Acupressure. CKD
Acupressure. CKD
Acupressure. CKD
org
Abstract
Objectives: Most patients bearing chronic renal failure (CRF) in end-stage renal disease (ESRD) need hemodialysis to survive. Although
there are many advanced hemodialysis equipment, some of them still have complications. Nausea is general complicacy during
hemodialysis, which leads to unsightly feeling. In this regard, the present study was conducted to investigate the effect of acupressure
on the severity of nausea during hemodialysis.
Materials and Methods: The current single-blind clinical trial was conducted on 60 patients in the dialysis wards of some selected
hospitals affiliated to Semnan University of Medical Sciences in Iran. The sampling method was easy, accessible, and purposive and
the order of interventions was selected randomly. In addition, the nausea severity was measured during hemodialysis in one group
in three different conditions of routine care, placebo administration, and acupressure. The verbal numerical rating scale was used to
measure the nausea severity. To determine the difference in the mean of nausea severity in different conditions, repeated measures
analysis of variance (ANOVA) test was used, followed by applying the post hoc test of Bonferroni for two-by-two comparisons in
different conditions.
Results: The mean of nausea severity was 1.15±2.08 in the routine care while it was 0.55±1.44 and 0.05±0.29 in placebo administration
and acupressure conditions. The findings of the repeated measures ANOVA test represented a remarkable difference among the mean
severity of nausea in different conditions (P < 0.001, F=11.61). Further, there was a significant difference between the mean of nausea
severity in routine care compared to placebo administration (P = 0.024) and acupressure (P < 0.001) conditions. Finally, a significant
difference was observed between the mean of nausea severity in placebo administration and acupressure conditions (P = 0.030).
Conclusions: The results demonstrated that acupressure was effective in attenuating the severity of nausea during hemodialysis thus
using acupressure can be suggested to reduce nausea during hemodialysis.
Keywords: Hemodialysis, Nausea, Acupressure
Received 5 November 2018, Accepted 11 February 2019, Available online 2 March 2019
1
Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran. 2Student Research Committee, Semnan University
of Medical Sciences, Semnan, Iran. 3Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan,
Iran and Department of Epidemiology and Statistics, Semnan University of Medical Sciences, Semnan, Iran.
*Corresponding Author: Ali Asghar Ghods, PhD, Tel/Fax: +98 23 33654190, Email: aaghods@semums.ac.ir
Asgari et al
nausea in clinical practices (8). Acupressure is considered signed the consent letters for participation in this research.
as one of the non-pharmacological therapies that is used The questionnaire contained two parts. The first
to control nausea in various clinical situations (9). More entailed demographic information like age, gender, the
precisely, it is a branch of acupuncture that uses no needle place of residence, occupation, education level, and
(10). Similarly, this intervention is a non-invasive and dialysis duration, as well as obvious pain in different
relatively inexpensive method with no side effects (11). body parts, obvious anxiety, and the signs of motion
The history of stimulating the meridian system in the sickness. The second part of the questionnaire contained
body by needle, heat, or pressure for treating diseases the measurement tool of nausea severity. The severity of
and relieve pain has originated in China more than 2500 nausea was evaluated by a verbal numeric rating scale
years ago (12). The use of acupuncture to relieve nausea (VNRS) and characterized as no nausea (0 scores), as
and vomiting was first reported in the British Journal of well as mild (1-3), moderate (4-6), severe (7-9), and very
Medicine by Dundee et al in 1986 (13). Acupressure can severe (10) nausea. In the present study, the reliability of
be performed by using finger pressure or elastic bands the tools was determined by a pilot study on the first 20
to stimulate the meridians in order to enhance the flow samples. Using the test-retest method, the reliability of the
of chi (9). In numerous studies, these acupressure bands tools was determined to be 97% for VNRS.
are effective in controlling morning sickness during The first part of the questionnaire was filled out with
pregnancy, chemotherapy-induced nausea, and motion demographic information. Then, the severity of nausea
sickness (14, 15) during hemodialysis was measured among all patients in
Considering the unpleasant effects of nausea on three conditions of routine care, placebo administration,
hemodialysis patients and the significant role of the nurses and acupressure. In a routine care setting, the researcher,
in providing care to CRF patients receiving hemodialysis, along with a nurse (as the collaborator of the project)
it is necessary to help these patients to reduce their visited the patient at the end of the hemodialysis and
problems (16). Accordingly, the present study intended measured the severity of nausea during hemodialysis
to evaluate the efficacy of acupressure on nausea severity by questioning. Before starting the hemodialysis, the
during hemodialysis. researcher accompanying a nurse visited the patient and
then the intervention point (PC6) was determined in the
Materials and Methods intervention setting using acupressure. The Pointer Excel,
This study was a single-blinded clinical trial registered which was a precise point finder device of acupuncture,
in the Iranian Registry of Clinical Trials (identifie: was used to find the intervention point (PC6). This device
IRCT201304298717N2; https://www.irct.ir/trial/9213), could mark the intervention point as soon as it reached
which was conducted on 60 dialysis patients in selected the point with a beep sound and light signal. Ten minutes
hospitals affiliated to Semnan University of Medical before inserting hemodialysis needles, the researcher
Sciences in Iran. Data collection was done from January tried Sea-Band on the patient’s wrist so that the button
2015 to April 2015. The severity of nausea during was placed on the p6 (Neiguan) point on the inner surface
hemodialysis was measured in a group of patients in three of the forearm two inches (three fingers wide) far from
conditions including routine care, placebo administration, the inner wrinkle line of the wrist between flexor carpi
and acupressure. The sampling method was simple, radialis and palmaris longus tendons. Sea-Band remained
accessible, and purposive and the order of interventions at the site during hemodialysis and was removed at the
was selected randomly. Moreover, the sample size was end of hemodialysis just before removing the hemodialysis
determined based on the results of a pilot study on 20 needles. In the setting of using a placebo, Sea-Band was
patients, with a 95% confidence interval and 80% power. fastened around the wrist like the intervention with
The inclusion criteria were being conscious, not taking acupuncture, but the button was located on the opposite
anti-nausea and anti-vomiting drugs six hours before side of the p6 point at the outer surface of the forearm
hemodialysis, passing three months after hemodialysis, as a false point. After removing hemodialysis needles and
being over 20 years old, and requiring four-hour dressing vascular access sites, the severity of nausea during
hemodialysis for three times. hemodialysis was measured by questioning the patient
Before initiating the research, the approval and using the VNRS, and then the related questionnaire was
permission were obtained from the Ethics Committee of filled out in all conditions.
Semnan University of Medical Sciences and the hospital The data were entered into SPSS 18. The repeated
managers regarding investigating the dialysis ward, measures analysis of variance (ANOVA) test was used to
respectively. Then, patients who had suitable conditions determine the difference in the mean of nausea severity
for recruiting in the study were selected as the sample. in different conditions. Eventually, the post hoc test of
The researcher presented himself to the subjects, then Bonferroni was used for two-by-two comparisons in
provided them with sufficient explanations regarding the different conditions and P<0.05 was considered as a
research objectives and method. Besides, the subjects were statistically significant level.
assured of the confidentiality of information, and finally,
78 Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020
Asgari et al
distribution of the subjects according to the severity of Routine Placebo 0.063 1.137 0.024*
care with
nausea in different conditions. In all conditions, most of Acupressure 0.430 1.770 <0.001*
the subjects had no sign of nausea and no subject had Placebo Routine care -1.137 -0.063 0.024*
severe nausea. In routine care, 28% of the patients had with Acupressure 0.037 0.963 0.030*
some degree of nausea. In addition, the mean of nausea Acupressure Routine care -1.770 0.430 <0.001*
severity was 1.15±2.08, 0.55±1.44, and 0.05±0.29 for with Placebo -0.963 -0.037 0.030*
routine care, placebo, and acupressure. Note. *There is a significant difference in P<0.05.
Table 2 demonstrates the results of comparing the mean
of nausea severity in the subjects in different conditions. The majority of the studied subjects (51.7%) were in
The result of repeated measures ANOVA test represented the age group of 60 years and older while the minority
a notable difference (P < 0.05) between the mean of nausea of the subjects (8.3%) was in the age group of 20 to 39
severity in different conditions. years old. Further, the mean age of the subjects was 59.5
Table 3 provides the results of the post hoc test of years. In the study of Mottahedian Tabrizi, the mean age
Bonferroni, which was used for two-by-two comparisons of hemodialysis patients was 55.05 years (17). In another
in different conditions. The results suggested that study, the incidence of CRF increased with age and most
there was a substantial difference between the mean of patients with renal failure were in the middle age (22).
nausea severity in routine care compared to the placebo Similarly, the mean duration of subjects’ hemodialysis
administration (P=0.024) and acupressure (P < 0.001). In was 46.32 months and hemodialysis duration in most
addition, a significant difference was observed between subjects was more than 48 months (26.7%). In the study
the mean of nausea severity in placebo and acupressure of Ghahri Sarabi, the mean duration of hemodialysis was
groups (P=0.030). 4.8 years (23).
During routine care, 28% of patients had some degree
Discussion of nausea. In another study, Chong and Tan investigated
In this study, 56.7% of the subjects were males and 43.3% the occurrence of gastrointestinal symptoms in Asian
were females. In many other studies, the number of men patients bearing regular hemodialysis and found that the
was reported more than that of the women (17-19). prevalence of nausea was 18.2% (24). In a study in Iran,
Moreover, considering hypertension as the second most the prevalence of nausea and vomiting reported up to
common cause of CRF (1, 20), the risk of ESRD was more 25.8% (25). The findings of the present study in terms of
than women because of hypertensive nephropathy in determining the severity of nausea in different conditions
men (21). suggested that the mean nausea severity was 1.15, 0.55,
Table 1. Absolute and Relative Frequency Distribution of the Subjects Pursuant to the Nausea Severity in Various Conditions
Condition
Nausea Severity Routine Care Placebo Acupressure
No. % No. % No. %
Lack of nausea 43 71.7 52 86.7 58 96.7
Mild nausea 7 11.7 2 3.3 2 3.3
Moderate nausea 8 13.3 6 10 0 0
Severe nausea 2 3.3 0 0 0 0
Very severe nausea 0 0 0 0 0 0
Mean & SD of nausea severity 1.15±2.08 0.55±1.44 0.05±0.29
SD, Standard deviation.
Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020 79
Asgari et al
and 0.05 in the routine care condition, placebo treatment, after cardiac surgery, as well as different mechanisms of
and the acupressure, respectively. The results of the study nausea in chemotherapy patients compared to patients on
by Khoshnevis et al showed that the prevalence of nausea hemodialysis.
was lower in the test group compared to the control group
(26). Likewise, Bastani et al reported that the severity of Conclusions
nausea was remarkably lower in the test group instantly In general, acupressure is considered effective in
and one hour after the intervention in comparison with the diminishing the severity of nausea during hemodialysis.
placebo group (27). The results of the above-mentioned Therefore, using acupressure can be suggested to reduce
studies confirm those of the present study. However, the nausea during hemodialysis.
results of some other studies are contrary to the results of
this study. For example, the results of the research by Adib- Limitations of the Study
Hajbaghery demonstrated that the nausea severity had no Despite all the precision and attention paid to this
remarkable difference in the test and control groups (28), research, the study had some limitations. For instance,
which contradicts the findings of the present study. nausea was a mental phenomenon and there was no
Based on the findings of this study with regard to objective measurement tool for its assessment. Therefore,
comparing the nausea severity during hemodialysis in it was only based on the patient’s response. In addition,
routine care, placebo administration, and acupressure in there were not different sizes of Sea-Band to be selected
hemodialysis patients, the results of the repeated measures for different wrist circumference thus just one size was
ANOVA test had a notable difference (P < 0.001) in the used for all patients.
mean of nausea severity in different subjects during Considering the limitations of this study, it is suggested
hemodialysis. According to the results of the study and the that future studies use at least two different measurement
comparison of the three conditions, the lowest and highest tools to evaluate nausea. Finally, different Sea-Band sizes
levels of nausea severity were observed in acupressure and should be prepared and used for different wrist sizes.
routine care with the means of 0.05 and 1.15, respectively.
The results of other studies are consistent with the results Conflict of Interests
of our study (26,29). Based on the results of the post hoc The authors have no conflicts of interest in this study.
test of Bonferroni in terms of two-by-two comparisons
of the mean severity of nausea in different conditions Ethical Issues
exhibited that there was a significant difference in this The ethics approval was obtained from the Semnan
regard in routine care compared to placebo administration University of Medical Ethics Committee (IR. SEMUMS.
(P=0.024) and acupressure (P < 0.000). In addition, a REC.1392.372055).
notable difference was found between the mean severity
of nausea in placebo administration and acupressure Financial Support
(P=0.030). The research reported in this publication was supported
The results of other studies showed that the mean by a grant (number 579) from the Semnan University of
severity of nausea was lower in acupressure compared to Medical Sciences, Semnan, Iran.
placebo administration and routine care, which is in line
with the results of this study. In a study, Barrett examined Acknowledgements
the effect of Sea-Band application on preventing and We would like to thank the Clinical Research Development
controlling nausea and vomiting during hemodialysis in Unit of Kowsar Educational, Research, and Therapeutic
seven patients and indicated that four patients reported Center of Semnan University of Medical Sciences for
that the bands helped them control nausea and vomiting providing facilities for this project.
during dialysis (30). Further, Saberi et al found that, based
on the Rhodes scale, the nausea severity decreased after References
intervention in the acupressure and placebo groups while 1. Asgari M, Soleimani M. Intensive Nursing Care in ICU,
the higher decrease was observed in the acupressure group CCU and dialysis wards. Tehran: Boshra Publication; 2018.
(14). The results of the above-mentioned studies support [Persian].
the findings of the present study. However, the results 2. Davids M. Chronic kidney disease–the silent epidemic.
of some other studies contradict those of our study. For Continuing Medical Education. 2007;25(8):378.
example, Klein et al demonstrated that acupressure could 3. Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner
and Suddarth’s Textbook of Medical Surgical Nursing. 12th
not reduce the severity of nausea in patients undergoing
ed. Philadelphia: Lippincott Williams & Wilkins; 2018.
cardiac surgery (31). Furthermore, Dibble et al concluded
4. Davenport A. Intradialytic complications during
that there was no difference in the incidence and severity hemodialysis. Hemodial Int. 2006;10(2):162-167.
of acute nausea in the acupressure, placebo, and routine doi:10.1111/j.1542-4758.2006.00088.x
care groups (15). These contradictory results are probably 5. Discovering Dialysis a manual for kidney and dialysis
due to the time of performing acupressure, which was patients. Renal Failure and Dialysis. [cited 2011 Sep 4];
80 Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020
Asgari et al
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