Authors: Wiwit Dwi Nurbadriyah  ( Department of Nursing, Airlangga University, Surabaya, Indonesia. )
Nursalam  ( Department of Nursing, Airlangga University, Surabaya, Indonesia. )
Ika Yuni Widyawati  ( STIKes Kepanjen, Malang, Indonesia. )

Objective: To examine the potential positive and negative effects of spirituality and religion on life quality of patients with chronic kidney disease.

 

Method: The systematic review comprised studies published from 2010 to 2020 on how spiritual and religious coping mechanisms impact the life quality of chronic kidney disease patients. The search was conducted using Google Scholar, PubMed, Scopus, Ebsco, Clinical Key, Wiley and ProQuest databases. The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

 

Results: Of the 519 studies initially identified, 10(1.9%) were reviewed in detail. Of them 7(70%) directly mentioned the elements of spiritual/religious coping mechanisms, 2(20%) mentioned the influence of spiritual/religious strategies on life quality through existential factors relating to physical or spiritual wellbeing, and 1(10%) stated that spiritual/religious coping strategies can have positive or negative effects on the life quality of chronic kidney disease patients.

 

Conclusion: Spiritual or religious coping mechanisms was found to have the potential to improve life quality of chronic kidney disease patients.

 

Keywords: Chronic kidney disease, Adaptation, Psychological, Renal insufficiency.  (JPMA 73: S-148 [Suppl. 2]; 2023)

 

DOI:https://doi.org/10.47391/JPMA.Ind-S2-34

 

Introduction

 

An unhealthy lifestyle can lead to unwanted health problems, including chronic kidney disease (CKD). The body’s capacity to maintain metabolic, fluid, and electrolyte balance diminishes due to CKD, resulting in urea accumulation, or uraemia.¹ CKD is the failure of the kidney function that progresses slowly and cannot be recovered, leaving the body unable to keep fluid, electrolyte and metabolic balance which causes uraemia.² Uraemia can poison all organs, including the brain, leading to complex problems and requiring comprehensive nursing. CKD patients require various medical treatments, including haemodialysis (HD), peritoneal dialysis (PD) or haemofiltration, fluid restriction and drugs to prevent serious complications requiring kidney transplantation.

One of the medical procedures for CKD patients is HD therapy³ which may prevent fatality. However, HD does not cure or reverse CKD. CKD patients on HD therapy have to deal with a variety of issues brought on by the failing kidneys. This becomes a physical stressor that has an impact on the patient’s bio, psycho, socio and spiritual components of life.^4-6 Patients on HD treatment may have physical weakness, including oedema, muscle weakness, discomfort, nausea and vomiting. Patients who undergo long-term HD therapy often feel depressed due to chronic illness and fear of death. Besides, there are other problems related to their condition, including financial problems, difficulty in maintaining a job, lost sex drive and impotence. In dealing with these conditions, individuals living with CKD adopt various coping processes.⁷ Coping is a process by which people try to manage the perceived discrepancy between their demands and resources.⁸ Coping efforts aim at correcting or controlling a problem, but they also help people change their perception of incongruity, tolerance or acceptance of threats or harm, or fleeing or avoiding situations. Coping with stress due to chronic illness is very influential in changing a person’s quality of life (QOL),⁹ which is a person’s assessment of the life quality, taking into account physical, social and emotional aspects.¹⁰

Prior research has looked at how improving QOL can lower morbidity and mortality rates in CKD patients, but literature on the relationship between religious/spiritual coping strategies and QOL is limited.^11-13 The current systematic review was planned to examine the potential positive and negative effects of spirituality and religion on QOL of CKD patients.

 

Material and methods

 

The systematic review comprised literature search on Google Scholar, PubMed, Scopus, Ebsco, Clinical Key, Wiley and ProQuest databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.¹⁴

The studies included were those published in English-language, peer-reviewed journals between 2010 and 2020 with primary focus on religious/spiritual coping strategies in CKD patients, and which allowed free access to both the abstract and the text. Stduies focussing on the caregivers or families of CKD patients were excluded.

Three reviewers independently conducted the search, using key words, like HD, life quality, religious coping strategies, CKD, coping strategies, spiritual coping, etc.

The studies identified were screened and shortlisted for detailed review. The review did not look at the difference in CKD stage and the duration of HD or any other treatment.

 

Results

 

Of the 519 studies initially identified, 10(1.9%) were reviewed in detail (Figure).

 

 

Of them 7(70%) directly mentioned the elements of spiritual/religious coping mechanisms, 2(20%) mentioned the influence of spiritual/religious strategies on QOL through existential factors relating to physical or spiritual wellbeing, and 1(10%) stated that spiritual/religious coping strategies can have positive or negative effects on QOL of CKD patients.^15-24 Spiritual wellbeing had a significant relationship with low suicide rates.¹⁸ The existential wellbeing affected QOL, and there was no connection between spirituality and mental health.^16,17

Religion specifically was generally not mentioned except in 2(20%) studies which stated that spiritual/religious coping strategies were Islamic approaches^15,22 and 1(10%) had sample limited to Protestants and Catholics. Overall, 3(30%) studies had been conducted in Brazil, 3(30%) in North America, 2(20%) in Iran and 1(10%) each in the Philippines and Indonesia. However, 1(33.3%) of the studies conducted in North America used a sample of patients with Asian ethnicity.

In terms of methodology, 5(50%) studies were cross-sectional, 2(20%) were cohorts, 2(20%) used an ethnographic design, and 1(10%) was a semi-experimental pre-post study.

The cross-sectional design resulted in a limitation as it does not deal with evidence of causality, while the findings of studies with ethnographic design are not generalisable to the larger community. A cohort study was unable to explain causality, while another cohort study had limitation related to the selection of the instrument.

The sample size varied greatly as did the duration and stage of CKD as well as that of the treatment (Table).

 

 

Discussion

 

Almost all the studies reviewed suggested that religious/spiritual coping mechanism had an impact on QOL. However, literature has also shown that religious/spiritual coping is a double-edged strategy that is not always beneficial to CKD patients.²⁰

The current review covered study subjects from several countries with different cultural backgrounds. This is important because spiritual and religious aspects depend on the religion practised and the social culture around a patient. The culture of religiosity in Indonesia is different from that in, say, Brazil or North America. These cultural differences create social environments and social support in different forms.^20,25-28

Another important point is that the concepts of spirituality and religiosity varied in the studies reviewed. This determined the use of instruments to measure the patient’s religiosity and spirituality. The difference in the measurement of spiritual and religious aspects provides a different picture of the meaning of religious and spiritual concepts.^16,21,29-31

The limitation of the current systematic review is that it was not registered with the International Prospective Register of Systematic Reviews (PROSPERO).³²

 

Conclusion

 

QOL of CKD patients is affected by spiritual and religious coping mechanisms, indicating that such mechanisms may enhance QOL of such patients. However, differences in beliefs related to spiritual and religious aspects provide a different picture of the meaning of religious and spiritual concepts.

 

Acknowledgment: We are grateful to all those who gave permission to conduct the review.

 

Disclaimer: The text was presented at the International Nursing Conference, 2022, held by Universitas Airlangga, Indonesia.

 

Conflict of Interest: None.

 

Source of Funding: None.

 

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