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International Journal of Pharmaceutical Research & Allied Sciences, 2016, 5(3):371-378

ISSN : 2277-3657
Research Article CODEN(USA) : IJPRPM

The Effect of Aromatherapy with Chicory essence On The Quality of Life In

Patients Undergoing Hemodialysis
Abdolamir Atapour1, Gholamreza Asghari2, Salar Nasr Esfahani3, Keyvan Mohseni Abyaneh4
1
Assistant Professor,Department of Nephrology,Isfahan Kidney Research Center(IKRC),Isfahan University of
Medical Sciences,Isfahan,Iran.
2
Professor,Department of Pharmacognosia,Isfahan University of Medical Sciences,Isfahan,Iran.
3
General Physician,Isfahan,Iran.
4
Medical Student,Isfahan University of Medical Sciences,Isfahan,Iran
________________________________________________________________________________________

ABSTRACT

Introduction and objective: Patients with end-stage chronic renal disease (ESRD) undergo dialysis therapy to
maintain their health.As increasing incidence of ESRD and because of chronic procedures in these patients, they
suffer from difficult conditions and complications associated with underlying diseases;Therefore, as continuous
dialysis procedure proceeds,it develops a number of physical and mental problems in patients that results in
reduced quality of life in these patients. Accordingly, it would be an important attempt to improve the life quality of
life in these patients. The aim of this study was to evaluate the effect of aromatherapy with chicory essence in
improving the quality of life in patients undergoing hemodialysis. Materials and methods: In this interventional
clinical trial study, a total number of 80 hemodialyzed patients were examined (divided in two independent groups
that each one consists of 40 individuals named as intervention and control groups). The intervention group were
given wet handkerchiefs scented with chicory essence and were asked to clean their hands and faces at least three
times a day, each time for five minutes during four weeks. The control group were provided with wet handkerchiefs
without the essence and they were also asked to repeat exactly the same task. The quality of life was determined
using a SF36V2 questionnaire at the beginning and the end of study and compared between the two groups.
Results. General health in the intervention patients was significantly better than the control group and the average
quality of life in the intervention group was measured superior than the control patients. Discussion and
Conclusion: The results of this study showed that aromatherapy with chicory essence increases the average quality
of life in hemodialyzed patients, although the enhanced quality of life was not so substantial that it could definitely
be recommended in these patients. Also, as other factors affect the quality of life and its changes in these patients,
the use of chicory essence can still be considered in hemodialyzed patients.
Keywords: Hemodialysis, Quality of Life, Aromatherapy, Chicory essence
_____________________________________________________________________________________________

INTRODUCTION

Increased incidence of chronic renal disease and increased healthcare costs of the patients involved vindicates the
need for primary care and follow-up of these patients to do what is necessary for these patients in the first-line
patient referral system. From the 1980s onwards, the number of patients who need kidney transplantation and/or
dialysis therapy (ESRD) has increased dramatically, and due to the high cost of both therapeutic methods and
disease complications’ treatments, exploration of an approach has always been considered to reduce the
complications of the disease [1]. Patients with ESRD undergo dialysis at final stages for their health care. The
number of patients under dialysis treatment has increased in recent years and due to the chronic procedure of
dialysis, the patient suffers from difficult situations; meanwhile, patients treated with dialysis are facing a variety of

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physical, mental and social stressors and have a feeling of anxiety concerning their future. The quality of life in
dialysis patients, therefore, is an important issue that deserves further investigations [2,3].

In many countries, most ESRD patients undergo hemodialysis at final stages to continue living. Paying attention to
these issues, it is necessary to conduct research in order to improve the quality of life in patients experiencing
hemodialysis [4]. Several studies have shown that the quality of life in patients treated with dialysis can depend on
various factors [5]. Obviously, both the adequacy and duration of dialysis affect the survival and life quality of the
patients [6,7]. Dialysis patients experience plenty of problems according to their own physical and mental conditions
[8]. Specific problems such as pain, depression, and increased stress levels can be noted in patients undergoing
dialysis [9]. In these patients, blood cortisol level is high [10], which increases their levels of stress.

So far, the usage of aromatherapy in the treatment of diseases have been demonstrated as complementary and
alternative medicine [11]; yet, more research is needed to evaluate the efficacy and safety of using medicinal herbs
[12]. Additionally, previous studies have shown that the rate of complementary medicine therapies (and especially
medicinal herbs) in hemodialyzed patients to be very high even up to sixty percent of the patients with end-stage
renal disease in one study [13]. This is despite the fact that none of the treatments applied have been proven to be
scientifically efficient and undertaken arbitrarily by the patients necessitating research in this area [13]. Furthermore,
in one study on hemodialyzed patients in Iran it was concluded that the use of chicory extract had the highest
frequency among the herbal medicines used in hemodialyzed patients; while no adequate studies are available on the
effectiveness of this product [13].

Chicory plant scientifically named as Cichorium Intybus is a herb that has long been used in traditional medicine as
an antipyretic, anti-inflammatory, and being useful in patients with liver and kidney diseases. The essence of this
plant consist of terines and ketones that is known as effective in reducing inflammation, and as a sedative as well as
an antipyretic [14 , 15].

Materials and methods

This study evaluated the effect of aromatherapy with chicory essence on the quality of life in hemodialyzed
patients admitted to the Rassol-e Akram Medical Center. (Morality of the study was accepted in ethics committe and
the research was given code No. 295037). The patients eligible for the study were investigated in an interventional
clinical trial, in two groups of 40 patients (as intervention and control groups). First, informed consents were taken
from the patients with inclusion criteria to participate in research and they were given assurance that their medical
history and information will be kept secretly and they were able to leave the study any time that they want. Then the
quality of life was assessed using a SF36V2 questionnaire for each patient before entering the study. The
intervention group were given packages containing wet handkerchiefs scented with chicory essence and trained
practically to clean their hands and faces thrice a day, each time for five minutes within four weeks. Each
handkerchief was supplied in separate packaging, which was discarded separately after use. The same procedure was
exactly performed to the control group, with the difference that they received only handkerchiefs with no essence.
This was a single-blind study in which the patients were not aware of the presence/absence of essence in a
handkerchief at baseline. Four weeks after the start of study, the above parameter (mean quality of life) was
measured again and the results were compared with the pre-measurement values using statistical tests. Data were
analyzed by SPSS software, and independent t-test compared mean quantitative variables between the two groups.
The life quality of patients in this study was measured using a SF36V2 questionnaire containing 36 questions in 8
different areas. The answers to the questionnaire is based on a scoring system assigning individual questions in each
area a score between zero to six, which are then compared according to the scores attained in each area. The validity
(reliability) of this questionnaire has been confirmed for the Iranian population (Montazeri et al., 2005; Asghari and
Faghehi, 2003). The internal consistency factors of its octoploid subscales have been reported to be between 70.0
and 85.0, and the retesting coefficients with an interval of one week to be between the 43.0 and 79.0 (Asghari and
Faghehi, 2003).

Inclusion criteria for this study was:

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1. Age over 18 years old.

2. Being on dialysis treatment for at least 3 months.

3. Being on hemodialysis at least 2 times in week.

4. Satisfaction to complete the quality of life questionnaire.

5. Lack of psychosis or cognitive problems.

6. Lack of allergy to Chicory essence.

7. Lack of use of complementary medicine (e.g. herbal medicine) in recent month.

8. Lack of hospitalization during the last two months.

9. Lack of history of renal transplantation.

Exclusion criteria for this study was:

1. Having any kinds of allergy symptoms after using Chicory essence.

2. Not using Chicory essence for more than 1 day.

3. Dying or renal transplantation.

Findings

In this study, there were 42 men and 38 women from a total of 80 patients eligible for inclusion in the study (23
men and 17 women in the intervention group and 19 men and 21 women in the control group) (Table1). The average
ages of the participants were 70.8 and 70.98 years, respectively, in the intervention and the control groups (Table2).

Table 1 . Frequencies of sex ratio between the intervention (1) group and control (2) grou

Male Female

Table 2 . Frequency of age (years) of patients in the intervention (1) and control (2) groups

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The mean age of all patients participating in this study was 70.92. The most common reasons of ESRD among
patients were diabetes mellitus and hypertension (with cummulative ratio of 78.8 percent of causes of ESRD among
patients) (Table 3).The mean time passed from beginning of dialysis treatment among the patients was 6.7 months
(7.9 months among patients in the intervention group and 5.5 months among patients in the control group).

Table 3. Frequency of different causes of ESRD among patients in the study

Causes of ESRD Frequency Percent

DM 37 46.3

HTN 26 32.5

Lupus nephritis 6 7.5

Wegner disease 1 3.8

Others(e.g.congenital
10 9.4
anomally,idiopathic)

Total 80 100.0

The results of this study were analyzed in eight areas as explained bellow.

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In “Physical Function”, ”Role-Limitations due to physical problems”, ”the Pain”, ”the Energy and Exhilaration”,
”the physical problem and its interaction with Social Affairs, and the patient's social health”, “the Role-Limitations
due to emotional problems”, and “the Mental and Psychiatric Health of patients”, A comparison between the
beginning and end of the study revealed no significant differences between the two groups of intervention and
control (P > 0.05), but the two groups were significantly different with respect to “General Health” before and after
the study, so that the level of general health was significantly better in intervention group than that in the control
samples (P < 0.05) in the end of the study. Tables 4 shows descriptive statistics for the quality of life in patients at
the beginning of the study. Table 5 shows descriptive statistics for the quality of life in patients after the
intervention.

Table 4. Baseline descriptive statistics for the life quality of patients

P
Variable Average
Value

Case 20.7 0/066

Physical performance
Control 18.5

Case 1.4 0/178

Role-limitations due to physical problems
Control 1.0

Case 5.9 0/308

Physical pain
Control 5.3

Case 15.7 0/101

General health
Control 15.7

Case 12.1 0/737

Exhilaration
Control 12.9

Case 5.7 0/898

Social Performance
Control 4.9

Case 1.1 0/911

Role-limitations due to emotional problems
Control 1.1

Case 11.7 0/9

Mental health
Control 11.8

Table 5. Descriptive statistics for the post-intervention quality of life in the samples

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P
Variable Average
Value

Case 20.9 0/051

Physical performance
Control 18.6

Case 1.5 0/106

Role-limitations due to physical problems
Control 1.4

Case 6.0 0/365

Physical pain
Control 5.3

Case 15.9 0/04

General health
Control 15.8

Case 12.0 0/406

Exhilaration
Control 12.9

Case 5.9 0/915

Social performance
Control 4.9

Case 1.4 0/853

Role-limitations due to emotional problems
Control 1.2

Case 12.0 0/5

Mental health
Control 11.9

This study evaluated the effect of aromatherapy with chicory essence on the quality of life in hemodialyzed
patients admitted to the Rasool-e Akram Medical Center. The patients eligible for the study were investigated in an
interventional clinical trial, in two groups of 40 patients (as intervention and control groups). First, informed
consents were taken from the patients that had inclusion criteria to participate in research and then the quality of life
was assessed using a SF36V2 questionnaire for each patient before entering the study. The intervention group were
given packages containing wet handkerchiefs scented with chicory essence and trained practically to clean their
hands and faces thrice a day, each time for five minutes within four weeks. Each handkerchief was supplied in
separate packaging, which was discarded separately after use. The same procedure was exactly performed to the
control group, with the difference that they received only handkerchiefs with no essence. This was a single-blind
study in which the patients were not aware of the presence/absence of essence in a handkerchief at the beginning of
the study. Four weeks later, the parameter (mean quality of life) was measured again and the results were compared
with the pre-measurement values using statistical tests. Data were analyzed by SPSS software, and independent t-
test compared mean quantitative variables between the two groups. The life quality of patients in this study was
measured using a SF36V2 questionnaire containing 36 questions in 8 different areas. The answers to the
questionnaire is based on a scoring system assigning individual questions in each area a score between zero to six,
which are then compared according to the scores attained in each area. The validity (reliability) of this questionnaire
has been confirmed for the Iranian population (Montazeri et al., 2005; Asghari and Faghehi, 2003). The internal
consistency factors of its octoploid subscales have been reported to be between 70.0 and 85.0, and the retesting
coefficients with an interval of one week to be between the 43.0 and 79.0 (Asghari and Faghehi, 2003).

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______________________________________________________________________________
Discussion and Conclusion

In this study, the effect of aromatherapy with chicory essence was studied on the quality of life in hemodialyzed
patients. Individuals undergoing hemodialysis face a number of stressors that have significant impacts on the
quality of life in hemodialysis patients.

During this study, it was found that aromatherapy with chicory essence had a positive effect on the general health of
hemodialyzed patients and altogether improved the average life quality of these patients; as it is shown in the table,
mean score of general health is much more better in intervention group than in control group (P<0.05); nonetheless,
this increase was not significant enough to definitely encourage the patients to take advantage of this plant.
Although previous studies introduced using chicory as a sedative and stress reducer [14 ,15], the results of this study
showed no supporting evidence; as two important factors assessing mental health in this questionnaire (role-
limitation due to emotional problems and mental health) show no significant differences between two groups at the
end of the study (P>0.05), which could be due to differences in the way of using this product (previous studies
examined the effect of chicory extract while this study questioned the effects of topical and inhaled uses).As it is
shown in the tables physical issues in the patients (measured by physical performance and role-limitation due to
physical problems) was a bit better in intervention group than control group at the end of the study and the
worsening process in role-limitation in intervention group was slower than control group (in intervention group the
mean of role-limitation due to physical problems changed from 1.4 to 1.5 ,but this change was greater in control
group 1.0 to 1.4);Meanwhile, when analyzed in association with other factors, it is not considerably different
(P>0.05).About physical pain ,as it is shown in the table, physical pain differences between two groups was not
significant at the end of the study (P>0.05) ;although the mean of this variable was a bit better in intervention group
means that patients in intervention group suffered less physical pain than patients in control group (mean 5.9
changed to 6.0 in intervention group and mean 5.3 remained at this rate in control group). Social performance
variable in intervention group was a bit better than in control group (5.7 changed to 5.9 in intervention group and 4.9
remains approximately the same in control group) but when analyzed by statistical tests it shows no significant
difference (P>0.05). looking at exhilaration score s and comparing
them between two groups shows that although patients in intervention group show less energy wasting, but when
assessed in comparison to control group it is not very significant difference between two groups at the end of the
study (12.1 changed to 12.0 in intervention group and 12.9 remained the same in control group). Considering that
this study applied aromatherapy in hemodialyzed patients using this plant, further investigations are required to
clarify the effect of the plant in other forms (e.g. oral) so that its impact on the life quality of patients could be
explained with greater certainty. It is also suggested that the effects of chicory in combination with other therapies in
hemodialyzed people to be explained by other studies in order to explore the possibility of increasing the
effectiveness and the pace of treatment of the complications in these patients.

Key words

Hemodialysis: A procedure based on diffusion through a semi-permeable membrane to separate blood components
using a hemodialysis machine.

Quality of life: Quality of life has a multidimensional and complex concept and involves both objective and
subjective factors. Quality of life is often a clear understanding of satisfaction in life, physical health, social and
family health, expectancy, etiquette, and mental health of patients. The major dimensions of quality of life include
physical, emotional, social, and psychological welfare.

Aromatherapy: Aromatherapy is a form of complementary medicine that uses essential oils or aromas extracted
from aromatic plants.

Chicory essence: Chicory with the scientific name of Cichorium Intybus is a plant belonging to the Asteraceae
family. Chicory is a herb that has long been used in traditional medicine because of febrifuge and urinary tract
cleansing properties. Chicory essence is the extract of chicory plant flowers.

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