1994 Volume 27 Issue 2 Pages 113-117
In an attempt to evaluate the influences of psychological stress induced by changes in a patient's life circumstances, as well as indispensable management of CAPD, we investigated 15 patients undergoing CAPD who fulfilled the criteria of positive indications for entry into the CAPD program and were expected to follow a stable clinical course. They were divided into 2 groups. Patients belonging to group I had recurrent attacks of congestive heart failure (CHF) and peritonitis and group II patients had a stable clinical course without such complications. The former consisted of 2 unmarried men, 2 men having their own businesses, a young woman with an infant, and the owner of a company and the latter included one unmarried man who had undergone hemodialysis one year before, 3 married men having their own businesses and 5 middle aged housewives.
The psychological stress value estimated using the Social Readjustment Rating Scale of Homes and Rahe was 73±17 (53-159) in group I and 110±12 (53-212) in group II just after the initiation of CAPD. However, in group I patients, it was increased to 295±48 (118-480) just before the complications occurred (p<0.005). The causes of an increase in this value were as follows; admission of a family member taking care of the patient, a change in the patient's occupation, reshuffling, retirement, building of a new house, child care and decreased income.
Middle aged housewives could manage their diet and CAPD well, because their children had already grown up and did not need to be taken care of. However, two young unmarried men and the young woman with an infant often ate out and did not restrict salt intake and adhere to a low protein diet.
Technical support and active participation in the patient's treatment by family members were not adequate in group I patients as compared to group II patients (p<0.05).
These results suggest that psychological stress caused by changes in life circumstances, as well as by CAPD itself which requires lifelong management, disturbed diet control and handling of bag exchange, and thus might have induced complications.
