Impaired Kidney Function and Associated Factors Among Rural Adults With Disabilities in Taiwan

偏鄉身心障礙居民腎功能不全及其影響因素之探討

陳秋月(Chu-Yeh Chen) ； 邱文南(Wen-Nan Chiu) ； 林裕珍(Yu-Chen Lin) ； 簡淑慧(Sui-Hwi Jane) ； 江欣虹(Hsin-Hung Chiang) ； 陳美燕(Mei-Yen Chen)

《The Journal of Nursing Research》 25卷2期 (2017/04) Pp. 120-130

https://doi.org/10.1097/jnr.0000000000000141

摘要

Background: The results of numerous studies indicate that people with disabilities seek more healthcare than those who are not disabled, particularly for conditions such as chronic kidney disease, cardiovascular disease, and obesity. However, little is known about the incidence of impaired kidney function and its associated factors among adults with disabilities in Taiwan. Purpose: The aim of this study was to explore the prevalence and factors associated with impaired kidney function among adults with disabilities. Methods: This descriptive study was nurse led and was conducted as part of a health promotion program for disadvantaged rural adults with disabilities in Chiayi County, Taiwan. Health screening and a health needs survey were conducted between July and December 2013. Kidney function, physiological biomarkers, health-related behaviors, and demographic characteristics were examined. Results: Eight hundred ten rural adults with disabilities were enrolled. The most common disabilities included physical-related disability (33.1%), intellectual-related disability (26.7%), and hearing and vision impairment (18.6%). The prevalence of impaired kidney function in this population was 85%. According to classification for chronic kidney disease, 68.6%were in Stages 1-2, and 16.8%were in Stages 3-4. Univariate analysis showed that impaired kidney function was significantly associated with lower educational level (p ＜ .001), hearing or vision impairment (p ＜ .001), being overweight or obese (p ＜ .05), high systolic blood pressure (p ＜ .01), fasting blood glucose (p ＜ .001), total cholesterol (p ＜ .001), total triglyceride (p ＜ .05), older age (p ＜ .001), smoking (p ＜ .05), chewing betel nuts (p = .001), and low levels of participation in social activities (p ＜ .05). The final logistic regression model showed that residents with disabilities who were older or had less education, high fasting blood glucose, and high total cholesterol tended to have impaired kidney function after adjustment for other potential confounding variables. Conclusions/Implications for Practice: Most participants showed impaired kidney function. The factors that were found to relate significantly to this impairment include being overweight, having hyperlipidemia, having hypertension, having high fasting blood glucose, and having an unhealthy lifestyle. Because of the lack of symptoms during the early stages of chronic kidney disease, a community-based health promotion program for these factors is an important element in health advocacy for this vulnerable population.

關鍵字

disabilities ； impaired kidney function ； estimated glomerular filtration rate ； chronic kidney disease

並列摘要

背景　許多研究顯示身心障礙者相較於非此群體有較高之醫療照護需求，特別是慢性腎臟疾病、心血管和肥胖情況；但是國內少有有關身心障礙之腎功能不全及其相關因素之研究。目的　本研究主要目的是瞭解身心障礙者腎功能不全之盛行率與探討影響身心障礙者腎功能不全之相關因素，以作為推動健康促進策略之依據。方法　本文為護理領導之健康促進團隊在嘉義縣鄉村社區針對身心障礙成人照護計畫之部分成果，採描述性研究方法，於2013年7月至12月以社區為基礎之健康及其需求之調查。資料收集內容包括腎功能、生理指標、健康相關行為以及個人基本人口學屬性。結果　共有810位身心障礙成人參與本研究。其中肢體障礙占33.1%，心智障礙26.7%及視聽覺障礙18.6%。此群體在腎功能不全的盛行率為85%，根據慢性腎臟病的分類，有68.6%屬於第1-2期，16.8%屬於第3-4期。單變量分析顯示腎功能不全與低教育程度（p ＜ .001）、多重障礙（p ＜ .001）、過重或肥胖（p ＜ .05）、異常收縮壓（p ＜ .01）、飯前血糖（ p ＜ 0.001）、總膽固醇（p ＜ .001）、三酸甘油脂（p ＜ .05）及年齡較高（p ＜ .001）有關。目前有抽菸（p ＜ .05）、嚼檳榔（p = .001）及較少參與社區活動者（p ＜ .05）與腎功能不全有關；多變量分析顯示在調整干擾因素後，影響腎功能不全之因素主要為高齡、教育程度較低、較高的飯前血糖和總膽固醇。結論／實務應用　本研究發現多數參與者有腎功能不全現象且與過重、高脂血症、高血壓、以及不健康的生活方式有關。由於慢性腎臟病在初期不易出現症狀，因此推動以社區為基礎的健康促進措施，提供此弱勢群體早期發現健康問題是重要的策略。

並列關鍵字

身心障礙 ； 腎功能不全 ； 腎絲球過濾率 ； 慢性腎臟病

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