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Clegg DJ, Headley SA, Germain MJ. Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet. Kidney Med 2020; 2:476-487. [PMID: 32775988 PMCID: PMC7406842 DOI: 10.1016/j.xkme.2020.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In patients with advanced-stage chronic kidney disease (CKD), progressive kidney function decline leads to increased risk for hyperkalemia (serum potassium > 5.0 or >5.5 mEq/L). Medications such as renin-angiotensin-aldosterone system inhibitors pose an additional hyperkalemia risk, especially in patients with CKD. When hyperkalemia develops, clinicians often recommend a diet that is lower in potassium content. This review discusses the barriers to adherence to a low-potassium diet and the impact of dietary restrictions on adverse clinical outcomes. Accumulating evidence indicates that a diet that incorporates potassium-rich foods has multiple health benefits, which may also be attributable to the other vitamin, mineral, and fiber content of potassium-rich foods. These benefits include blood pressure reductions and reduced risks for cardiovascular disease and stroke. High-potassium foods may also prevent CKD progression and reduce mortality risk in patients with CKD. Adjunctive treatment with the newer potassium-binding agents, patiromer and sodium zirconium cyclosilicate, may allow for optimal renin-angiotensin-aldosterone system inhibitor therapy in patients with CKD and hyperkalemia, potentially making it possible for patients with CKD and hyperkalemia to liberalize their diet. This may allow them the health benefits of a high-potassium diet without the increased risk for hyperkalemia, although further studies are needed.
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Affiliation(s)
- Deborah J. Clegg
- Drexel College of Nursing and Health Professions, Philadelphia, PA
| | - Samuel A. Headley
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, MA
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52
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Lim JH, Lim CKM, Ibrahim I, Syahrul J, Mohamed Zabil MH, Zakaria NF, Daud ZAM. Limitations of Existing Dialysis Diet Apps in Promoting User Engagement and Patient Self-Management: Quantitative Content Analysis Study. JMIR Mhealth Uhealth 2020; 8:e13808. [PMID: 32478665 PMCID: PMC7296424 DOI: 10.2196/13808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 09/23/2019] [Accepted: 03/31/2020] [Indexed: 01/27/2023] Open
Abstract
Background With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable. Objective This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients. Methods This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P<.05. Results A total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (r=.65, P=.001) and health-behavior theory constructs (r=.55, P=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, P=.03) and usability (β=.41, P=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, P=.008) and the engagement quality (β=.66, P=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, P=.007) and knowledge (β=.45, P=.01). Conclusions Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality.
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Affiliation(s)
- Jun-Hao Lim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Cordelia-Kheng-May Lim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Imliya Ibrahim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Jazlina Syahrul
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mohd Hazli Mohamed Zabil
- Department of Computing, College of Computing and Informatics, Universiti Tenaga National, Kajang, Malaysia
| | - Nor Fadhlina Zakaria
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zulfitri Azuan Mat Daud
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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53
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Ebrahim Z, Esau N, Cilliers L. Keeping the Diet Simple and Natural in Chronic Kidney Disease: A South African-Based Dietary Infographic. J Ren Nutr 2020; 30:e58-e65. [PMID: 32303412 DOI: 10.1053/j.jrn.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/23/2019] [Accepted: 11/11/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Zarina Ebrahim
- Department of Human Nutrition, Stellenbosch University, Stellenbosch, South Africa.
| | - Nazeema Esau
- Department of Dietetics, Tygerberg Hospital, Cape Town, South Africa
| | - Lynette Cilliers
- Department of Dietetics, Groote Schuur Hospital, Cape Town, South Africa
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54
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Pereira RA, Ramos CI, Teixeira RR, Muniz GAS, Claudino G, Cuppari L. Diet in Chronic Kidney Disease: an integrated approach to nutritional therapy. ACTA ACUST UNITED AC 2020; 66Suppl 1:s59-s67. [PMID: 31939537 DOI: 10.1590/1806-9282.66.s1.59] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A healthy diet is an essential requirement to promote and preserve health, even in the presence of diseases, such as chronic kidney disease (CKD). In this review, nutritional therapy for CKD will be addressed considering not only the main nutrients such as protein, phosphorus, potassium, and sodium, which require adjustments as a result of changes that accompany the reduction of renal functions, but also the benefits of adopting dietary patterns associated with better outcomes for both preventing and treating CKD. We will also emphasize that these aspects should also be combined with a process of giving new meaning to a healthy diet so that it can be promoted. Finally, we will present the perspective of an integrated approach to the individual with CKD, exploring the importance of considering biological, psychological, social, cultural, and economic aspects. This approach has the potential to contribute to better adherence to treatment, thus improving the patient's quality of life.
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Affiliation(s)
- Raíssa Antunes Pereira
- Programa de Pós-Graduação em Nutrição, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Christiane Ishikawa Ramos
- Programa de Pós-Graduação em Nefrologia, Disciplina de Nefrologia, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Renata Rodrigues Teixeira
- Programa de Pós-Graduação em Nutrição, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Gisselma Aliny Santos Muniz
- Programa de Pós-Graduação em Nefrologia, Disciplina de Nefrologia, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Gabriele Claudino
- Programa de Pós-Graduação em Nefrologia, Disciplina de Nefrologia, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil
| | - Lilian Cuppari
- Programa de Pós-Graduação em Nutrição, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil.,Programa de Pós-Graduação em Nefrologia, Disciplina de Nefrologia, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil.,Fundação Oswaldo Ramos - Hospital do Rim, São Paulo, SP, Brasil
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55
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Wright HH, Kickbusch H, Swanepoel E, Gray N. Factors Influencing Low Sodium Intake in People with Non‐Dialysis Dependent Chronic Kidney Disease. J Ren Care 2019; 46:95-105. [DOI: 10.1111/jorc.12311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hattie H. Wright
- School of Health and Sport SciencesUniversity of the Sunshine CoastMaroochydore Queensland Australia
| | - Heidi Kickbusch
- School of Health and Sport SciencesUniversity of the Sunshine CoastMaroochydore Queensland Australia
| | - Elizabeth Swanepoel
- School of Health and Sport SciencesUniversity of the Sunshine CoastMaroochydore Queensland Australia
| | - Nicholas Gray
- Renal UnitSunshine Coast Hospital and Health ServiceBirtinya Queensland Australia
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56
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Skoumalova I, Kolarcik P, Madarasova Geckova A, Rosenberger J, Majernikova M, Klein D, van Dijk JP, Reijneveld SA. Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4295. [PMID: 31694265 PMCID: PMC6862452 DOI: 10.3390/ijerph16214295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022]
Abstract
Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We performed a multicentric cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; response rate: 70.1%; mean age = 63.6 years; males: 60.7%). We assessed the association between nine domains of HL and non-adherence (high serum potassium, high serum phosphate, relative overhydration, and self-reported NADFIR) using general linear models adjusted for age and gender. Moreover, we assessed the moderation by socioeconomic status (SES). We found higher NADFIR among patients with less sufficient information for health management (high serum phosphate level; odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63-0.94), with a lower ability to actively manage their health (self-reported diet non-adherence; OR: 0.74; 95% CI: 0.62-0.89), and those less able to actively engage with healthcare providers (overhydrated; OR: 0.78; 95% CI: 0.65-0.94). Moreover, SES modified this relation. Low HL affects the adherence of dialyzed patients. This shows a need to support patients with low HL and to train healthcare providers to work with these patients, taking into account their SES.
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Affiliation(s)
- Ivana Skoumalova
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia;
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| | - Peter Kolarcik
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
| | - Jaroslav Rosenberger
- Department of Health Psychology, Faculty of Medicine, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (P.K.); (A.M.G.); (J.R.)
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia;
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
- II. Internal Clinic, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 11 Kosice, Slovakia;
| | - Maria Majernikova
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 11 Kosice, Slovakia;
| | - Daniel Klein
- Institute of Mathematics, Faculty of Science, P. J. Safarik University, Jesenna 5, 040 01 Kosice, Slovakia;
| | - Jitse P. van Dijk
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia;
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, Olomouc 771 11, Czech Republic
| | - Sijmen A. Reijneveld
- Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
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57
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Boslooper-Meulenbelt K, Patijn O, Battjes-Fries MCE, Haisma H, Pot GK, Navis GJ. Barriers and Facilitators of Fruit and Vegetable Consumption in Renal Transplant Recipients, Family Members and Healthcare Professionals-A Focus Group Study. Nutrients 2019; 11:nu11102427. [PMID: 31614629 PMCID: PMC6835653 DOI: 10.3390/nu11102427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022] Open
Abstract
Low fruit and vegetable consumption is associated with poor outcomes after renal transplantation. Insufficient fruit and vegetable consumption is reported in the majority of renal transplant recipients (RTR). The aim of this study was to identify barriers and facilitators of fruit and vegetable consumption after renal transplantation and explore if certain barriers and facilitators were transplant-related. After purposive sampling, RTR (n = 19), their family members (n = 15) and healthcare professionals (n = 5) from a Dutch transplant center participated in seven focus group discussions (three each for RTR and family members, one with healthcare professionals). Transcripts were analyzed using social cognitive theory as conceptual framework and content analysis was used for identification of themes. Transplant-related barriers and facilitators were described separately. In categorizing barriers and facilitators, four transplant-related themes were identified: transition in diet (accompanied by, e.g., fear or difficulties with new routine), physical health (e.g., recovery of uremic symptoms), medication (e.g., cravings by prednisolone) and competing priorities after transplantation (e.g., social participation activities). Among the generic personal and environmental barriers and facilitators, food literacy and social support were most relevant. In conclusion, transplant-related and generic barriers and facilitators were identified for fruit and vegetable consumption in RTR. The barriers that accompany the dietary transition after renal transplantation may contribute to the generally poorer fruit and vegetable consumption of RTR. These findings can be used for the development of additional nutritional counseling strategies in renal transplant care.
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Affiliation(s)
- Karin Boslooper-Meulenbelt
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands.
| | - Olga Patijn
- Louis Bolk Insitute, Bunnik, 3981 AJ, The Netherlands.
| | | | - Hinke Haisma
- Population Research Center, Faculty Spatial Sciences, University of Groningen, Groningen, 9747 AD, The Netherlands.
| | - Gerda K Pot
- Louis Bolk Insitute, Bunnik, 3981 AJ, The Netherlands.
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands.
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58
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Flythe JE, Bansal N. The relationship of volume overload and its control to hypertension in hemodialysis patients. Semin Dial 2019; 32:500-506. [PMID: 31564065 DOI: 10.1111/sdi.12838] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hypertension is highly prevalent and associated with poor clinical outcomes among individuals receiving maintenance hemodialysis (HD). Volume overload is a key modifiable contributor to hypertension and cardiovascular disease in the HD population. Despite their importance, assessment and treatment of volume overload and hypertension remain major clinical challenges and have substantial implications for both clinical outcomes and patient experiences of care. This review will summarize current data on the diagnosis, epidemiology, pathophysiology, and clinical consequences of hypertension and volume overload in HD patients. We will also identify priorities for future research studies.
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Affiliation(s)
- Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Nisha Bansal
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.,Kidney Research Institute, University of Washington, Seattle, Washington
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59
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Opiyo RO, Nyasulu PS, Olenja J, Zunza M, Nguyen KA, Bukania Z, Nabakwe E, Mbogo A, Were AO. Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya: a mixed-methods survey. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0237-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis.
Methods
A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit “Collect software” while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, “adherence to diet prescription” was analyzed as a binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed.
Results
Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were “flexibility in the diets” (AOR 2.65, 95% CI 1.11–6.30, P 0.028), “difficulties in following diet recommendations” (AOR 0.24, 95% CI 0.13–0.46, P < 001), and “adherence to limiting fluid intake” (AOR 9.74, 95% CI 4.90–19.38, P < 0.001).
Conclusions
For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones. Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based on the individual patient’s usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet adherence messages should be integrated with fluid limitation messages. Further research on understanding patients’ adherence to fluid restriction is also suggested.
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60
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Notaras S, Galea L, Lee P, Mak M, Lambert K, Makris A. The association between dietetic consultation and time to dialysis for patients attending a pre-dialysis clinic: A retrospective cohort study. Nephrology (Carlton) 2019; 25:390-397. [PMID: 31353675 DOI: 10.1111/nep.13639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 12/16/2022]
Abstract
AIM A multidisciplinary approach, including dietetics, is considered the optimal model of care for dialysis preparation. Dietetic consultation (DC) focuses on symptom management and dietary changes to delay time to dialysis. Evidence of the effectiveness of DC on time to dialysis is limited. This study aimed to investigate the impact of DC on time to dialysis for patients attending a pre-dialysis clinic. METHODS A retrospective cohort study was designed to include all patients attending outpatient pre-dialysis clinics at a large metropolitan renal service between January 2014 and March 2018. Time to dialysis (days) was compared between patients that received DC and those who did not. Cox proportional hazards analysis allowing for adjustment of differences and confounders was undertaken. RESULTS A cohort of 246 patients was identified. Median estimated glomerular filtration rate was 16mL/min per 1.73 m2 (interquartile range = 13-20) at initial pre-dialysis clinic visit and 63% commenced dialysis during the study period. Only 41% of patients received dietetic consultation. Significantly fewer patients needed to commence dialysis in the DC group compared to the no-DC group (hazards ratio 0.63; 95% confidence interval (CI) 0.45-0.89; P = 0.008 Cox proportion hazard). The DC group commenced dialysis significantly later than the no-DC group; 933 days (95% CI 832-1034) versus 710 days (95% CI 630-790) respectively, after the initial pre-dialysis clinic visit; log-rank 0.005. CONCLUSION DC provided to patients attending a pre-dialysis clinic was associated with a delayed time to dialysis. Standardised referral pathways to improve patient access to renal dietetic services are recommended to optimise care.
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Affiliation(s)
- Stephanie Notaras
- Department of Dietetics, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Leanne Galea
- Department of Dietetics, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Paul Lee
- Department of Dietetics, Liverpool Hospital, Sydney, New South Wales, Australia
| | - May Mak
- Department of Dietetics, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kelly Lambert
- Department of Nutrition and Dietetics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Angela Makris
- School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Renal Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
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61
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Tao X, Zhang H, Yang Y, Zhang C, Wang M. Daily dietary phosphorus intake variability and hemodialysis patient adherence to phosphate binder therapy. Hemodial Int 2019; 23:458-465. [PMID: 31328873 DOI: 10.1111/hdi.12769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/08/2019] [Accepted: 06/13/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Xingjuan Tao
- School of NursingShanghai Jiao Tong University Shanghai China
| | - Haifen Zhang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
| | - Yan Yang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
| | - Caihong Zhang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
| | - Min Wang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
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Kitamura M, Mochizuki Y, Kitamura S, Mukae Y, Nakanishi H, Ota Y, Muta K, Yamashita H, Obata Y, Iwata T, Nishikido M, Kawanami S, Takashima M, Sasaki H, Sakai H, Mukae H, Nishino T. Prediction of Nonadherence and Renal Prognosis by Pre-Transplantation Serum Phosphate Levels. Ann Transplant 2019; 24:260-267. [PMID: 31073118 PMCID: PMC6530439 DOI: 10.12659/aot.914909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Identifying characteristics of patients at high risk of poor adherence before transplantation would be advantageous. However, the optimal approach for characterizing such patients remains unknown. We aimed to evaluate the association between factors for hemodialysis nonadherence and post-transplant renal prognosis. We hypothesized that these factors would influence post-transplantation adherence and worsen renal prognosis. Material/Methods We reviewed patients on hemodialysis who underwent kidney transplantation at our hospital between 2000 and 2017 to identify risk factors associated with poor prognosis. The patients’ background and pre-transplantation data, known hemodialysis nonadherence factors, serum phosphate and potassium levels, and interdialytic weight gains were evaluated. The primary endpoint was renal death. We also evaluated the fluctuation of calcineurin inhibitor concentration and weight gain after transplantation. Results Seventy-seven patients were eligible, and the mean observational period was 83.2 months (standard deviation, 50.5). Thirteen patients reached the endpoint. Cox proportional hazards regression analysis showed that pre-transplantation serum phosphate level was a risk factor for renal death (p<0.05), while serum potassium levels and weight gain were not. In addition, fluctuation of calcineurin inhibitor concentration was observed in patients with higher phosphate levels before transplantation (p=0.03). Weight gain after transplantation was not associated with the hemodialysis nonadherence factors. Conclusions High pre-transplantation serum phosphate levels are considered to represent poor drug adherence and/or an unhealthy lifestyle. Patient education that conveys the importance of adhering to medications and provides nutritional guidance is crucial for improving post-transplantation renal prognosis.
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Affiliation(s)
- Mineaki Kitamura
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Yasushi Mochizuki
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Urology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Satoko Kitamura
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Yuta Mukae
- Department of Urology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Hiromi Nakanishi
- Department of Urology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Hiroshi Yamashita
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Yoko Obata
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Takahisa Iwata
- Department of Urology, Isahaya General Hospital, Isahaya, Nagasaki, Japan
| | | | - Sachiko Kawanami
- Department of Nursing, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Miwa Takashima
- Division of Dietary Service, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Hitoshi Sasaki
- Hospital Pharmacy, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Hideki Sakai
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Urology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
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Psychosocial Mediators between Socioeconomic Status and Dietary Restrictions among Patients Receiving Hemodialysis in Japan. Int J Nephrol 2019; 2019:7647356. [PMID: 31139469 PMCID: PMC6500646 DOI: 10.1155/2019/7647356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/31/2019] [Indexed: 11/24/2022] Open
Abstract
The generalizability of differences in dietary restrictions (DRs) as function of socioeconomic status (SES) and the pathways of the associations between SES and DRs remain unclear. Therefore, we aimed to explore SES differences in DRs and psychosocial mediators between SES and DRs in Japanese patients receiving hemodialysis. This study was a cross-sectional survey of 6,644 outpatients (average age = 66.5 years; 65% males) of hemodialysis facilities across Japan. DRs were assessed by self-reported and objective measures, and SES was assessed based on education and income. Three psychosocial mediators were used: self-efficacy, control expectancy, and social support. Indirect influences of SES through the mediators were evaluated with a multiple mediator model. Although higher education was significantly associated with higher self-reported DRs, higher income was significantly associated with lower self-reported DRs. Significant SES differences in objective DRs were not observed. The relationships between education and self-reported DRs and objective DRs were significantly mediated by self-efficacy and/or control expectancy. The influences of income were mediated by social support. It becomes possible to design interventions targeting modifiable psychosocial factors including self-efficacy, control expectancy, and social support in order to reduce SES inequalities in DRs.
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Morgan K, Jersey S, Mason B, Young A. Guidelines for review of patients on haemodialysis: Are we meeting patient needs? Nutr Diet 2019; 76:166-173. [DOI: 10.1111/1747-0080.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Kate Morgan
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Susan Jersey
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
- School of Exercise and Nutrition SciencesFaculty of Health, Queensland University of Technology Brisbane Queensland Australia
| | - Belinda Mason
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Adrienne Young
- Department of Nutrition and DieteticsRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
- School of Exercise and Nutrition SciencesFaculty of Health, Queensland University of Technology Brisbane Queensland Australia
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65
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Development and preliminary results on the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics. BMC Nephrol 2019; 20:48. [PMID: 30755163 PMCID: PMC6373020 DOI: 10.1186/s12882-019-1231-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/25/2019] [Indexed: 01/05/2023] Open
Abstract
Background Adherence to the diet prescription for chronic kidney disease is suboptimal. Interventions to improve dietary adherence suggest that improving communication between the patient and the health professional is fundamental to improving outcomes. Providing patients with a question prompt sheet prior to the consultation has been demonstrated to be an effective method for improving communication between patient and health professional. In the absence of a renal diet specific version, the aims of this study were to develop and test the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics. Methods Phase one utilized social listening methodology, online content analysis and clinic observations to obtain an extensive list of frequently asked questions about the renal diet. Following refinement with health professionals, the draft question prompt sheet was then sent in Phase two to patients one week prior to their scheduled consultation with the renal dietitian. Feedback was obtained from patients, carers and dietitians using semi structured interviews post clinic consultation. Quantitative data was analyzed using counts and proportions, while free text responses were analyzed thematically. Results A total of 769 unique renal diet related questions were reduced to an 18-item question prompt sheet. Feedback from thirteen patients (six males), six carers and six dietitians involved in the preliminary feasibility study was overwhelmingly positive. The majority of patients found the question prompt sheet to be easy to understand and agreed it facilitated communication with the dietitian. All participants agreed that they would recommend use of question prompt sheet to other patients. Suggestions for future use included health professional training in use of the sheet, particularly about how to help patients prioritize their most important questions. Conclusions The 18-item renal diet question prompt sheet developed in this preliminary study appears to be a feasible tool for use in nephrology consultations especially by dietitians. Further research quantifying the impact on question asking and patient centeredness should be undertaken. In addition, user testing with patients from culturally diverse and low literacy backgrounds would be useful. Electronic supplementary material The online version of this article (10.1186/s12882-019-1231-3) contains supplementary material, which is available to authorized users.
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66
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Carey S, Tu W, Hyde‐Jones L, Koh C. Assessing Patient Preferences for Intestinal Failure Management Using the Time Trade‐Off Methodology. JPEN J Parenter Enteral Nutr 2019; 43:912-917. [DOI: 10.1002/jpen.1506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/03/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Sharon Carey
- Royal Prince Alfred Hospital Sydney Australia
- University of Sydney Sydney Australia
| | - Wendy Tu
- University of Sydney Sydney Australia
| | | | - Cherry Koh
- Royal Prince Alfred Hospital Sydney Australia
- University of Sydney Sydney Australia
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67
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Lambert K, Mansfield K, Mullan J. How do patients and carers make sense of renal dietary advice? A qualitative exploration. J Ren Care 2018; 44:238-250. [DOI: 10.1111/jorc.12260] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital; Illawarra Shoalhaven Local Health District; Wollongong New South Wales Australia
| | - Kylie Mansfield
- Graduate Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong New South Wales Australia
| | - Judy Mullan
- Graduate Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong New South Wales Australia
- Director Illawarra Health Information Platform, Australian Health Services Research Institute; University of Wollongong; Wollongong New South Wales Australia
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Umeukeje EM, Mixon AS, Cavanaugh KL. Phosphate-control adherence in hemodialysis patients: current perspectives. Patient Prefer Adherence 2018; 12:1175-1191. [PMID: 30013329 PMCID: PMC6039061 DOI: 10.2147/ppa.s145648] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges. METHODS A literature search including the terms "phosphorus", "phosphorus control", "hemo-dialysis", "phosphate binder medications", "phosphorus diet", "adherence", and "nonadherence" was undertaken using PubMed, PsycInfo, CINAHL, and Embase. RESULTS Hyperphosphatemia is associated with cardiovascular and all-cause mortality in dialysis patients. Management of hyperphosphatemia depends on phosphate binder medication therapy, a low-phosphorus diet, and dialysis. Phosphate binder therapy is associated with a survival benefit. Dietary restriction is complex because of the need to maintain adequate protein intake and, alone, is insufficient for phosphorus control. Similarly, conventional hemodialysis alone is insufficient for phosphorus control due to the kinetics of dialytic phosphorus removal. Thus, all three treatment approaches are important contributors, with dietary restriction and dialysis as adjuncts to the requisite phosphate binder therapy. Phosphate-control adherence rates are suboptimal and are influenced directly by patient, provider, and phosphorus-control strategy-related factors. Psychosocial factors have been implicated as influential "drivers" of adherence behaviors in dialysis patients, and factors based on self-motivation associate directly with adherence behavior. Higher-risk subgroups of nonadherent patients include younger dialysis patients and non-whites. Provider attitudes may be important - yet unaddressed - determinants of adherence behaviors of dialysis patients. CONCLUSION Adherence to phosphate binders, low-phosphorus diet, and dialysis prescription is suboptimal. Multicomponent strategies that concurrently address therapy-related factors such as side effects, patient factors targeting self-motivation, and provider factors to improve attitudes and delivery of culturally sensitive care show the most promise for long-term control of phosphorus levels. Moreover, it will be important to identify patients at highest risk for lack of control, and for programs to be ready to deliver flexible person-centered strategies through training and dedicated resources to align with the needs of all patients.
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Affiliation(s)
- Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
| | - Amanda S Mixon
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
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69
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Lambert K, Mansfield K, Mullan J. Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet. Nutr Diet 2018; 76:126-134. [PMID: 29968271 DOI: 10.1111/1747-0080.12443] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
AIM Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet. METHODS Semi-structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. RESULTS Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process. CONCLUSIONS The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kylie Mansfield
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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70
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Stevenson J, Tong A, Gutman T, Campbell KL, Craig JC, Brown MA, Lee VW. Experiences and Perspectives of Dietary Management Among Patients on Hemodialysis: An Interview Study. J Ren Nutr 2018; 28:411-421. [PMID: 29691161 DOI: 10.1053/j.jrn.2018.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/05/2018] [Accepted: 02/16/2018] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Diet and fluid management can reduce mortality, serious comorbidities, and debilitating symptoms in patients on hemodialysis, but restrictions may also be a major burden, and nonadherence remains high. We aimed to describe the perspectives and experiences of patients on hemodialysis regarding their dietary management to understand both facilitators and barriers to adherence and to identify strategies to improve care. DESIGN AND METHODS Semi-structured interviews were conducted with 35 people on maintenance hemodialysis from six dialysis units in New South Wales, Australia. Transcripts were thematically analyzed using principles of grounded theory. RESULTS We identified 5 major themes. Two themes reflect barriers to dietary change: exacerbating disruption (adding to treatment burden, contradicting healthy eating, confused by fragmented advice, conflicting cultural norms, changing appetite and palate, isolation from family and friends) and losing control (crises derailing discipline, frustrated by failure, combating bodily need for hydration). Three themes represent enablers for dietary change: attaining health benefits (avoiding medical catastrophes, enhancing benefits of dialysis, alleviating and managing symptoms, improving health), achieving treatment goals (building familiarity and acceptance, flexibility and moderation, taking personal responsibility), and succeeding withsupport (leaning on family for strength, trusting expert guidance, empowered with flexible and practical advice, relying on reminders and cues, motivation through shared experience). CONCLUSIONS Patients on hemodialysis believe dietary control helps to reduce symptom burden and enhance general health and well-being, but competing medical and social issues coupled with contradictory and/or irrelevant dietary advice prevents them from implementing diet and fluid restrictions. Interventions involving collaborative multidisciplinary care including clinicians with dietetic expertise, and consistent information that addresses cultural and personal circumstances, may support adherence to dietary recommendations and improve outcomes.
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Affiliation(s)
- Jessica Stevenson
- Western Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Vincent W Lee
- Western Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
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