: Shahid Beheshti University of Medical Sciences; 1994.
57. Ashvandi K. The effect of self‑care education on reducing the
problems of hemodialysis patients. Tehran: Tarbiat Modares
University; 1994.
58. Kozlowska L, Rosolowska H, Rydzewski A. Low protein diet causes
a decrease in serum concentrations of leptin and tumour necrosis
factor-alpha in patients with conservatively treated chronic renal
failure. Nephrology 2004;9:319‑24.
59. Salehi S. The effect of diet education on the laboratory parameters
and weight gain between dialysis sessions. Tehran: Iran university
of Medical Sciences; 2000.
60. Shichiri M, Nishio Y, Ogura M, Marumo F. Effect of low‑protein,
very‑low‑phosphorus diet on diabetic renal insufficiency with
proteinuria. Am J Kidney Dis 1991;18:26‑32.
61. Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG.
Prevalence, treatment, and control of hypertension in chronic
hemodialysis patients in the United States. Am J Med 2003;115:291‑7.
62. Oka M, Tomura S, Takahashi H, Tsuchiya S. Treatment regimen adherence and life‑satisfaction in hemodialysis patients:
A covariance structure analysis. Clin Exp Nephrol 1999;3:
198‑206.
63. Durose CL, Holdsworth M, Watson V, Przygrodzka F. Knowledge
of dietary restrictions and the medical consequences of
noncompliance by patients on hemodialysis are not predictive of
dietary compliance. J Am Diet Assoc 2004;104:35‑41.
64. Rahimi A. Effect of continuous care model on quality of life
in hemodialysis patients of Tehran. Tehran: Tarbiat Modares
University; 2004.
65. Levendoğlu F, Altintepe L, Okudan N, Uğurlu H, Gökbel H, Tonbul Z,
et al. A twelve week exercise program improves the psychological
status, quality of life and work capacity in hemodialysis patients.
J Nephrol 2004;17:826‑32.
and aggressive treatment is vital. Am J Nurs 2005;105:40‑9.
2. Mahdavi‑Mazdeh M, Heidary Rouchi A, Norouzi S, Aghighi M,
Rajolani H, Ahrabi S. Renal replacement therapy in Iran. Urol J
2007;4:66‑70.
3. Modi G, Jha V. The incidence of end‑stage renal disease in India:
A population‑based study. Kidney Int 2006;70:2131‑3.
4. Seck SM. Issues of renal replacement therapy in elders living
low‑income African countries. Nephrourol Mon 2012;4:648‑9.
5. Smyth A. End‑stage renal disease and renal replacement therapy
in older patients. Nephrourol Mon 2012;4:425‑30.
6. Lessan‑Pezeshki M, Rostami Z. Contributing factors in health‑related
quality of life assessment of ESRD patients: A single center study.
Int J Nephrol Urol 2009;1:129‑136.
7. Maffei S, Savoldi S, Triolo G. When Should Commence
Hemodialysis: Focusing on the Prehemodialysis Condition.
Nephrourol Mon 2013;5:723‑7.
8. Bruce MA, Beech BM, Crook ED, Sims M, Griffith DM, Simpson SL,
et al. Sex, Weight Status, and Chronic Kidney Disease Among
African Americans: The Jackson Heart Study. J Investig Med
2013;61:701‑7.
9. Ricardo AC, Madero M, Yang W, Anderson C, Menezes M,
Fischer MJ, et al. Adherence to a healthy lifestyle and all‑cause
mortality in CKD. Clin J Am Soc Nephrol 2013;8:602‑9.
10. Levey AS, Coresh J. Chronic kidney disease. Lancet
2012;379:165‑80.
11. Aghighi M, Mahdavi‑Mazdeh M, Zamyadi M, Heidary Rouchi A,
Rajolani H, Nourozi S. Changing epidemiology of end‑stage renal
disease in last 10 years in Iran. Iran J Kidney Dis 2009;3:192‑6.
12. Fauci AS. Harrison’s principles of internal medicine. New York:
McGraw‑Hill Medical Publication; 2008.
13. Pounds LL, TeodorescuVJ. Chronic kidney disease and hemodialysis
access in women. J Vasc Surg 2013;57:49S‑53.
14. Fukuhara S, Lopes AA, Bragg‑Gresham JL, Kurokawa K, Mapes DL,
Akizawa T, et al. Health‑related quality of life among hemodialysis
patients on three continents: The Hemodialysis Outcomes and
Practice Patterns Study. Kidney Int 2003;64:1903‑10.
15. Moreiras‑Plaza M, Blanco‑García R, Cossio‑Aranibar CR,
Rodriguez‑Goyanes G. Assessment of health‑related quality of
life: The cinderella of peritoneal hemodialysis? Int J Nephrol
2011;2011:1‑8
16. Mapes DL, Lopes AA, Satayathum S, Mccullough KP, Goodkin DA,
Locatelli F, et al. Health‑related quality of life as a predictor of
mortality and hospitalization: The Hemodialysis Outcomes and
Practice Patterns Study (DOPPS). Kidney Int 2003;64:339‑49.
17. Sørensen V, Mathiesen E, Watt T, Bjorner J, Andersen MV,Feldt‑Rasmussen B. Diabetic patients treated with hemodialysis:
Complications and quality of life. Diabetologia 2007;50:2254‑62.
18. Allender JA, Spradley BW. Community health nursing: Promoting
and protecting the public’s health: Lippincott williams and wilkins;
2005. p 1‑945.
19. Cohen JJ. Collaborative care: A new model for a new century. Acad
Med 2000;75:107‑12.
20. Dwight CA, Bispham BZ, Callen LJ, Brady K, Chonchol M,
Spiegel DM. A collaborative practice model for the care of
hemodialysis patients: Assessment of outcomes. Hemodial
Transplant 2002;31:287.
21. Mohammadi I. Designing a Collaborative care model for the control
of high blood pressure. Tehran: Tarbiat Modares University; 2002.
22. Merkus MP, Jager KJ, Dekker FW, Boeschoten EW, Stevens P,
Krediet RT. Quality of life in patients on chronic hemodialysis:
Self‑assessment 3 months after the start of treatment. Am J Kidney
Dis 1997;29:584‑92.
23. Manns B, Johnson J, Taub K, Mortis G, Ghali W, Donaldson C.
Quality of life in patients treated with hemodialysis or peritoneal
hemodialysis: What are the important determinants? Clin Nephrol
2003;60:341‑51.
24. Malkian L. The study of self care self efficacy and its relationship to
quality of life in hemodialysis patients of pastor hospital in the city
of Bam 2013. Iran, Kerman: Kerman University of Medical Sciences;
2013.
25. Heidarzadeh M, Atashpeikar S, Jalilazar T. Relationship between
quality of life and self‑care ability in patients receiving hemodialysis.
Iran J Nurs Midwifery Res 2010;15:71.
26. Masoudi R, Mohammadi A, Nabavi M, Ahmadi F. The effect of
self‑care program based on Orem’s model on physical dimension
of quality of life in multiple sclerosis patients. J Shahrekord Univ
Med Sci 2008;10:21‑9.
27. Tsay SL, Lee YC. Effects of an adaptation training programme for
patients with end-stage renal disease. J Adv Nurs 2005;50:39‑46.
28. Tsay SL, Healstead M. Self‑care self‑efficacy, depression, and quality
of life among patients receiving hemodialysis in Taiwan. Int J Nurs
Stud 2002;39:245‑51.
29. Baraz S, Mohammadi E, Broumand B. The effect of self‑care
educational program on decreasing the problems and improving
the quality of life of hemodialysis patients. Hayat 2005;11:63‑70.
30. Pakpour AH, Saffari M, Yekaninejad MS, Panahi D, Harrison AP,
Molsted S. Health‑related quality of life in a sample of Iranian
patients on hemodialysis. Iran J Kidney Dis 2010;4:50‑9.
31. Moattari M, Ebrahimi M, Sharifi N, Rouzbeh J. The effect of
empowerment on the self‑efficacy, quality of life and clinical
and laboratory indicators of patients treated with hemodialysis:
A randomized controlled trial. Health Qual Life Outcomes
2012;10:115.
32. Klang B, Björvell H, Clyne N. Prehemodialysis education helps
patients choose hemodialysis modality and increases diseasespecific knowledge. J Adv Nurs 1999;29:869‑76.
33. Corbin JM, Strauss A. A nursing model for chronic illness
management based upon the trajectory framework. Res Theory
Nurs Pract 1991;5:155‑74.
34. Kristjanson LJ, Tamblyn R, Kuypers JA. A model to guide
development and application of multiple nursing theories. J Adv
Nurs 2006;12:523‑9.
35. Sweeney NM. A concept analysis of personal knowledge:
Application to nursing education. J Adv Nurs 2008;20:917‑24.
36. Azadi F, Mohammadi E. Evaluation of partnership care model
on quality of life in patients with coronary disease. Nurs Surv J
2007;1:23‑9.
37. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short
Form Health Survey (SF‑36): Translation and validation study of
the Iranian version. Qual Life Res 2005;14:875‑82.
38. Ware Jr JE, Gandek B. Overview of the SF‑36 health survey and
the international quality of life assessment (IQOLA) project. J Clin
Epidemiol 1998;51:903‑12.
39. Osthus TB, von der Lippe N, Ribu L, Rustøen T, Leivestad T.
Health‑related quality of life and all‑cause mortality in patients with
diabetes on dialysis. BMC Nephrol 2012;13:78.
40. Maor Y, King M, Olmer L, Mozes B. A comparison of three measures:
The time trade‑off technique, global health‑related quality of life and
the SF‑36 in hemodialysis patients. J Clin Epidemiol 2001;54:565‑70.
41. King CR, Hinds PS. Quality of life: From nursing and patient
perspectives. United States: Jones and Bartlett Learning; 2011.
42. Rostami Z, Einollahi B, Lessan‑Pezeshki M, Soleimani Najaf Abadi A,
Mohammadi Kebar S, Shahbazian H, et al. Health‑Related Quality
of Life in Hemodialysis Patients: An Iranian Multi‑Center Study.
Nephrourol Mon 2013;5:901‑12.
43. Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development
of the kidney disease quality of life (KDQOLTM) instrument. Qual
Life Res 1994;3:329‑38.
44. Mau LW, Chiu HC, Chang PY, Hwang SC, Hwang SJ. Health‑related
quality of life taiwanese hemodialysis patients: Effects of
hemodialysis modality. Kaohsiung J Med Sci 2008;24:453‑60.
45. Cleary J, Drennan J. Quality of life of patients on haemohemodialysis
for end-stage renal disease. J Adv Nurs 2005;51:577‑86.
46. Molsted S, Prescott L, Heaf J, Eidemak I. Assessment and clinical
aspects of health‑related quality of life in hemodialysis patients
and patients with chronic kidney disease. Nephron Clin Pract
2007;106:c24‑33.
47. Fujisawa M, Ichikawa Y, Yoshiya K, Isotani S, Higuchi A, Nagano S,
et al. Assessment of health‑related quality of life in renal transplant
and hemodialysis patients using the SF‑36 health survey. Urology
2000;56:201‑6.
48. Diaz‑Buxo JA, Lowrie EG, Lew NL, Zhang H, Lazarus JM. Quality‑of‑life
evaluation using Short Form 36: Comparison in hemodialysis and
peritoneal dialysis patients. Am J Kidney Dis 2000;35:293‑300.
49. Brunner LS, Smeltzer SCC, Bare BG, Hinkle JL, Cheever KH. Brunner
and Suddarth’s Textbook of Medical‑surgical Nursing: Lippincott
williams and wilkins;2010. p 1‑2240.
50. Iliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM,
Singer MA, et al. Quality of sleep and health-related quality of life
in haemodialysis patients. Nephrol Dial Transplant 2003;18:126‑32.
51. Sadeghi H, Azizzadeh Forouzi M, Haghdust AA, Mohammad AS.
Effect of implementing continuous care model on sleep quality of
hemodialysis patients. Crit Care Nurs 2009;3:13‑8.
52. Braz S. Comparison two methods of verbal and non verbal education
on quality of life in hemodyialisis patients. Tehran: Tarbiat Modares
University; 2004.
53. Lugon JR. Uremic pruritus: A review. Hemodial Int 2005;9:180‑8.
54. Jennen C, Uhlenbruck G. Exercise and life‑satisfactory‑fitness:
Complementary strategies in the prevention and rehabilitation of
illnesses. Evid Based Complement Alternat Med 2004;1:157‑65.
55. Salehi S. Effect of self‑care education on labratory indicators and
Overweight in two dialysis sessions. Tehran: Iran University of
Medical Sciences; 2002.
56. Sarafi M. The effect of self‑care education on knowledge, attitude
and pphysical conditions of patients treated with hemodialysis.
Tehran: Shahid Beheshti University of Medical Sciences; 1994.
57. Ashvandi K. The effect of self‑care education on reducing the
problems of hemodialysis patients. Tehran: Tarbiat Modares
University; 1994.
58. Kozlowska L, Rosolowska H, Rydzewski A. Low protein diet causes
a decrease in serum concentrations of leptin and tumour necrosis
factor-alpha in patients with conservatively treated chronic renal
failure. Nephrology 2004;9:319‑24.
59. Salehi S. The effect of diet education on the laboratory parameters
and weight gain between dialysis sessions. Tehran: Iran university
of Medical Sciences; 2000.
60. Shichiri M, Nishio Y, Ogura M, Marumo F. Effect of low‑protein,
very‑low‑phosphorus diet on diabetic renal insufficiency with
proteinuria. Am J Kidney Dis 1991;18:26‑32.
61. Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG.
Prevalence, treatment, and control of hypertension in chronic
hemodialysis patients in the United States. Am J Med 2003;115:291‑7.
62. Oka M, Tomura S, Takahashi H, Tsuchiya S. Treatment regimen adherence and life‑satisfaction in hemodialysis patients:
A covariance structure analysis. Clin Exp Nephrol 1999;3:
198‑206.
63. Durose CL, Holdsworth M, Watson V, Przygrodzka F. Knowledge
of dietary restrictions and the medical consequences of
noncompliance by patients on hemodialysis are not predictive of
dietary compliance. J Am Diet Assoc 2004;104:35‑41.
64. Rahimi A. Effect of continuous care model on quality of life
in hemodialysis patients of Tehran. Tehran: Tarbiat Modares
University; 2004.
65. Levendoğlu F, Altintepe L, Okudan N, Uğurlu H, Gökbel H, Tonbul Z,
et al. A twelve week exercise program improves the psychological
status, quality of life and work capacity in hemodialysis patients.
J Nephrol 2004;17:826‑32.
)