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Ouirdani M, Boutib A, Azizi A, Chergaoui S, Saad EM, Hilali A, Marfak A, Youlyouz-Marfak I. Impact of Nutrition Education on Various Health-Related Components of Hemodialysis Patients: A Systematic Review. Healthcare (Basel) 2024; 12:1197. [PMID: 38921311 PMCID: PMC11203892 DOI: 10.3390/healthcare12121197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
This study aimed to identify the impact of nutrition education on various health-related components of hemodialysis patients. A systematic review was conducted according to the PRISMA guidelines. Relevant literature published between 2013 and 2023 was identified across two databases (PubMed and Science Direct). The protocol was registered in PROSPERO (CRD42023460681). Two independent reviewers retrieved the data, and 41 studies were selected. Nine components related to the impact of nutrition education in hemodialysis patients were identified. Each component was clarified by mentioning each study and its results. This study enabled us to characterize the various components of the impact of nutritional education in hemodialysis patients, namely biological markers, quality of life, cost of care, adherence to dietary recommendations, knowledge, malnutrition inflammation, dietary intake, weight change, and behavior change. This systematic review enables healthcare providers to assess the impact of nutritional education on hemodialysis patients. Also, it gives professionals an exact idea of the impact of nutrition education on hemodialysis patients, with knowledge of new methods using behavior change theories and innovative technological tools.
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Affiliation(s)
- Marouane Ouirdani
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Amal Boutib
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Asmaa Azizi
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Samia Chergaoui
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - El Madani Saad
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Abderraouf Hilali
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Abdelghafour Marfak
- National School of Public Health, Ministry of Health and Social Protection, Rabat 6329, Morocco;
- Pole of Health, Euro-Mediterranean University of Fez (UEMF), Fez 51, Morocco
| | - Ibtissam Youlyouz-Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
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Taylor KS, Umeukeje EM, Santos SR, McNabb KC, Crews DC, Hladek MD. Context Matters: A Qualitative Synthesis of Adherence Literature for People on Hemodialysis. KIDNEY360 2023; 4:41-53. [PMID: 36700903 PMCID: PMC10101575 DOI: 10.34067/kid.0005582022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with ESKD treated with hemodialysis in the United States have persistently higher rates of nonadherence compared with patients in other developed countries. Nonadherence is associated with an increased risk of death and higher medical expenditure. There is an urgent need to address it with feasible, effective interventions as the prevalence of patients on hemodialysis in the United States continues to grow. However, published adherence interventions demonstrate limited long-term efficacy. METHODS We conducted a synthesis of qualitative studies on adherence to hemodialysis treatment, medications, and fluid and dietary restrictions to identify gaps in published adherence interventions, searching PubMed, CINAHL, PsychInfo, Embase, and Web of Science databases. We analyzed qualitative data with a priori codes derived from the World Health Organization's adherence framework and subsequent codes from thematic analysis. RESULTS We screened 1775 articles and extracted qualitative data from 12. The qualitative data revealed 20 factors unique to hemodialysis across the World Health Organization's five dimensions of adherence. In addition, two overarching themes emerged from the data: (1) adherence in the context of patients' whole lives and (2) dialysis treatment as a double-edged sword. Patient-level factors reflected in the qualitative data extended beyond knowledge about hemodialysis treatment or motivation to adhere to treatment. Patients described a profound grieving process over the loss of their "old self" that impacted adherence. They also navigated complex challenges that could be exacerbated by social determinants of health as they balanced treatment, life tasks, and social roles. CONCLUSIONS This review adds to the growing evidence that one-size-fits-all approaches to improving adherence among patients on hemodialysis are inadequate. Adherence may improve when routine care incorporates patient context and provides ongoing support to patients and families as they navigate the logistical, physical, and psychological hardships of living with dialysis. New research is urgently needed to guide a change in course.
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Affiliation(s)
| | - Ebele M. Umeukeje
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sydney R. Santos
- Behavioral Biology, Johns Hopkins University, Baltimore, Maryland
| | | | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bossola M, Pepe G, Antocicco M, Severino A, Di Stasio E. Interdialytic weight gain and educational/cognitive, counseling/behavioral and psychological/affective interventions in patients on chronic hemodialysis: a systematic review and meta-analysis. J Nephrol 2022; 35:1973-1983. [PMID: 36112313 PMCID: PMC9584995 DOI: 10.1007/s40620-022-01450-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This work aimed to shed light on the notorious debate over the role of an educational/cognitive/behavioral or psychological approach in the reduction of interdialytic weight gain (IDWG) in patients on chronic hemodialysis. METHODS Searches were run from 1975 to January 2022 on Medline, PubMed, Web of Science, and the Cochrane Library. The search terms included "hemodialysis/haemodialysis" AND "adherence" AND ("fluid intake" OR "water intake") AND ("weight gain" OR "interdialytic weight gain" OR "IDWG") AND "patient-level interventions. Randomized controlled studies were eligible if they were in English, published in a peer-reviewed journal and regarded adults patients with on chronic hemodialysis for at least 6 months; compared educational/cognitive and/or counseling/behavioral or psychological interventions to no intervention on interdialytic weight gain. Outcome of interest was interdialytic weight gain. The review was registered on the International Prospective Register of Systematic Reviews in Health and Social Care (PROSPERO, ID number CRD42022332401). RESULTS Eighteen studies (1759 patients) were included in the analysis. Compared to the untreated group, educational/cognitive and/or counseling/behavioral interventions significantly reduced interdialytic weight gain with a pooled mean difference of - 0.15 kg (95% CI - 0.26, 30-0.05; P = 0.004). On the other hand, psychological/affective interventions reduced interdialytic weight gain with a pooled mean difference of - 0.26 kg (95% CI - 0.48, - 0.04; P = 0.020). CONCLUSIONS Educational/cognitive, counseling/behavioral or psychological/affective interventions significantly reduced the interdialytic weight gain in patients on chronic hemodialysis, although such reduction did not appear to be clinically relevant on hard outcomes.
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Gilda Pepe
- Servizio Emodialisi, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuela Antocicco
- Dipartimento Scienze Dell'invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Rome, Italy
| | - Altea Severino
- Dipartimento di Scienze biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Di Stasio
- Dipartimento di Scienze biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie Università Cattolica del Sacro Cuore, Rome, Italy
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Kim H, Jeong IS, Cho MK. Effect of Treatment Adherence Improvement Program in Hemodialysis Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11657. [PMID: 36141929 PMCID: PMC9517018 DOI: 10.3390/ijerph191811657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Herein, we performed a meta-analysis evaluating the effects of treatment adherence enhancement programs on treatment adherence and secondary outcomes for hemodialysis patients. Twenty-five Korean and international articles published prior to 31 March 2022 were selected following the PRISMA and Cochrane Systematic Review guidelines. We calculated summary effect sizes, conducted homogeneity and heterogeneity testing, constructed a funnel plot, and performed Egger's regression test, Begg's test, trim-and-fill method, subgroup analyses, and univariate meta-regression. The overall effect of treatment adherence enhancement programs for hemodialysis patients was statistically significant (Hedges' g = 1.10, 95% CI: 0.77, 1.43). On performing subgroup analysis to determine the cause of effect size heterogeneity, statistically significant moderating effects were found for a range of input variables (Asian countries, study centers, sample size, study design, intervention types, number of sessions, quality assessment scores, funding, and evidence-based interventions). On univariate meta-regression, larger synthesized effect sizes were found for a range of study characteristics (Asian populations, single-center studies, studies with <70 participants, quasi-experimental studies, educational interventions, studies with >12 sessions, studies with quality assessment scores above the mean, unfunded studies, and non-theory-based interventions). Our results provide evidence-based information for enhancing program efficacy when designing treatment adherence enhancement programs for hemodialysis patients.
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Sawma T, Sanjab Y. The association between sense of coherence and quality of life: a cross-sectional study in a sample of patients on hemodialysis. BMC Psychol 2022; 10:100. [PMID: 35428334 PMCID: PMC9013051 DOI: 10.1186/s40359-022-00805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients on hemodialysis universally experience detriments in their general quality of life (QOL). Sense of coherence (SOC) is a long-standing factor that affects QOL. Nevertheless, the association between SOC and QOL in patients on hemodialysis was seldom investigated. Our research aims to study this association in a sample of Lebanese adult patients on hemodialysis. Methods In this cross-sectional study, SOC was measured using the short version of the “Orientation of Life" scale (SOC-13). QOL was assessed using the Kidney Disease Quality of Life- Short Form (KDQOL-SF). The association between SOC and QOL and its submodalities was first explored using Pearson Correlation and multivariate linear regression analyses, controlling for sociodemographic variables and medical variables. Results 157 patients on hemodialysis (mean(SD) age: 62.1(13.81) years; 58.6% males) were included. Mean QOL score was 51.65 and that of SOC was 48.06. SOC was strongly corrected with the total QOL (r = 0.832; p value < 0.001), as well as its physical functioning (r = 0.767; p value < 0.001), emotional functioning (r = 0.757; p value < 0.001), cognitive functioning (r = 0.740; p value < 0.001), and social functioning (r = 0.773; p value < 0.001) submodailties. SOC was moderately correlated with professional functioning submodality of QOL (r = 0.618; p value < 0.001), but not correlated with the satisfaction with the quality of care (r = 0.052; p = 0.520). Within the regression models accounting for sociodemographic and medical variables, SOC was significantly associated with the total QOL (unstandardized B = 0.803; 95% CI 0.714, 0.893), physical functioning (unstandardized B = 0.761; standardized B = 0.763; 95% CI 0.661, 0.861), emotional functioning (unstandardized B = 1.205; standardized B = 0.757; 95% CI 1.037, 1.372), professional functioning (unstandardized B = 1.142; standardized B = 0.498; 95% CI 0.843, 1.442), cognitive functioning (unstandardized B = 1.239; standardized B = 0.739; 95% CI 1.058, 1.420), and social functioning (unstandardized B = 0.912; standardized B = 0.768; 95% CI 0.790, 1.034). Conclusions In a sample of adult patients on hemodialysis, SOC was positively significantly associated with QOL and its submodalities, expect the satisfaction with the quality of care. The confirmation of the general hypothesis that relates the SOC with the QOL encourages more salutogenic research among this patient population.
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Pahus J, Lindberg M, Finderup J, Ludvigsen MS. The Fluid Intake Appraisal Inventory for low fluid intake among patients on haemodialysis: Translation and psychometric evaluation of the Danish version. Scand J Caring Sci 2020; 35:1152-1159. [PMID: 33200436 DOI: 10.1111/scs.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To translate and evaluate the psychometric properties of a Danish version of the Fluid Intake Appraisal Inventory (Da-FIAI) regarding reliability and validity. BACKGROUND Patients on haemodialysis are advised to restrict their fluid intake, which often requires patients to change their way of life and health behaviour. DESIGN Cross-sectional study. METHODS The FIAI was translated to Danish by two sets of target translations and two sets of back-translations (n = 4). One hundred and ninety-five patients on haemodialysis needing ultrafiltration completed the questionnaire for the evaluation study of the Da-FIAI, and psychometric properties were evaluated. RESULTS Criterion validity was supported, and the Da-FIAI had an excellent internal consistency; known-groups validity and the factor structure could not be confirmed in the Danish sample. CONCLUSIONS We have shown that the Da-FIAI is useful in a Danish haemodialysis population to score the patient's ability to avoid drinking in specific situations. RELEVANCE TO CLINICAL PRACTICE Using the Da-FIAI in the continuing nurse-patient communication, nurses have a validated instrument to evaluate patients' self-efficacy in fluid intake management and systematically identify and advise patients who need additional support.
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Affiliation(s)
- Jytte Pahus
- Health and Welfare Technology, VIA University College, Silkeborg, Denmark
| | - Magnus Lindberg
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine, Randers Regional Hospital, Aarhus University, Aarhus, Denmark.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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Plumb TJ, Alvarez L, Ross DL, Lee JJ, Mulhern JG, Bell JL, Abra GE, Prichard SS, Chertow GM, Aragon MA. Self-care training using the Tablo hemodialysis system. Hemodial Int 2020; 25:12-19. [PMID: 33047477 PMCID: PMC7891342 DOI: 10.1111/hdi.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the training time required to be competent in self-care, the degree of dependence on health care workers and caregivers after training was complete, and participants' assessment of the ease-of-use of Tablo. METHODS We collected data on the time required to set up concentrates and the Tablo cartridge prior to treatment initiation. We asked participants to rate system setup, treatment, and takedown on a Likert scale from 1 (very difficult) to 5 (very simple) and if they had required any assistance with any aspect of treatment over the prior 7 days. In a subgroup of 15 participants, we recorded the number of training sessions required to be deemed competent to do self-care dialysis. FINDINGS Eighteen men and 10 women with a mean age of 52.6 years completed the study. Thirteen had previous self-care experience using a different dialysis system. Mean set up times for the concentrates and cartridge were 1.1 and 10.0 minutes, respectively. Participants with or without previous self-care experience had similar set-up times. The mean ease-of-use score was 4.5 or higher on a scale from 1 to 5 during the in-home phase. Sixty-five percent required no assistance at home and on average required fewer than four training sessions to be competent in managing their treatments. Results were similar for participants with or without previous self-care experience. CONCLUSIONS Participants in the Tablo IDE trial were able to quickly learn and manage hemodialysis treatments in the home, found Tablo easy to use, and were generally independent in performing hemodialysis.
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Affiliation(s)
- Troy J Plumb
- University of Nebraska, Nebraska Medical Center, Omaha, Nebraska, 68198, USA
| | - Luis Alvarez
- Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, California, 94301, USA
| | - Dennis L Ross
- Kansas Nephrology Research Institute, 1007 N. Emporia, Wichita, Kansas, 67214, USA
| | - Joseph J Lee
- Nephrology Associates Medical Group, 3660 Park Sierra #208, Riverside, California, 92505, USA
| | - Jeffrey G Mulhern
- Fresenius Kidney Care Pioneer Valley Dialysis, 208 Ashley Ave, West Springfield, Massachusetts, 01089, USA
| | - Jeffrey L Bell
- Southwest Georgia Nephrology Clinic, 1200 North Jefferson Street, Albany, Georgia, 31701, USA
| | - Graham E Abra
- Stanford University, 300 Pasteur Drive, 1st floor, Suite A175, Stanford, California, 94305, USA
| | | | - Glenn M Chertow
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, California, 94034, USA
| | - Michael A Aragon
- DaVita Grapevine at Home, 1600 W. Northwest Hwy, Suite 100, Grapevine, Texas, 76051, USA
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Murali KM, Lonergan M. Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients. Semin Dial 2020; 33:475-485. [DOI: 10.1111/sdi.12925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Maureen Lonergan
- Department of Nephrology Wollongong Hospital Wollongong NSW Australia
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Al-Jaishi AA, Carroll K, Goldstein CE, Dixon SN, Garg AX, Nicholls SG, Grimshaw JM, Weijer C, Brehaut J, Thabane L, Devereaux PJ, Taljaard M. Reporting of key methodological and ethical aspects of cluster trials in hemodialysis require improvement: a systematic review. Trials 2020; 21:752. [PMID: 32859245 PMCID: PMC7456003 DOI: 10.1186/s13063-020-04657-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022] Open
Abstract
Background The hemodialysis setting is suitable for trials that use cluster randomization, where intact groups of individuals are randomized. However, cluster randomized trials (CRTs) are complicated in their design, analysis, and reporting and can pose ethical challenges. We reviewed CRTs in the hemodialysis setting with respect to reporting of key methodological and ethical issues. Methods We conducted a systematic review of CRTs in the hemodialysis setting, published in English, between 2000 and 2019, and indexed in MEDLINE or Embase. Two reviewers extracted data, and study results were summarized using descriptive statistics. Results We identified 26 completed CRTs and five study protocols of CRTs. These studies randomized hemodialysis centers (n = 17, 55%), hemodialysis shifts (n = 12, 39%), healthcare providers (n = 1, 3%), and nephrology units (n = 1, 3%). Trials included a median of 28 clusters with a median cluster size of 20 patients. Justification for using a clustered design was provided by 15 trials (48%). Methods that accounted for clustering were used during sample size calculation in 14 (45%), during analyses in 22 (71%), and during both sample size calculation and analyses in 13 trials (42%). Among all CRTs, 26 (84%) reported receiving research ethics committee approval; patient consent was reported in 22 trials: 10 (32%) reported the method of consent for trial participation and 12 (39%) reported no details about how consent was obtained or its purpose. Four trials (13%) reported receiving waivers of consent, and the remaining 5 (16%) provided no or unclear information about the consent process. Conclusion There is an opportunity to improve the conduct and reporting of essential methodological and ethical issues in future CRTs in hemodialysis. Review Registration We conducted this systematic review using a pre-specified protocol that was not registered.
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Affiliation(s)
- Ahmed A Al-Jaishi
- Lawson Health Research Institute, London, ON, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. .,ICES, Toronto, Canada.
| | - Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Cory E Goldstein
- Department of Philosophy, Western University, London, ON, Canada
| | - Stephanie N Dixon
- Lawson Health Research Institute, London, ON, Canada.,ICES, Toronto, Canada.,Department Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada.,Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Amit X Garg
- Lawson Health Research Institute, London, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,ICES, Toronto, Canada.,Department Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Charles Weijer
- Department of Philosophy, Western University, London, ON, Canada.,Department Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Xing Z, Wang Y, Li H, Li Y, Wan Z, Sun D, Sun J. Theory-Based Interventions to Promote Fluid Intake Adherence Among Dialysis Patients: A Systematic Review. Res Theory Nurs Pract 2020; 33:357-391. [PMID: 31666394 DOI: 10.1891/1541-6577.33.4.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Dialysis involves a complex regimen including diet, fluid, medication, and treatment. Therapeutic regimen adherence determines the therapeutic success, quality of life, and survival of patients on dialysis. Complying with fluid management is the most difficult among the therapeutic regimen. Several theory-based interventions have been designed to promote fluid intake compliance in patients receiving dialysis. This review has two aims. One is to explore the effectiveness of theory-based interventions. The other is to examine the extent of the combination of theory and interventions in improving adherence to fluid intake among dialysis patients. METHODS A literature review was performed using PubMed, PsycINFO, Embase, Web of Science, and the Cochrane Library to acquire associated studies. Data were extracted independently by two researchers. The degree of theory application was accessed using a theory coding scheme (TCS). RESULTS Eight studies were identified as eligible for inclusion, and five theories were cited as basis (health belief model, social cognitive theory, self-regulation model, transtheoretical model). According to the TCS, adherence outcomes and the extent of theory use were not optimal. IMPLICATIONS FOR PRACTICE Combining theory with patient health education might be beneficial in improving fluid intake adherence of dialysis patients. The framework and TCS could be considered to guide theory utilization and promote nursing education in improving the quality of renal nursing care.
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Affiliation(s)
- Zhuangjie Xing
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China.,Department of Intensive Care Unit, Linyi City People Hospital, Linyi, China
| | - Yonghong Wang
- Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Huanhuan Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Yuan Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Zhenzhen Wan
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Dan Sun
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Jiao Sun
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
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Yoowannakul S, Vongsanim S, Tangvoraphonkchai K, Mohamed A, Davenport A. Falls in systolic blood pressure during dialysis which require no nursing intervention are associated with increased patient intra-dialytic symptom self-reporting and prolonged post-dialysis recovery times. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-019-0249-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
Haemodialysis (HD) patients may suffer symptoms during dialysis and take time to recover post HD. We wished to determine whether patients with symptomatic intra-dialytic hypotension (IDH), requiring nursing interventions, or an asymptomatic fall in systolic blood pressure (SBP) reported more symptoms during dialysis.
Methods
Six hundred three HD patients completed self-reported intra-dialytic symptom questionnaires and recovery using a visual analogue scale, which were compared with their dialysis session records.
Results
Twenty-nine (4.8%) of patients suffered symptomatic IDH, and 187 (31.0%) had a fall in SBP of > 20 mmHg. Symptomatic patients had greater total symptom scores (30 (23–44) vs 23 (10–38), p < 0.05, versus asymptomatic patients, with increased low blood pressure, dizziness, cramps, palpitations and feeling cold reported (all p < 0.05). Patients with a SBP fall of > 20 mmHg had greater total scores compared with those with a SBP increase of > 10 mmHg (26 (13–38) vs 17 (7–34), p < 0.05), with more dizziness, cramps, backache, shortness of breath and headache reported (all p < 0.05). Although ultrafiltration rates were similar, HD weight loss was greater for patients with a SBP fall of > 20 mmHg (2.5 ± 1.1 vs 2.0 ± 1.3%, p < 0.05). Patients with highest symptoms scores (highest vs lowest quartile) had longer recovery times (40.3 vs 7.6% > 4 h), p < 0.001.
Multivariable analysis showed that patients reporting more intradialytic symptoms had higher psychological distress thermometer scores (odds ratio (OR) 1.34 (95% confidence limits 1.26–1.44)), systolic blood pressure < 100 mmHg (OR 2.53 (1.04–6.1)), whereas symptom scores were lower for male gender (OR 0.34 (0.22–0.51)), and with increasing age (OR 0.99 (0.97–0.99)).
Conclusion
Patients with both symptomatic and asymptomatic IDH, self-reported more symptoms during dialysis, and those patients reporting more symptoms had longer recovery times. We found that younger, female patients, those with greater psychological distress, and lower systolic blood pressure self-reported more intra-dialytic symptoms. More attention is required to prevent falls in intra-dialytic blood pressure to improve the patient experience of HD and shorten post-dialysis recovery times.
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Maharjan SRS, Davenport A. The effects of supported shared‐care and hemodialysis self‐care on patient psychological well‐being, interdialytic weight gain, and blood pressure control. Hemodial Int 2019; 24:29-35. [DOI: 10.1111/hdi.12799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - Andrew Davenport
- UCL Department of NephrologyRoyal Free Hospital, University College London London NW3 2PF UK
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13
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Ren Q, Lian M, Liu Y, Thomas-Hawkins C, Zhu L, Shen Q. Effects of a transtheoretical model-based WeChat health education programme on self-management among haemodialysis patients: A longitudinal experimental intervention study. J Adv Nurs 2019; 75:3554-3565. [PMID: 31441525 DOI: 10.1111/jan.14182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 07/12/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
AIM To examine the effects of a transtheoretical model-based WeChat health education programme on self-management in haemodialysis patients in China. DESIGN A longitudinal experimental intervention study. METHODS Patients (N = 120) who underwent haemodialysis from December 2015-November 2017 were recruited and randomly allocated to either group 1 (who received a 3-month WeChat health education immediately after randomization) or group 2 (who was combined with group 1 and received the same intervention at the 5th month after enrolment in the study). Self-management, knowledge and self-efficacy were assessed at baseline (T0 ), 3 months after enrolment in the study (T1 ), 21 months after enrolment in the study (T2 ). RESULTS There were significant group effects on self-efficacy; time effects on partnership, self-care, emotion management with total self-management; interaction effects on problem-solving and emotion management within total self-management according to the two-way repeated measures ANCOVA. Further between-group comparisons indicated that patients in group 1 had better self-management than those in group 2 at T1 . Within-group comparisons demonstrated that, compared with the baseline values, group 1 had significantly improved self-management at T1 ; however, group 2 had improved self-management at T2 . CONCLUSION The transtheoretical model-based WeChat health education programme had a potentially positive effect on improving the self-management of haemodialysis patients. IMPACT Self-management is often difficult yet crucial for haemodialysis patients. This study indicated that the transtheoretical model-based WeChat health education resulted in improved self-management in haemodialysis patients and can be implemented in continuing care during the interdialysis period to improve self-management in patients. TRIAL REGISTRATION ChiCTR1800018172.
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Affiliation(s)
- Qingli Ren
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China.,Nursing College, Shanxi Medical University, Taiyuan, China
| | - Minling Lian
- Kidney Medical Ward, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yang Liu
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China
| | | | - Lixia Zhu
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qu Shen
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China
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Pereira CV, Leite ICG. Qualidade de vida relacionada à saúde de pacientes em terapêutica hemodialítica. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo identificar e mensurar fatores associados à qualidade de vida relacionada à saúde de pacientes renais crônicos em hemodiálise e analisar a associação da qualidade de vida relacionada à saúde e a adesão ao regime terapêutico hemodialítico. Métodos Estudo transversal com 258 pacientes em terapia hemodialítica. Avaliou-se a qualidade de vida relacionada à saúde através do questionário Kidney Disease Quality of Life Short Form. Foram analisados os componentes específicos da doença renal crônica e os componentes sumarizados físico e mental. A análise da não adesão ao regime terapêutico hemodialítico teve como base os indicadores do estudo The Dialysis Outcomes and Practice Patterns Study. Utilizaram-se, para a análise os testes de Mann Whitney e Kruskal Wallis. Resultados Indivíduos do sexo feminino, com menos de 60 anos, brancos, baixo nível socioeconômico, que necessitam de acompanhante, em terapia hemodialítica por menos de 5 anos, que possuem prescrição medicamentosa com dez ou mais fármacos, com baixos níveis séricos de albumina e hemoglobina e que não aderiram à restrição hídrica e à terapia apresentaram piora na qualidade de vida relacionada à saúde. Conclusão A avaliação da qualidade de vida relacionada à saúde dos pacientes em hemodiálise apresentou associação com as características sociodemográficas, clínicas e terapêutica. A monitoração desses parâmetros, bem como a busca do alcance dos padrões recomendáveis poderão subsidiar a prática clínica, aprimorar o planejamento assistencial e trazer melhorias em diversos aspectos da vida dos pacientes.
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15
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Glyde M, Keane D, Dye L, Sutherland E. Patients' perceptions of their experience, control and knowledge of fluid management when receiving haemodialysis. J Ren Care 2019; 45:83-92. [PMID: 30938066 DOI: 10.1111/jorc.12275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Person-centred care is increasingly promoted, empowering patients to become more involved in their treatment rather than being passive recipients of care (Barnes et al. 2013). Haemodialysis is typically required three times a week, with fluid management decision-making occurring at each treatment session (Ahmed et al. 2017). However, no research has yet explored how haemodialysis patients' perceptions of their fluid management may impact upon this decision-making. OBJECTIVES This study sought to explore patients' perceptions of their fluid management. METHOD DESIGN, PARTICIPANTS & APPROACH: Semi-structured interviews were conducted with 12 patients undergoing in-hospital haemodialysis treatment. These were digitally recorded one-to-one interviews to allow for verbatim transcription. The data was analysed by thematic analysis, generating thematic patterns across patients' experiences, control and knowledge of their fluid management. RESULTS Five themes were produced: determining who has the expertise, impediments affecting patients' lifestyle, additional difficulty of experiencing comorbidities, perceived quality of care, and establishing consistency. CONCLUSIONS Despite varied levels of patient participation in their treatment, overall there appears to be a limited understanding of specific areas of fluid management. The implications for further research and the development of shared-care are discussed.
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Affiliation(s)
- Megan Glyde
- School of Psychology, University of Leeds, Leeds, UK
| | - David Keane
- St. James' Hospital, Renal Medicine, Renal Research, Leeds, UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, UK
| | - Ed Sutherland
- School of Psychology, University of Leeds, Leeds, UK
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16
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Murali KM, Mullan J, Roodenrys S, Hassan HC, Lambert K, Lonergan M. Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials. PLoS One 2019; 14:e0211479. [PMID: 30695068 PMCID: PMC6350978 DOI: 10.1371/journal.pone.0211479] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/18/2018] [Indexed: 12/21/2022] Open
Abstract
Background In patients with end stage kidney disease (ESKD) on dialysis, treatment non-adherence is common and results in poor health outcomes. However, the clinical benefits of interventions to improve adherence in dialysis patients are difficult to evaluate since trialled interventions and reported outcomes are highly diverse/ heterogeneous. This review summarizes existing literature on randomized controlled trials (RCTs) evaluating adherence interventions in ESKD patients focusing on the intervention category, outcome efficacy and persistence of benefit beyond the intervention. Methods We performed electronic database searches in Medline, Embase & Cochrane CENTRAL upto 1st July 2018 for RCTs evaluating interventions to improve diet, fluid, medication or dialysis adherence in ESKD patients. Study characteristics including category of interventions, outcomes, efficacy and follow-up were assessed. Meta-analysis was used to compute pooled estimates of the effects on the commonest reported outcome measures. Results From 1311 citations, we included 36 RCTs (13 cluster-randomized trials), recruiting a total of 3510 dialysis patients (mean age 55.1 ± 5.8 years, males 58.1%). Overall risk of bias was ‘high’ for 24 and of ‘some concern’ for 12 studies. Most interventions (33 trials, 92%) addressed patient related factors, and included educational/cognitive (N = 11), behavioural / counselling (N = 4), psychological/affective (N = 4) interventions or a combination (N = 14) of the above. A majority of (28/36) RCTs showed improvement in some reported outcomes. Surrogate measures like changes in phosphate (N = 19) and inter-dialytic weight gain (N = 15) were the most common reported outcomes and both showed significant improvement in the meta-analysis. Sixteen trials reported follow-up (1–12 months) beyond intervention and the benefits waned or were absent in nine trials within 12 months post-intervention. Conclusions Interventions to improve treatment adherence result in modest short-term benefits in surrogate outcome measures in dialysis patients, but significant improvements in trial design and outcome reporting are warranted to identify strategies that would achieve meaningful and sustainable clinical benefits. Limitations Poor methodological quality of trials. Frequent use of surrogate outcomes measures. Low certainly of evidence.
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Affiliation(s)
- Karumathil M. Murali
- Department of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
- * E-mail:
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, NSW, Australia
| | - Steven Roodenrys
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Hicham C. Hassan
- Department of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Kelly Lambert
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, NSW, Australia
| | - Maureen Lonergan
- Department of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
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Hamilton AJ, Caskey FJ, Casula A, Inward CD, Ben-Shlomo Y. Associations with Wellbeing and Medication Adherence in Young Adults Receiving Kidney Replacement Therapy. Clin J Am Soc Nephrol 2018; 13:1669-1679. [PMID: 30327297 PMCID: PMC6237074 DOI: 10.2215/cjn.02450218] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Young adults receiving kidney replacement therapy (KRT) have impaired quality of life and may exhibit low medication adherence. We tested the hypothesis that wellbeing and medication adherence are associated with psychosocial factors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a cross-sectional online survey for young adults on KRT. Additional clinical information was obtained from the UK Renal Registry. We compared outcomes by treatment modality using age- and sex-adjusted regression models, having applied survey weights to account for response bias by sex, ethnicity, and socioeconomic status. We used multivariable linear regression to examine psychosocial associations with scores on the Warwick-Edinburgh Mental Wellbeing Scale and the eight-item Morisky Medication Adherence Scale. RESULTS We recruited 976 young adults and 64% responded to the survey; 417 (71%) with transplants and 173 (29%) on dialysis. Wellbeing was positively associated with extraversion, openness, independence, and social support, and negatively associated with neuroticism, negative body image, stigma, psychologic morbidity, and dialysis. Higher medication adherence was associated with living with parents, conscientiousness, physician access satisfaction, patient activation, age, and male sex, and lower adherence was associated with comorbidity, dialysis, education, ethnicity, and psychologic morbidity. CONCLUSIONS Wellbeing and medication adherence were both associated with psychologic morbidity in young adults. Dialysis treatment is associated with poorer wellbeing and medication adherence.
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Affiliation(s)
- Alexander James Hamilton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom; and
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- United Kingdom Renal Registry, Bristol, United Kingdom; and
| | - Anna Casula
- United Kingdom Renal Registry, Bristol, United Kingdom; and
| | - Carol D Inward
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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18
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Bossola M, Pepe G, Vulpio C. The Frustrating Attempt to Limit the Interdialytic Weight Gain in Patients on Chronic Hemodialysis: New Insights Into an Old Problem. J Ren Nutr 2018; 28:293-301. [DOI: 10.1053/j.jrn.2018.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 01/10/2023] Open
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Tangvoraphonkchai K, Davenport A. Extracellular Water Excess and Increased Self-Reported Fatigue in Chronic Hemodialysis Patients. Ther Apher Dial 2018; 22:152-159. [DOI: 10.1111/1744-9987.12648] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/25/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - Andrew Davenport
- UCL Centre for Nephrology; Royal Free Hospital, University College London; London UK
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20
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Keyworth C, Hart J, Thoong H, Ferguson J, Tully M. A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe. JMIR Hum Factors 2017; 4:e17. [PMID: 28765104 PMCID: PMC5558044 DOI: 10.2196/humanfactors.7153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/23/2017] [Accepted: 04/20/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. OBJECTIVE Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. METHODS Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. RESULTS MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use "If-Then" plans for patient management. Technology, as opposed to other methods of learning (eg, traditional "paper based" learning), was seen as a positive advancement for continued learning. CONCLUSIONS MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers' training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jo Hart
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Hong Thoong
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jane Ferguson
- Health Management Group, Alliance Manchester Business School, Faculty of Humanities, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mary Tully
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Effects of self-management on chronic kidney disease: A meta-analysis. Int J Nurs Stud 2017; 74:128-137. [PMID: 28689160 DOI: 10.1016/j.ijnurstu.2017.06.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Self-management programs may facilitate the improvement of outcomes in medical, role, and emotional management and health-related quality of life in patients with chronic kidney disease. Studies on the effect of three self-management tasks have reported conflicting findings. In addition, systematic reviews are unavailable. OBJECTIVE This study evaluated the effects of self-management programs on medical, role, and emotional management and health-related quality of life in chronic kidney disease. DESIGN Meta-analysis of randomized controlled studies. DATA SOURCES The meta-analysis involved an online search of the English literature from PubMed, Cochrane, Web of Science, and CINAHL and the Chinese literature from the Airiti Library that were published from the inception of the websites until January 1, 2017. REVIEW METHODS The meta-analysis was conducted to evaluate the effects of self-management on chronic kidney disease outcomes. Electronic databases were searched by using keywords: chronic kidney disease, end-stage renal disease, renal failure, dialysis, self-management, self-efficacy, empowerment, cognitive behavioral, and educational. The methodological quality of randomized controlled trials was assessed using the Cochrane Handbook. Data were analyzed using Comprehensive Meta-Analysis software 2.0. RESULTS Eighteen randomized controlled trials met our inclusion criteria. The results revealed that the self-management program significantly enhanced the effects of self-management on outcomes of medical, role, and emotional management and health-related quality of life in patients with chronic kidney disease. The following Hedges' g (effect size) values were obtained: (1) interdialytic weight gain, -0.36 (95% confidence interval, -0.60 to -0.12, p<0.01); (2) self-efficacy, 0.57 (95% confidence interval, 0.18-0.96, p<0.01); (3) anxiety, -0.95 (95% confidence interval, -1.65 to -0.25, p=0.01); (4) depression, -0.63 (95% confidence interval, -0.85 to -0.41, p<0.01) (5) health-related quality of life for the mental component of the SF-36, 0.71 (95% confidence interval, 0.45-0.97, p<0.01); (6) the physical component of the SF-36, 0.61 (95% confidence interval, 0.35-0.86, p<0.01); and (7) the Kidney Disease Quality of Life, 0.41 (95% confidence interval, 0.17-0.65, p<0.01). DISCUSSION This study revealed a small effect of self-management on interdialytic weight gain; medium effects on self-efficacy, depression, and health-related quality of life; and a large effect on anxiety. However, high-quality randomized controlled trial designs are required to confirm these results, although the existing evidence can guide clinical practitioners and health policy makers.
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Gkza A, Davenport A. Estimated dietary sodium intake in haemodialysis patients using food frequency questionnaires. Clin Kidney J 2017; 10:715-720. [PMID: 28979785 PMCID: PMC5622899 DOI: 10.1093/ckj/sfx037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/04/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In clinical practice, dietary sodium assessment requires reliable and rapid screening tools. We wished to evaluate the usefulness of food frequency questionnaires (FFQ) in estimating dietary sodium intakes in haemodialysis patients. METHODS We used the Derby Salt Questionnaire (DSQ), and Scored Sodium Questionnaire (SSQ) to estimate sodium intake. Body composition was determined by bioimpedance. RESULTS In total, 139 haemodialysis patients (95 men) completed the FFQs, with mean ± standard deviation age 67 ± 15 years. The mean FFQ scores were DSQ 3.5 ± 2.0 and SSQ 68.4 ± 24.5. Men had higher estimated dietary sodium intakes [DSQ median (range) 3.6 (0.6-10.1) versus female 2.2 (0.5-9.1), P = 0.007)]. Younger patients and those aged >75 years had the higher SSQ dietary sodium scores; 70.7 ± 27.8 and 76.8 ± 24.6 versus those aged 55-75 years, 61.8 ± 22.3, P = 0.04. Patients with greater estimated sodium intake had higher extracellular water (ECW) to intracellular water (ICW) ratios pre-dialysis [75.1 ±12.5 versus 67.7 ± 4.8, P < 0.001] and ECW excess pre-dialysis [1.8 (1.5-2.6) versus 1.3 (0.8-2.0) L, P < 0.05]. Mean arterial pressure (MAP) and inter-dialytic weight gains did not differ; however, the fall in MAP during dialysis was lower in the higher estimated dietary sodium group (0.9 ± 13.7% versus 6.5 ± 14.1%, P = 0.04). CONCLUSIONS Both questionnaires were acceptable to patients and identified higher estimated dietary sodium intake for men, those with greater ECW and, somewhat surprisingly, we found that older patients had a greater dietary sodium intake than expected.
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Affiliation(s)
- Anastasia Gkza
- Department of Nutrition, University College London, London, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
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Bradbury D, Upsher R, Chilcot J. A pilot randomised test of a self-affirmation implementation intention intervention to reduce dietary salt intake. J Health Psychol 2016; 23:765-775. [DOI: 10.1177/1359105316650511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-affirmation may reduce defensive processing towards health messages. We tested the effects of a self-affirmation implementation intentional intervention with regard to salt risk message acceptance, estimates of daily-recommended intake and self-reported intake. Participants ( n = 65) who consumed over 6 g/day of salt were randomised into three conditions: self-affirmation, self-affirming implementation intention and control. Participants attended the laboratory and completed a 2-week follow-up. There was no effect of the condition on message acceptance, salt estimation and 2-week salt intake. Across conditions, 2-week salt intake was reduced. We found no evidence for either intervention with regard to salt risk message acceptance and behaviour change.
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Affiliation(s)
- Daisy Bradbury
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
| | - Rebecca Upsher
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
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