The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand

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Chronic kidney disease (CKD) is a global public health problem 1. Between 8 and 10% of the adult population has some form of kidney damage, and every year millions die prematurely of complications related to CKD 2. Over 8 000 000 Thai people were diagnosed with CKD in 2014; 2 000 000 developed end‐stage renal disease (ESRD) 3. CKD refers to the progressive and irreversible reduction of renal function when the kidneys are unable to maintain normal metabolic and fluid balance 4. CKD is defined as GFR < 60 mL/minute/1.73 m2 continuously for 3 months or more, irrespective of the underlying cause. CKD is classified into five stages (see Table 1) 5.
CKD can progress to ESRD and is an important risk factor for cardiovascular disease and death 7. Renal replacement therapy (RRT) includes peritoneal dialysis (PD), haemodialysis (HD) and kidney transplantation (KT) and is required for survival when CKD reaches stage five 9. HD is available to people who cannot, or prefer not to, be treated with PD when KT is also unavailable or the criteria for transplantation are not met 11. HD is the most common method of treating stage five CKD in Thailand, and it is also used to maintain kidney function while people await a KT 12. HD may be required for a considerable period of time because of long KT waiting lists 13.
HD enables individuals with CKD to maintain life; unfortunately, it also exposes them to the psychological, socioeconomic and physical effects associated with CKD and its treatment 14. These effects include anxiety, stress and depression associated with changes such as adjustments in family and social roles, food and fluid restrictions and financial issues (15). Thus, people undergoing HD need to develop coping strategies to help them face their life challenges.
Coping refers to constantly changing one's cognitive and behavioural efforts to manage specific external or internal demands that tax or exceed one's resources 18. Lazarus 19 referred to coping as the process people use to manage stress and deal with stressful events in their lives. However, many stressful situations cannot be solved and people, including Thai people with CKD, need to learn to live with their disease and develop effective coping strategies.
Coping strategies refer to the ways individuals alter their subjective perceptions of stressful life circumstances. Thus, coping strategies enable individuals to come to terms with the stressful event or life crisis. Religion and spirituality are two common coping techniques people use to deal with life challenges 14. The term religion stems from the Latin re‐ligare, which means to reconnect 22. Many authors view religion as an organised system of beliefs about the cause, purpose and nature of the world that is shared by a group of people and encompasses practices such as worship and ritual related to the particular religious system 23.
Religion in all cultures is grounded in traditional practices such as festivals, storytelling, moral guidance, grieving rituals and developmental practice 24. Buddhism is a fundamental and significant aspect of Thai people's values and beliefs, perceptions and knowledge and provides guidance about how to live in the world 27. Buddhism influences behaviour and affects how people make sense of and find meaning throughout their lives 28. Numerous studies suggest religion is important to the way Thai people cope with the burden of illness 26 because it provides a cognitive framework that can minimise suffering, increase one's sense of purpose and help people find meaning in illness 31.
The term spirituality comes from the Latin spiritus, which means breath, which in Greek refers to spirit or soul.
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