1
|
Wu YY, Li JY, Xia QJ, Gao YY, Zhang C, Xu PJ, Liu J, Zhang HJ, Yu RZ. Analysis of Risk Factors of Sarcopenia in Patients with Maintenance Hemodialysis and Its Correlation with Emotional Status and Quality of Life. J Multidiscip Healthc 2024; 17:3743-3751. [PMID: 39104383 PMCID: PMC11299645 DOI: 10.2147/jmdh.s469900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/21/2024] [Indexed: 08/07/2024] Open
Abstract
Objective Sarcopenia is more common in maintenance hemodialysis (MHD) patients, and the aim of this study is to analyze the risk factors associated with sarcopenia in MHD patients, along with its correlation to emotional status and quality of life. Methods This is a cross-sectional cohort study. A total of 111 MHD patients who were treated in the Department of Nephrology of our hospital were selected as the study subjects by convenience sampling. The quality of life and emotional status were evaluated by health survey scale (SF-36), self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Regression analysis was used to explore the influencing factors of sarcopenia. Correlation analysis was used to investigate the correlation between sarcopenia and quality of life and emotional status. Results The prevalence of sarcopenia was 59.8%. The results showed that age, gender, body mass index (BMI), dialysis time, economic status, marital status and pre-dialysis creatinine were significant factors affecting the development of sarcopenia in hemodialysis patients (p<0.05). The SF-36 total score was significantly lower in the sarcopenia group (72.05±12.28 vs 78.03±10.55) than in the non-sarcopenia group, but the anxiety scale score (52.97±4.67 vs 36.2±3.36) and depression scale score (57.67±4.58 vs 38.71±3.77) were significantly higher than those in the non-sarcopenia group (p< 0.001). Correlation analysis showed that sarcopenia was positively correlated with SAS and SDS scores and negatively correlated with SF-36 total score (p < 0.05). Conclusion The risk of sarcopenia was higher among MHD patients who were older, male, single, with a longer MHD duration, lower economic status, lower BMI, comorbid diabetes and lower levels of creatinine.
Collapse
Affiliation(s)
- Yong-Yao Wu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Jun-Yuan Li
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Qiao-Jing Xia
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Yi-Yi Gao
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Chao Zhang
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Peng-Jie Xu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Jiang Liu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Hao-Jie Zhang
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China
| | - Ri-Zhen Yu
- Urology & Nephrology Center, Department of Nephrology, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, 310014, People’s Republic of China
| |
Collapse
|
2
|
Pan Y, Wu X, Zhu M, Zhang T, Gao L, Zhu Y, Mao H, Lv X, Sun G. Clinical significance and correlation of compliance to thirst in maintenance hemodialysis patients. Technol Health Care 2024; 32:1733-1743. [PMID: 38073346 DOI: 10.3233/thc-230749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND The main treatment method for end-stage renal disease (ESRD) is maintenance hemodialysis (MHD). With the continuous improvement of dialysis technology, the survival period of MHD patients has been effectively prolonged, but dialysis technology still cannot completely replace renal function. OBJECTIVE To study the dietary compliance and its correlation with thirst in MHD patients and to provide guidance for clinical development of corresponding intervention countermeasures. METHODS A total of 90 patients who received MHD treatment from March 2021 to March 2022 were selected as objects. The Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ) were used to analyze the dietary compliance and thirst status of patients. Pearson correlation analysis was used to analyze the correlation between diet compliance and thirst. RESULTS Positive correlations were found between VAS and DTI, SXI and TDS (P< 0.05). Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and compliance in facing difficulties (P< 0.05), and negatively correlated with self-care compliance (r=-0.35, P< 0.05). Health attitude was positively correlated with VAS, DTI and SXI (P< 0.05). Acceptance attitude was positively correlated with DTI, SXI and TDS (P< 0.05). High RAAQ was associated with high VAS (b= 0.11, 95% CI: 0.05, 0.18), DTI (b= 0.28, 95% CI: 0.17, 0.38), SXI (b= 0.24, 95% CI: 0.14, 0.34) and TDS (b= 0.26, 95% CI: 0.13, 0.4). CONCLUSION The overall performance of dietary compliance in patients with MHD is at a moderate level, and dietary compliance is negatively correlated with disease perception.
Collapse
Affiliation(s)
- Yanyan Pan
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiujuan Wu
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Miao Zhu
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tingting Zhang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lanlan Gao
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yamei Zhu
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huijuan Mao
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaolin Lv
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guozhen Sun
- Department of Cardiovascular Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
3
|
Mechta Nielsen T, Marott T, Hornum M, Feldt-Rasmussen B, Kallemose T, Thomsen T. Non-adherence, medication beliefs and symptom burden among patients receiving hemodialysis -a cross-sectional study. BMC Nephrol 2023; 24:321. [PMID: 37891566 PMCID: PMC10604404 DOI: 10.1186/s12882-023-03371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Non-adherence to medication is a common and complex issue faced by individuals undergoing hemodialysis (HD). However, more knowledge is needed about modifiable factors influence on non-adherence. This study investigated the prevalence of non-adherence, medication beliefs and symptom burden and severity among patients receiving HD in Denmark. Associations between non-adherence, medications beliefs and symptom burden and severity were also explored. METHOD A cross-sectional questionnaire-based multisite study, including 385 participants. We involved patient research consultants in the study design process and the following instruments were included: Medication Adherence Report Scale, Beliefs about Medication Questionnaire and Dialysis Symptom Index. Logistic regression analysis was performed. RESULTS The prevalence of non-adherence was 32% (95% CI 27-37%) using a 23-point-cut-off. Just over one third reported being concerned about medication One third also believed physicians to overprescribe medication, which was associated with 18% increased odds of non-adherence. Symptom burden and severity were high, with the most common symptoms being tiredness/ lack of energy, itching, dry mouth, trouble sleeping and difficulties concentrating. A high symptom burden and/or symptom severity score was associated with an increased odd of non-adherence. CONCLUSION The study found significant associations between non-adherence and, beliefs about overuse, symptom burden and symptom severity. Our results suggest health care professionals (HCP) should prioritize discussion about medication adherence with patients with focus on addressing patient-HCP relationship, and patients' symptom experience. Future research is recommended to explore the effects of systematically using validated adherence measures in clinical practice on medication adherence, patient-HCP communication and trust. Additionally, studies are warranted to further investigate the relationship between symptom experience and adherence in this population. TRIAL REGISTRATION NCT03897231.
Collapse
Affiliation(s)
- Trine Mechta Nielsen
- Department of Nephrology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Trine Marott
- Department of Nephrology, Copenhagen University Hospital - Herlev, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Herlev Acute, Critical and Emergency Science Unit - Herlev-ACES, Department of Anesthesiology, Copenhagen University Hospital -Herlev, Copenhagen, Denmark
| |
Collapse
|
4
|
Chan FHF, Newman S, Khan BA, Griva K. Prevalence and trajectories of subjective cognitive complaints and implications for patient outcomes: A prospective study of haemodialysis patients. Br J Health Psychol 2023; 28:651-671. [PMID: 36720474 DOI: 10.1111/bjhp.12645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Cognitive impairment is common in haemodialysis patients and is associated with increased hospitalization and mortality. However, subjective cognitive complaints (SCCs), the self-experienced difficulties in everyday cognitive activities, remain poorly understood. This study examined the prevalence and course of SCCs in haemodialysis patients and its longitudinal associations with sociodemographic, clinical and patient-reported variables. DESIGN Observational prospective study with baseline and 12-month follow-up assessment. METHODS Based on a validated cut-off point on the Kidney Disease Quality of Life Cognitive Function subscale, haemodialysis patients (N = 159; 40.3% female, mean age 53.62) were classified into cognitive complaint trajectories: (1) resilient (60.4%; no/low SCCs throughout); (2) persistent (8.8%; stable high SCCs); (3) deterioration (17.6%; from no/low to high SCCs); and (4) recovery (13.2%; from high to no/low SCCs). Sociodemographic/clinical characteristics, self-efficacy, self-management skills, adherence, mood and biochemical assays were measured at both assessments and compared among trajectories using mixed ANOVAs. RESULTS Interaction effects indicated significant improvements in the recovery group in clinical outcomes (i.e., decreased phosphorus and calcium-phosphorus product), self-efficacy and mood over time. Group effects indicated significantly poorer self-efficacy, self-management skills and adherence in the persistent group than other trajectories across both assessments. None of the sociodemographic/clinical characteristics was associated with SCC trajectories. CONCLUSIONS The extent of SCCs vary over time across haemodialysis patients. Routine screening of SCCs in dialysis settings may help identifying patients at risk of poor self-management and worse prognosis. Strategies that compensate for cognitive lapses may mitigate the perceived cognitive burden of this population.
Collapse
Affiliation(s)
- Frederick H F Chan
- Population/Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Stanton Newman
- Division of Health Services Research and Management, School of Health Sciences, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore City, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Konstadina Griva
- Population/Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| |
Collapse
|
5
|
Celano CM, Zambrano J, Harnedy L, Arroyo-Ariza D, Carrillo A, Chung WJ, Massey CN, Cohen-Bucay A, Huffman JC. A novel health behaviour intervention to promote adherence in kidney failure. J Ren Care 2023; 49:24-34. [PMID: 35638610 PMCID: PMC9708944 DOI: 10.1111/jorc.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health behaviour adherence is associated with improved survival in kidney failure (KF); however, most patients with KF do not adhere to one or more health behaviours. Existing health behaviour interventions have significant limitations and do not focus on psychological factors that are associated with adherence and health. OBJECTIVES To examine the feasibility, acceptability, and preliminary efficacy of a 12-week, phone-delivered, positive psychology-motivational interviewing (MI) intervention to promote psychological well-being and adherence in KF. DESIGN Single-arm, proof-of-concept trial (N = 10). PARTICIPANTS Participants were adults with KF undergoing haemodialysis and reporting suboptimal adherence to physical activity, diet, and/or medications. Participants attended weekly phone sessions with a study trainer, completed weekly positive psychology exercises (focused on gratitude, strengths, and meaning), and worked towards physical activity, diet, and/or medication goals. MEASUREMENTS Feasibility was measured by the percentage of sessions completed, while acceptability was assessed through participant ratings of positive psychology and MI session ease and utility (0-10 Likert scales). We explored the intervention's impact on psychological outcomes and health behaviour adherence using validated scales and accelerometers. RESULTS Participants completed 78% of sessions and rated the program's components as easy to complete (positive psychology: 8.7 ± 1.5; MI: 8.3 ± 2.0) and subjectively helpful (positive psychology: 8.8 ± 1.2; MI: 8.8 ± 1.6). The intervention led to promising but nonsignificant improvements in psychological and adherence measures. CONCLUSIONS This 12-week, phone-delivered program was feasible, well-accepted, and associated with nonsignificant improvements health behaviour adherence, highlighting the need for a larger efficacy trial.
Collapse
Affiliation(s)
- Christopher M. Celano
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juliana Zambrano
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Arroyo-Ariza
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alba Carrillo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Wei-Jean Chung
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christina N. Massey
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Abraham Cohen-Bucay
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Renal Division and Transplant Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Chan FHF, Newman S, Khan BA, Griva K. The role of subjective cognitive complaints in self-management among haemodialysis patients: a cross-sectional study. BMC Nephrol 2022; 23:363. [PMID: 36376848 PMCID: PMC9661809 DOI: 10.1186/s12882-022-02994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Subjective cognitive complaints refer to self-experienced difficulties with everyday cognitive tasks. Although there has been a fair amount of research on cognitive impairments and cognitive complaints in end-stage renal disease, the practical implications of these complaints remain unclear. The current study aims to examine the associations of cognitive complaints with sociodemographic and clinical variables, mood, as well as key patient-reported outcomes, i.e., self-efficacy, self-management skills, and treatment adherence. Methods A total of 305 haemodialysis patients (mean age = 53.97 years, 42.6% female) completed the Kidney Disease Quality of Life Cognitive Function subscale, a brief measure of cognitive complaints. The recommended cut-off point of 60 was used to identify probable cognitive impairment. Measures of self-efficacy, self-management skills (i.e., symptom coping, health monitoring, health service navigation), treatment adherence, and mood symptoms were also administered. Between-group comparisons and correlational analyses were performed to examine associations of cognitive complaints with sociodemographic, clinical, and health behaviour variables. Mediation analyses were also conducted to investigate the mediating role of self-efficacy on the relationship between cognitive complaints and treatment adherence. Results Nearly a quarter (23.0%) of haemodialysis patients reported cognitive complaints indicative of clinical impairments. Risk of probable impairments was higher for patients with hypertension, diabetes, those diagnosed with end-stage renal disease at an older age, and those with shorter time on dialysis. Subjective cognitive complaints (both rates of probable impairments as per cut-off and continuous scores) were significantly associated with lower disease and treatment self-efficacy, poorer self-management skills, lower treatment adherence, as well as higher symptoms of distress. Mediation analysis indicated that treatment self-efficacy mediated the relationship between cognitive complaints and treatment adherence. Conclusions The current study demonstrated the clinical characteristics of haemodialysis patients who report cognitive complaints indicative of probable cognitive impairments and showed the associations of these complaints with self-management outcomes. Future studies should adopt more comprehensive measures of cognitive complaints and longitudinal designs to confirm the current findings.
Collapse
|
7
|
Abstract
Patients on chronic hemodialysis are counseled to reduce dietary sodium intake to limit their thirst and consequent interdialytic weight gain (IDWG), chronic volume overload and hypertension. Low-sodium dietary trials in hemodialysis are sparse and mostly indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake and IDWG. Additional nutritional restrictions and numerous barriers further complicate dietary adherence. A low-sodium diet may also reduce tissue sodium, which is positively associated with hypertension and left ventricular hypertrophy. A potential alternative or complementary approach to dietary counseling is home delivery of low-sodium meals. Low-sodium meal delivery has demonstrated benefits in patients with hypertension and congestive heart failure but has not been explored or implemented in patients undergoing hemodialysis. The objective of this review is to summarize current strategies to improve volume overload and provide a rationale for low-sodium meal delivery as a novel method to reduce volume-dependent hypertension and tissue sodium accumulation while improving quality of life and other clinical outcomes in patients undergoing hemodialysis.
Collapse
Affiliation(s)
- Luis M Perez
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Denver, CO, USA
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | |
Collapse
|
8
|
Sawinski D, Lindner H, Fitzsimmons R, Shults J, Locke JE, Cohen JB, MacLennan PA, Reese PP. Dialysis Nonadherence and Kidney Transplant Outcomes: A Retrospective Cohort Study. Am J Kidney Dis 2021; 80:46-54. [PMID: 34673160 DOI: 10.1053/j.ajkd.2021.09.011] [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: 11/13/2020] [Accepted: 09/16/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE AND OBJECTIVE Concerns about non-adherent behaviors often prevent dialysis patients from entering waitlists for transplantation, despite an inconsistent association with posttransplant outcomes. We examined the association between plausible metrics of non-adherence related to dialysis treatment and posttransplant outcomes. STUDY DESIGN Retrospective cohort. We linked national dialysis treatment data with transplant registry data. SETTING AND PARTICIPANTS Adult patients on maintenance hemodialysis from 1/1/2004-12/31/2014 who received a kidney transplant at US centers. EXPOSURES We examined five nonadherence metrics: serum potassium (≥5.2 mEq/L), serum phosphorus (>5.5 mg/dL), intradialytic weight gain (IDWG, ≥5 L), shortened treatments (≥30 minutes) and missed treatments (≥1); missed treatment data was only available for 2004-2009. These metrics were characterized as the proportion of time under observation. Dialysis observation time was divided into 3-month intervals (quarters) and the number of "non-adherent" measurements in each domain was calculated for each quarter. OUTCOMES Allograft loss; mortality; and acute rejection in the first posttransplant year. ANALYTICAL APPROACH Using Cox proportional hazards and logistic regression, we estimated the hazard ratios (HRs) for graft loss and mortality, and odds ratios (OR) for rejection. RESULTS 9543 patients met inclusion criteria. In our primary model, hyperphosphatemia (aHR 1.27, 05% CI 1.08-1.49), IDWG (aHR 1.39, 95% CI 1.23-1.59) and shortened treatments (aHR 1.54, 95% CI 1.12-2.13) were associated with greater rates of allograft loss but hyperkalemia was not. IDWG (aHR 1.49, 95% CI 1.29-1.73) and shortened treatments (aHR 1.34, 95% CI 1.13-1.58) were associated with mortality while hyperkalemia and hyperphosphatemia were not. Only shortened treatments was associated with an increased risk of acute rejection (aOR 3.88, 95% CI 1.98-7.58). In models limited to the years 2004 to 2009 that included missed treatments, missed treatments were only associated with mortality. LIMITATIONS Unmeasured confounding (e.g., dietary data); adherence metrics used may have multiple, complex causes. CONCLUSIONS Plausible measures of dialysis nonadherence have long-term associations with allograft and patient survival. Behavioral metrics were more closely associated with outcomes than laboratory markers. The implications of non-adherent behaviors for dialysis patients must be carefully considered before excluding patients from transplantation.
Collapse
Affiliation(s)
- Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia PA.
| | - Hanna Lindner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham AL
| | - Jordana B Cohen
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia PA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Paul A MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham AL
| | - Peter P Reese
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia PA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
9
|
Mbeje PN, Mtshali N. Perceived predictors of quality of life in patients with end-stage renal disease on dialysis. Curationis 2021; 44:e1-e11. [PMID: 34636621 PMCID: PMC8517801 DOI: 10.4102/curationis.v44i1.2251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/04/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Reduced quality of life (QOL) is associated with shorter survival, and is more marked in patients with end-stage renal disease (ESRD). Predictors of health, which include policymaking, social factors, health services, individual behaviour, biology and genetics, have an impact on the QOL of patients with ESRD. Patients with ESRD in South Africa are cared for in public and private hospitals, with public health institutions characterised by several challenges. OBJECTIVE To explore and analyse the perceived predictors of QOL in patients with ESRD in the three district hospitals that provide renal services in KwaZulu-Natal. METHODS An exploratory, descriptive qualitative research approach based on grounded theory research design was used and three focus group discussions (FGDs) were conducted. The researcher recruited 18 participants, 6 in each focus group. Three phases of data analysis were followed: open coding, axial coding, and selective coding. RESULTS Predictors of QOL that emerged were the geographic location of the patients, accessibility of haemodialysis centres, patients' adaptation and acceptance of the condition, self-management, support by family members and caregivers and availability of adequately trained nurses. CONCLUSION Predictors of QOL in patients with ESRD are associated with an increased risk of morbidity and mortality resulting from dialysis. The broad range of dimensions of life is negatively affected and requires intervention by the renal team and policymakers to improve the QOL of patients.
Collapse
Affiliation(s)
- Pretty N Mbeje
- Department of Nursing, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
| | | |
Collapse
|
10
|
Halle MP, Nelson M, Kaze FF, Jean Pierre NM, Denis T, Fouda H, Ashuntantang EG. Non-adherence to hemodialysis regimens among patients on maintenance hemodialysis in sub-Saharan Africa: an example from Cameroon. Ren Fail 2021; 42:1022-1028. [PMID: 33028122 PMCID: PMC7580605 DOI: 10.1080/0886022x.2020.1826965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Non-adherence (NA) to hemodialysis regimens is one of the contributors to the high morbidity and mortality observed in patients with end-stage kidney disease (ESKD). We aimed to determine the prevalence and predictors of NA to hemodialysis (HD) regimens among patients on maintenance HD in Cameroon. Methods A cross-sectional study in two HD centers in Cameroon was conducted from January to February 2016. Consenting patients on HD for ≥3 months were included. NA to fluid restriction was defined as a mean interdialytic weight gain (IDWG) in the past month >5.7% of the dry weight, NA to dietary restriction as a pre dialysis serum phosphorus >5.5 mg/dl in a patient on phosphate binders and who is well-nourished, and NA to HD sessions as skipping at least one session in the past month. The study was approved by the institutional ethics board. Results A total of 170 (112 males) participants with a median age of 49 years (range 14–79) were included. The median dialysis vintage was 35 months (range 3–180 months). The prevalence of NA was 15.3% to fluid restriction, 26.9% to dietary restriction, and 21.2% to dialysis sessions. Age ≤49 years (p = .006, OR: 5.07, 95% CI: 1.59–16.20) and unmarried status (p = .041, OR: 2.63, 95% CI: 1.04–6.66) were independently associated with NA to fluid restrictions. No factor was associated with NA to dietary restrictions and HD sessions. Conclusions NA to HD regimens is common amongst patients in Cameroon. Younger age and being unmarried were the predictors of NA to fluid restriction.
Collapse
Affiliation(s)
- Marie Patrice Halle
- Department of Internal Medicine, Faculty of Medicine and Pharmaceutical Science, Douala General Hospital, University of Douala, Douala, Cameroon
| | - Musaga Nelson
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | | | - Tewafeu Denis
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Hermine Fouda
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, Douala General Hospital Cameroon, University of Yaoundé I, Yaoundé, Cameroon
| | - Enow Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaoundé, Cameroon
| |
Collapse
|
11
|
Descombes E, Hemett OM, Erard V, Chuard C. Comment on: "Post-Dialysis Parenteral Antimicrobial Therapy in Patients Receiving Intermittent High-Flux Haemodialysis". Drugs 2021; 81:1121-1123. [PMID: 34037962 DOI: 10.1007/s40265-021-01535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Eric Descombes
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Route de Bertigny, 1708, Fribourg, Switzerland.
| | - Ould Maouloud Hemett
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Route de Bertigny, 1708, Fribourg, Switzerland
| | - Véronique Erard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Fribourg, Switzerland
| | - Christian Chuard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Fribourg, Switzerland
| |
Collapse
|
12
|
Li X, Shan Y, Gao Y, Jiang X, Wang H, Yang X, Ding Y. The Cross-Cultural Adaptation and the Reliability Test for the Chinese-Version Dietary Behavior and Psychological Series Scales in Maintenance Hemodialysis Patients. Patient Prefer Adherence 2021; 15:1903-1912. [PMID: 34511886 PMCID: PMC8418376 DOI: 10.2147/ppa.s322868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To translate three novel measures of psychological mechanisms associated with dietary behavior, including the Dietary Goal-Desire Incongruence scale (DG-DI), the Motivation for Dietary Self-control scale (MDSC), the Satisfaction with Dietary Behavior scale (SWDB), to cross-culturally adapt the measures into Chinese and verify their reliability and validity in maintenance hemodialysis patients. METHOD After the forward translation and the back-translation, the perspective of a panel of experts and cognitive interviews with maintenance hemodialysis patients were used to ensure cultural relevance of the three scales. Subsequently, 420 maintenance hemodialysis patients from three hemodialysis centers in Zhengzhou were recruited for the item analysis and the internal consistency, content validity, construct validity and reliability tests. RESULTS The moderate associations between items and domains (r>0.50) and the significant differences between the high and low groups were measured by an independent sample t test (P<0.001). The Cronbach's α coefficient of the DG-DI reached 0.884. The Cronbach's α of the MDSC was 0.831, with Cronbach's α values (0.865,0.800 and 0.797 for "Internal", "External" and "Amotivation", respectively). In addition, the Cronbach's alpha of the SWDB was 0. 914. The scale-level content validity index (S-CVI) reached 0.96, 0.98 and 1.00 for the DG-DI, the MDSC and the SWDB, respectively. The exploratory factor analysis verified the scale structures of five factors, and the cumulative variance contribution rate of the respective factor was 65.507%. The confirmatory factor analysis was conducted to test the original structure of the scale. CONCLUSION The DG-DI, the MDSC and the SWDB showed satisfactory psychometric characteristics. They could effectively assess the eating behavior of hemodialysis patients. Subsequent studies should recruit other different population samples in China to verify the applicability of the scale.
Collapse
Affiliation(s)
- Xue Li
- Nursing and Health School of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Yan Shan
- Medical School of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
- Correspondence: Yan Shan Email
| | - Yajing Gao
- Nursing and Health School of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Xinxin Jiang
- Nursing and Health School of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Hong Wang
- Nursing and Health School of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Xuzhen Yang
- Nursing and Health School of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Yabo Ding
- Nursing and Health School of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| |
Collapse
|
13
|
Sezer TA, Çavuşoğlu H, Düzova A. Self-management program for adolescents with chronic kidney disease: A randomized controlled trial. J Ren Care 2020; 47:146-159. [PMID: 33373118 DOI: 10.1111/jorc.12357] [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: 05/23/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is important to develop self-management behaviours in adolescents to prevent chronic kidney disease progression. OBJECTIVES This study evaluates the effect of a self-management program that was developed based on individual and family self-management theory to aid adolescents with chronic kidney disease in the acquisition of competencies in the management of their disease. DESIGN This is a randomized controlled study. PARTICIPANTS The study was conducted with 20 intervention and 20 control patients, who were treated at two hospitals in Ankara between December 2018 and May 2019. MEASUREMENTS Self-Management Assessment Form, Paediatric Quality of Life Inventory-Adolescent Form and clinical parameters. A training program, specific to chronic kidney disease, was administered over three sessions in a group training setting when the patients came to the clinic for follow-up. After the training program was completed, the patients were monitored for three months through home visits once every two weeks, totalling six visits. RESULTS Following the application of self-management training, a statistically significant difference was found self-management knowledge and behaviours, quality of life and anxiety mean scores of intervention and control group (p <.05), a significant decrease in only blood urea nitrogen among the clinical parameters when compared to the control group. CONCLUSIONS In this study, a self-management training program was developed based on Individual and Family Self-Management Theory, aiming to have a positive effect on the self-management behaviours of adolescents in the cognitive and psychosocial domains.
Collapse
Affiliation(s)
- Tufan Aslı Sezer
- Nursing Department, Faculty of Nursing, Ankara University, Ankara, Turkey
| | - Hicran Çavuşoğlu
- Head of Pediatric Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Ali Düzova
- Department of Pediatric Nephrology, İhsan Doğramacı Children Hospital, Hacettepe University, Ankara, Turkey
| |
Collapse
|
14
|
Perez LM, Fang HY, Ashrafi SA, Burrows BT, King AC, Larsen RJ, Sutton BP, Wilund KR. Pilot study to reduce interdialytic weight gain by provision of low-sodium, home-delivered meals in hemodialysis patients. Hemodial Int 2020; 25:265-274. [PMID: 33150681 DOI: 10.1111/hdi.12902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with kidney failure undergoing maintenance hemodialysis (HD) therapy are routinely counseled to reduce dietary sodium intake to ameliorate sodium retention, volume overload, and hypertension. However, low-sodium diet trials in HD are sparse and indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake. This study aimed to determine whether 4 weeks of low-sodium, home-delivered meals in HD patients reduces interdialytic weight gain (IDWG). Secondary outcomes included changes in dietary sodium intake, thirst, xerostomia, blood pressure, volume overload, and muscle sodium concentration. METHODS Twenty HD patients (55 ± 12 years, body mass index [BMI] 40.7 ± 16.6 kg/m2 ) were enrolled in this study. Participants followed a usual (control) diet for the first 4 weeks followed by 4 weeks of three low-sodium, home-delivered meals per day. We measured IDWG, hydration status (bioimpedance), standardized blood pressure (BP), food intake (3-day dietary recall), and muscle sodium (magnetic resonance imaging) at baseline (0 M), after the 4-week period of usual diet (1 M), and after the meal intervention (2 M). FINDINGS The low-sodium meal intervention significantly reduced IDWG when compared to the control period (-0.82 ± 0.14 kg; 95% confidence interval, -0.55 to -1.08 kg; P < 0.001). There were also 1 month (1 M) to 2 month (2 M) reductions in dietary sodium intake (-1687 ± 297 mg; P < 0.001); thirst score (-4.4 ± 1.3; P = 0.003), xerostomia score (-6.7 ± 1.9; P = 0.002), SBP (-18.0 ± 3.6 mmHg; P < 0.001), DBP (-5.9 ± 2.0 mmHg; P = 0.008), and plasma phosphorus -1.55 ± 0.21 mg/dL; P = 0.005), as well as a 0 M to 2 M reduction in absolute volume overload (-1.08 ± 0.33 L; P = 0.025). However, there were no significant changes in serum or tissue sodium (all P > 0.05). DISCUSSION Low-sodium, home-meal delivery appears to be an effective method for improving volume control and blood pressure in HD patients. Future studies with larger sample sizes are needed to examine the long-term effects of home-delivered meals on these outcomes and to assess cost-effectiveness.
Collapse
Affiliation(s)
- Luis M Perez
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Hsin-Yu Fang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Sadia-Anjum Ashrafi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Brett T Burrows
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alexis C King
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ryan J Larsen
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Bradley P Sutton
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Kenneth R Wilund
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| |
Collapse
|
15
|
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
| |
Collapse
|
16
|
Dantas LG, Rocha MS, Cruz CMS. Non-adherence to hemodialysis, perception of the illness, and severity of advanced nephropathy. J Bras Nefrol 2020; 42:413-419. [PMID: 32779688 PMCID: PMC7860651 DOI: 10.1590/2175-8239-jbn-2019-0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: Hemodialysis (HD) is a complex therapy that imposes several changes in the patient's life. Failure to follow therapy recommendations is called non-adherence (NA). The patient's illness perception, severity of chronic kidney disease, and individual strategies for coping with HD can have an impact on NA to the demands of therapy. Methods: This was a cross-sectional study with end-stage renal disease patients on conventional HD in Salvador, Bahia. We evaluated attendance to treatment and interdialytic weight gain (IDWG) as parameters of NA to HD, and investigated its association with clinical aspects and measures of disease perception (illness effects questionnaire - IEQ) and severity of nephropathy (end stage renal disease severity index - ESRD-SI), by analyzing Pearson or Spearman correlation. Results: 79 patients were evaluated, 57% male, aged 53.1 ± 12.3 years, with length of HD of 108 (89 - 131.5) months. Age correlated with ESRD-SI (r = 0.43) and NA parameters: negative correlation with relative IDWG (r = -0.41) and reduction in sessions (r = -0.31) and positive correlation with %HD performed (r = 0.25). The scores on the IEQ and ESRD-SI showed a positive correlation (r = 0.44; p <0.001), but did not show any correlation with the analyzed NA parameters. Conclusions: We did not find a correlation between illness perception and severity index of advanced nephropathy with the behaviors of NA to chronic HD. In this study, age correlated both with the perception of severity of advanced nephropathy and the parameters of NA to chronic HD.
Collapse
Affiliation(s)
- Lianna Gonçalves Dantas
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brasil.,Clínica Senhor do Bonfim, Salvador, Bahia, Brasil
| | | | - Constança Margarida Sampaio Cruz
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brasil.,Obras Sociais Irmã Dulce, Programa de Residência de Clínica Médica, Salvador, Bahia, Brasil
| |
Collapse
|
17
|
Liu J, Zhang F, Wang Y, Wu D. Prevalence and association of depression with uremia in dialysis population: a retrospective cohort analysis. Medicine (Baltimore) 2020; 99:e20401. [PMID: 32541461 PMCID: PMC7302619 DOI: 10.1097/md.0000000000020401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Depression may hamper the immune system and nutritional status, which leads to poor outcomes of treatment. It is very common in dialysis patients. There are the numbers of parameters affected by the depression of patients and available studies are not enough to define the association between biological parameters and depression in the dialysis population. The purposes of the study were to find the prevalence of depression and association of it with the biochemical abnormalities in the dialysis patients.The selected battery of tests (clinician-administered questionnaires) were applied to dialysis patients (test cohort, n = 298) and caregivers (control cohort, n = 202) for establishing depression. The demographic and clinical conditions of participants were also collected. Univariate analysis followed by multiple regression analysis was performed for demographical parameters, clinical conditions, and laboratory results for the detection of association of them with depression. The abnormal test considered as more than 2 SD of mean below the normal value. Out of all tests, at least 2 abnormal tests were considered as mild depression. More than half of abnormal parameters among all tests were considered as moderate depression and all abnormal parameters were considered as severe depression.There was a significant difference for all the test between dialysis patients and the caregivers (P < .0001 for all). The half (153 out of 298) of dialysis patients were depressive and clinically asymptomatic. 70 (23%) dialysis patients were mild depressive, 45 (15%) dialysis patients were moderate depressive, and 38 (13%) dialysis patients were severely depressive. Serum phosphate (P = .023), level of parathyroid hormone (P = .021), and urea reduction rate (P = .048) were directly associated with depression.Biochemical abnormalities (serum phosphate level, parathyroid hormone, and urea reduction rate) were independent predictors of depression in the dialysis population.Level of evidence: III.
Collapse
|
18
|
Fotheringham J, Smith MT, Froissart M, Kronenberg F, Stenvinkel P, Floege J, Eckardt KU, Wheeler DC. Hospitalization and mortality following non-attendance for hemodialysis according to dialysis day of the week: a European cohort study. BMC Nephrol 2020; 21:218. [PMID: 32517695 PMCID: PMC7285433 DOI: 10.1186/s12882-020-01874-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The extension of the interdialytic interval due to due to dialysis session non-attendance varies according to which session of the week the patient misses. The impact of this on subsequent hospitalization and mortality is unknown. METHODS The ARO cohort study prospectively collected data from hemodialysis patients across 15 European countries on demography, comorbidity, laboratory, hospitalisation, mortality and individual hemodialysis sessions from 2007 to 2014. Event rates for death and hospitalisation according to dialysis day of the week were calculated for patients who attended the three previous scheduled hemodialysis sessions, who then on the next scheduled dialysis day either attended or did not attend. The hazard ratio for these events following non-attendance for the first compared to the second dialysis session of the week was estimated using Cox proportional hazards model adjusted for patient demographics. RESULTS 3.8 million hemodialysis sessions in 9397 patients were analysed. The non-attendance rates for Monday/Wednesday/Friday sessions were 0.8, 0.9% & 1.4% respectively, and for Tuesday/Thursday/Saturday sessions were 0.6, 1.0% & 1.2% respectively. Compared to those who attended, for the 48-72 h between non-attendance and the next scheduled haemodialysis session, mortality significantly increased from 4.86 to 51.9/100 pt-yrs and hospitalisation increased from 0.58 to 2.1/yr. As time from the two-day break increased, the risk associated with non-attendance lessened: compared to missing the second hemodialysis session, missing the first session had a hazard ratio for mortality of 2.04 (95% CI 1.27-3.29), and for hospitalisation 1.78 (95% CI 1.29-2.47). In patients who attended their scheduled dialysis session and the three preceding, after the two-day break there were absolute increases in mortality (8.3 vs. 4.9/100 pt-yrs) and hospitalisation (1.0 vs. 0.6/yr for the rest of the week) comparable to previous studies. CONCLUSIONS In addition to hospitalisation and mortality increases seen after the two-day break, additional harm may be manifested in the greater increases in mortality and hospitalisation observed after non-attendance for the first hemodialysis session after the two-day break compared to missing other sessions.
Collapse
Affiliation(s)
- James Fotheringham
- Northern General Hospital, Sheffield Kidney Institute, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK. .,School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | | | - Marc Froissart
- Clinical Trial Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Stenvinkel
- Department of Renal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin-Berlin, Berlin, Germany
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| |
Collapse
|
19
|
Jung MJ, Roh YS. Factors influencing the patient education performance of hemodialysis unit nurses. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30328-1. [PMID: 32563706 DOI: 10.1016/j.pec.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aimed to identify the perceptions, barriers, and facilitators of patient education and factors influencing the performance of patient education among hemodialysis unit nurses. METHODS This study used a descriptive correlational design in which a total of 262 nurses from 27 hemodialysis facilities in six provinces in the Republic of Korea participated. Self-administered questionnaires were used to identify the perceptions, barriers, facilitators, and performance of patient education. Data were analyzed using a t-test, one-way ANOVA, Pearson's correlation, and stepwise multiple regression. RESULTS Factors influencing patient education performance were nurses' total clinical experience, perceptions, working experience in a hemodialysis unit, facilitators, number of nurses in the hemodialysis unit, and barriers. These variables accounted for 37.2 % of the variance in the final model. CONCLUSION Nurses' performance in patient education was significantly influenced by perceptions, facilitators, and barriers. Nurses' total clinical experience, working experience in a hemodialysis unit, and number of nurses in the unit also influenced patient education performance. PRACTICE IMPLICATIONS A nurse training program should be developed to reinforce nurses' patient education competency.
Collapse
Affiliation(s)
- Myung Jin Jung
- Chung-Ang University, Red Cross College of Nursing, Seoul, Republic of Korea
| | - Young Sook Roh
- Chung-Ang University, Red Cross College of Nursing, Seoul, Republic of Korea.
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Psychosocial considerations and recommendations for care of pediatric patients on dialysis. Pediatr Nephrol 2020; 35:767-775. [PMID: 30895367 DOI: 10.1007/s00467-019-04227-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
Dialysis treatment has evolved to enable children to live longer and transition to adulthood. Thus, the focus of care shifts to a consideration of pediatric patients' quality of life and psychosocial functioning across childhood, adolescence, and young adulthood. Despite well-documented concerns in various domains (including depression/anxiety, self-esteem and social functioning, behavior problems, and academic and cognitive functioning), limited literature exists regarding psychosocial guidelines for children and adolescents undergoing dialysis. This article aims to address this gap by providing a review of the pediatric literature examining psychosocial functioning in patients treated with dialysis, as well as recommendations for specific psychosocial concerns. Overall recommendations for care include screening for anxiety and depression, referral to pediatric psychologists for evidence-based intervention, utilization of child life specialists, opportunities to promote social functioning, neuropsychological evaluation and school programming, ongoing support in preparing for transition to adult care, and periodic measure of quality of life. Together, these suggestions promote a holistic approach to patient-centered care by supporting both physical and psychosocial well-being.
Collapse
|
22
|
Chilvers M, Johnston K, Ferrar K, Williams MT. Dyspnoea Assessment In Adults With End‐Stage Kidney Disease: A Systematic Review. J Ren Care 2020; 46:137-150. [DOI: 10.1111/jorc.12321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Maria Chilvers
- School of Nursing and MidwiferyUniversity of South AustraliaAdelaide South Australia 1067 Australia
| | - Kylie Johnston
- School of Health SciencesUniversity of South AustraliaAdelaide South Australia 1067 Australia
| | - Katia Ferrar
- School of Health SciencesUniversity of South AustraliaAdelaide South Australia 1067 Australia
| | - Marie T. Williams
- School of Health SciencesUniversity of South AustraliaAdelaide South Australia 1067 Australia
| |
Collapse
|
23
|
Elisabeth Stømer U, Klopstad Wahl A, Gunnar Gøransson L, Hjorthaug Urstad K. Health Literacy in Kidney Disease: Associations with Quality of Life and Adherence. J Ren Care 2020; 46:85-94. [DOI: 10.1111/jorc.12314] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Une Elisabeth Stømer
- Faculty of Health ScienceUniversity of StavangerStavanger Norway
- Department of NephrologyStavanger University HospitalStavanger Norway
| | | | - Lasse Gunnar Gøransson
- Department of NephrologyStavanger University HospitalStavanger Norway
- Department of Clinical Medicine, Faculty of MedicineUniversity of BergenBergen Norway
| | | |
Collapse
|
24
|
Snyder RL, Jaar BG, Lea JP, Plantinga LC. Association of Patient-Reported Difficulty with Adherence with Achievement of Clinical Targets Among Hemodialysis Patients. Patient Prefer Adherence 2020; 14:249-259. [PMID: 32103909 PMCID: PMC7024794 DOI: 10.2147/ppa.s227191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/28/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Non-adherence to dialysis recommendations is common and associated with poor outcomes. We used data from a cohort of in-center hemodialysis patients to determine whether patients' reported difficulties with adherence were associated with achievement of clinical targets for treatment recommendations. PATIENTS AND METHODS We included 799 in-center patients receiving hemodialysis from February 2010 to October 2016 at Emory Dialysis (Atlanta, GA, USA). Patient-reported difficulty with adherence (yes vs no) across multiple domains (coming to dialysis, completing dialysis sessions, fluid restrictions, diet restrictions, taking medications) was obtained from baseline social worker assessments. Achievement of clinical targets for coming to dialysis (missing ≥3 expected sessions), completing dialysis sessions (shortening >3 sessions by ≥15 min), fluid restrictions (mean interdialytic weight gain ≥3 kg), diet restrictions (mean potassium ≥5.0 mEq/L, mean phosphate >5.5 mg/dL), and taking medications (mean phosphate >5.5 mg/dL) was estimated over the following 12 weeks, using electronic medical record data. Crude agreement was assessed, and multivariable logistic regression was used to estimate the associations between these measures. RESULTS Agreement between reported difficulty in adherence and failure to achieve clinical targets was generally poor across all domains (percent agreement: 52.9-65.3%). After adjustment, patients reporting difficulty with fluid restrictions were 62% more likely to have mean interdialytic weight gain ≥3 kg than those not reporting difficulty (OR: 1.62, 95% CI: 1.08, 2.43). Patients reporting difficulty with coming to dialysis were 41% more likely to miss ≥3 expected dialysis sessions over 12 weeks (OR: 1.41, 95% CI: 0.96, 2.07); however, this association was not statistically significant. There were no significant associations between reported difficulty and failure to achieve clinical targets in other categories. CONCLUSION While reported difficulty with only fluid restrictions and coming to dialysis were associated with failure to achieve clinical targets in our study, the general lack of agreement between reported difficulty with adherence and failure to achieve clinical targets highlights a gap that could be explored to develop and target educational interventions aimed at increasing adherence among dialysis patients.
Collapse
Affiliation(s)
- Rachel L Snyder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
| | - Janice P Lea
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Laura C Plantinga
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
- Correspondence: Laura C Plantinga Department of Medicine, Emory University, 1841 Clifton Road, Wesley Woods Health Center Room 552, Atlanta, GA30329Tel +1 404 727 3460Fax +1 404 728 6425 Email
| |
Collapse
|
25
|
Damery S, Sein K, Nicholas J, Baharani J, Combes G. The challenge of managing mild to moderate distress in patients with end stage renal disease: results from a multi-centre, mixed methods research study and the implications for renal service organisation. BMC Health Serv Res 2019; 19:989. [PMID: 31870358 PMCID: PMC6929506 DOI: 10.1186/s12913-019-4808-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/04/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lower-level emotional and psychological difficulties ('distress') in patients with end stage renal disease (ESRD), can lead to reduced quality of life and poor clinical outcomes. National guidelines mandate provision of emotional and psychological support for renal patients yet little is known about the support that patients may require, or the challenges that staff experience in identifying and responding to patient distress. METHODS Mixed methods study in renal units at four NHS Trusts in the West Midlands, UK involving cross-sectional surveys of ESRD patients and renal unit staff and semi-structured interviews with 46 purposively-sampled patients and 31 renal unit staff. Interviews explored patients' experience of distress and personal coping strategies, staff attitudes towards patient distress and perceptions of their role, responsibility and capacity. RESULTS Patient distress was widespread (346/1040; 33.3%), and emotional problems were frequently reported. Younger patients, females, those from black and minority ethnic (BME) groups and patients recently initiating dialysis reported particular support needs. Staff recognised the value of supporting distressed patients, yet support often depended on individual staff members' skills and personal approach. Staff reported difficulties with onward referral to formal counselling and psychology services and a lack of immediate access to less formalised options. There was also a substantial training/skills gap whereby many staff reported lacking the confidence to recognise and respond to patient distress. Staff fell broadly into three groups: 'Enthusiasts' who considered identifying and responding to patient distress as integral to their role; 'Equivocators' who thought that managing distress was part of their role, but who lacked skills and confidence to do this effectively, and 'Avoiders' who did not see managing distress as part of their role and actively avoided the issue with patients. CONCLUSIONS Embedding the value of emotional support provision into renal unit culture is the key to 'normalising' discussions about distress. Immediately accessible, informal support options should be available, and all renal staff should be offered training to proactively identify and reactively manage patient distress. Emotional support for staff is important to ensure that a greater emphasis on managing patient distress is not associated with an increased incidence of staff burnout.
Collapse
Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands UK
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands UK
| | - Johann Nicholas
- Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire, Shrewsbury, SY3 8XQ UK
- Renal Unit, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands UK
| |
Collapse
|
26
|
Combes G, Damery S, Sein K, Allen K, Nicholas J, Baharani J. Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support. PLoS One 2019; 14:e0225269. [PMID: 31751382 PMCID: PMC6871782 DOI: 10.1371/journal.pone.0225269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease. METHODS Qualitative semi-structured interviews with staff in two hospitals (n = 31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory. RESULTS Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to. CONCLUSIONS Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.
Collapse
Affiliation(s)
- Gill Combes
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Johann Nicholas
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Jyoti Baharani
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| |
Collapse
|
27
|
Dantas LGG, de Seixas Rocha M, Junior JAM, Paschoalin EL, Paschoalin SRKP, Sampaio Cruz CM. Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study. BMC Nephrol 2019; 20:402. [PMID: 31694560 PMCID: PMC6836324 DOI: 10.1186/s12882-019-1573-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Patients with chronic kidney diseases (CKD) on haemodialysis (HD) have high morbidity and mortality rates, which are also due to the inherent risks associated with nephropathy. Non-adherence (NA) to the different demands of the treatment can have consequences for the outcome of patients undergoing HD; nevertheless, there are still doubts about such repercussions. This study was conducted to evaluate the association between NA to conventional HD and all-cause mortality and cardiovascular mortality. Methods We prospectively evaluated mortality in a 6-year period in a cohort of 255 patients on HD in northeast Brazil. The evaluated parameters of NA to HD were interdialytic weight gain (IDWG) ≥ 4% of dry weight (DW), hyperphosphatemia and regular attendance at treatment, assessed as the correlation between the periods on HD completed and those prescribed. We used the Cox multivariate regression model to analyse survival and the predictors of all-cause mortality and cardiovascular mortality. Results With a median follow-up period of 1493 days and a mortality rate of 9.1 per 100 people-years, there were 87 deaths, of which 54% were cardiovascular deaths. IDWG ≥4% of DW was associated with a risk of all-cause mortality however presenting a borderline outcome for cardiovascular mortality, with hazard ratios of 2.02 (CI 95% 1.17–3.49, p = 0.012) and 2.09 (CI 95% 1.01–4.35, p = 0.047), respectively. No significant association was found between other parameters of NA and mortality. Subgroup analysis showed that for patients with IDWG ≥4% of DW, malnutrition, age and diagnosis of cardiovascular and cerebrovascular diseases were associated with higher all-cause mortality. Conclusions IDWG ≥4% of DW was identified as an independent predictor of all-cause mortality and demonstrated a borderline outcome for cardiovascular mortality in patients on conventional HD. The occurrence of excessive IDWG in the presence of malnutrition represented a significant increase in the risk of death, indicating a subgroup of patients with a worse prognosis.
Collapse
Affiliation(s)
- Lianna G G Dantas
- Clínica Senhor do Bonfim. Rua Plínio de Lima, 1. Monte Serrat, Salvador, BA, Brazil. .,Postgraduate Course in Medicine and Human Health, Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil.
| | - Mário de Seixas Rocha
- Postgraduate Course in Medicine and Human Health, Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil
| | | | | | | | - Constança M Sampaio Cruz
- Postgraduate Course in Medicine and Human Health, Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil.,Department of Multidisciplinary Research Hospital Santo Antonio, Social Works of Irmã Dulce, Salvador, Brazil
| |
Collapse
|
28
|
Fakih El Khoury C, Karavetian M, Halfens RJG, Crutzen R, El Chaar D, Schols JMGA. Dietary Application for the Management of Patients with Hemodialysis: A Formative Development Study. Healthc Inform Res 2019; 25:262-273. [PMID: 31777669 PMCID: PMC6859267 DOI: 10.4258/hir.2019.25.4.262] [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: 06/24/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives To describe the step-by-step person-centered, theory-based development of the KELA.AE app for Arabic speaking hemodialysis patients. Methods A step-by-step person-driven theory-based approach was conducted to develop a self-monitoring and educational dietary app for hemodialysis patients. The development follows the Integration, Design, Assessment, and Sharing (IDEAS) framework. Qualitative, semi-structured interviews with 6 hemodialysis patients and 6 healthcare practitioners (dietitians and nephrologists) were performed to assess the need for an app, the willingness to use an app, and features desired in an app. Results The KELA.AE app, which includes a self-monitoring feature, CKD-friendly recipes, and a theory-based, evidence-based educational feature was developed. Qualitative analysis of interviews revealed two predominant themes from patient interviews ‘Experience with the diet’, ‘App evaluation’, and one theme from interviews with healthcare practitioners ‘App evaluation’. Patients expressed frustration with current accessibility of dietary information along with the need for educational materials in the app. The review of the KELA.AE prototype was positive overall, and patients reported a willingness to use the app. Healthcare practitioners considered the app accurate, simple, and culturally sensitive but expressed concerns about app misuse and the replacement of healthcare practitioners. Conclusions The KELA.AE app was found to be satisfactory and supportive of the participants' needs. Changes were made to the app as suggested during the interviews.
Collapse
Affiliation(s)
- Cosette Fakih El Khoury
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Ruud J G Halfens
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- Department of Health Sciences, Zayed University, Dubai, UAE
| | - Dayana El Chaar
- Department of Natural Sciences, School of Arts and Science, Lebanese American University, Beirut, Lebanon
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
29
|
Analysis of the factors affecting the hospital readmission incidence of hemodialysis patients in Bandar Lampung, Indonesia. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
30
|
Ozen N, Cinar FI, Askin D, Mut D, Turker T. Nonadherence in Hemodialysis Patients and Related Factors: A Multicenter Study. J Nurs Res 2019; 27:e36. [PMID: 30720548 PMCID: PMC6641098 DOI: 10.1097/jnr.0000000000000309] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nonadherence to dietary and fluid restrictions, hemodialysis (HD), and medication treatment has been shown to increase the risks of hospitalization and mortality significantly. Sociodemographic and biochemical parameters as well as psychosocial conditions such as depression and anxiety are known to affect nonadherence in HD patients. However, evidence related to the relative importance and actual impact of these factors varies among studies. PURPOSE The aim of this study was to identify the factors that affect nonadherence to dietary and fluid restrictions, HD, and medication treatment. METHODS This descriptive study was conducted on 274 patients who were being treated at four HD centers in Turkey. The parameters used to determine nonadherence to dialysis treatment were as follows: skipping multiple dialysis sessions during the most recent 1-month period, shortening a dialysis session by more than 10 minutes during the most recent 1-month period, and Kt/V < 1.4. The parameters used to determine nonadherence to dietary and fluid restriction were as follows: serum phosphorus level > 7.5 mg/dl, predialysis serum potassium level > 6.0 mEq/L, and interdialytic weight gain > 5.7% of body weight. The Morisky Green Levine Medication Adherence Scale was performed to determine nonadherence to medication treatment. A patient was classified as nonadherent if he or she did not adhere to one or more of these indices. The Hospital Anxiety and Depression Scale was used to identify patient risk in terms of anxiety and depression. Logistic regression was used to determine the predictors of nonadherence. RESULTS The nonadherence rate was 39.1% for dietary and fluid restrictions, 33.6% for HD, and 20.1% for medication. The risk of nonadherence to dietary and fluid restriction was found to be 4.337 times higher in high school graduates (95% CI [1.502, 12.754], p = .007). The risk of nonadherence to HD treatment was 2.074 times higher in men (95% CI [1.213, 3.546], p = .008) and 2.591 times higher in patients with a central venous catheter (95% CI [1.171, 5.733], p = .019). Longer duration in HD resulted in 0.992 times decrease in risk of nonadherence to treatment (95% CI [0.986, 0.998], p = .005). CONCLUSIONS/IMPLICATIONS FOR PRACTICE Educational status, being male, having a central venous catheter, and having a short HD duration were found to be risk factors for nonadherence. Nurses must consider the patient's adherence to the dietary and fluid restrictions, HD, and medication treatment at each visit.
Collapse
Affiliation(s)
| | - Fatma Ilknur Cinar
- PhD, RN, Associate Professor, Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Dilek Askin
- RN, Deparment of Paediatric, Haydarpasa Sultan Abdulhamid Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek Mut
- RN, Department of Obstetrics and Gynecology, Dogubayazit Doç. Dr. Yasar Eryilmaz State Hospital, Agri, Turkey
| | - Turker Turker
- MD, Associate Professor, Department of Public Health and Epidemiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
31
|
Abstract
Abstract
Objective
To explore the concept of adherence in the context of rehabilitation of patients with chronic illnesses. This concept analysis is helpful in predicting health behaviors and intentions including physical activity and dietary behaviors in patients with chronic illnesses.
Methods
The framework of Walker and Avant was used to analyze the concept of adherence.
Results
Adherence is defined as the extent to which a person’s behavior, such as taking medication, following a diet, and/or executing lifestyle changes, corresponds to agreed recommendations from a health-care provider. The antecedents of adherence are the biomedical status of the individual, social support, self-efficacy, and education. Self-report questionnaires and patient self-reporting are the most common measurement tools of adherence. Thus, the reliable and valid instrument of monitoring adherence in the clinical settings is challenging.
Conclusions
Analyzing the concept of adherence is necessary to help understand how best to promote adherence to improve health-related outcomes.
Collapse
|
32
|
Damery S, Brown C, Sein K, Nicholas J, Baharani J, Combes G. The prevalence of mild-to-moderate distress in patients with end-stage renal disease: results from a patient survey using the emotion thermometers in four hospital Trusts in the West Midlands, UK. BMJ Open 2019; 9:e027982. [PMID: 31097489 PMCID: PMC6530384 DOI: 10.1136/bmjopen-2018-027982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess the prevalence of mild-to-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics. DESIGN Cross-sectional survey using emotion thermometer and distress thermometer problem list. SETTING Renal units in four hospital Trusts in the West Midlands, UK. PARTICIPANTS Adult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant. OUTCOMES The prevalence of mild-to-moderate distress, and the incidence of distress thermometer problems and patient support needs. RESULTS In total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-to-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalence was significantly higher in younger versus older patients (χ2=14.33; p=0.0008), in women versus men (χ2=6.63; p=0.01) and in black and minority ethnic patients versus patients of white ethnicity (χ2=10.36; p=0.013). Over 40% of patients (n=141) reported needing support. More than 95% of patients reported physical problems and 91.9% reported at least one emotional problem. CONCLUSIONS Mild-to-moderate distress is common in patients with ESRD, and there may be substantial unmet support needs. Regular screening could help identify patients whose distress may otherwise remain undetected. Further research into differences in distress prevalence over time and at specific transitional points across the renal disease pathway is needed, as is work to determine how best to support patients requiring help.
Collapse
Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Celia Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford NHS Trust, Shrewsbury, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
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.
Collapse
|
35
|
Brauer A, Waheed S, Singh T, Maursetter L. Improvement in Hyperphosphatemia Using Phosphate Education and Planning Talks. J Ren Nutr 2019; 29:156-162. [DOI: 10.1053/j.jrn.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 01/04/2023] Open
|
36
|
Park OL, Kim SR. Integrated self-management program effects on hemodialysis patients: A quasi-experimental study. Jpn J Nurs Sci 2019; 16:396-406. [PMID: 30669185 DOI: 10.1111/jjns.12249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/02/2018] [Accepted: 11/05/2018] [Indexed: 01/06/2023]
Abstract
AIM To evaluate the effects of an integrated self-management program using a mobile application, a short message service using a smartphone, and face-to-face counseling and education among hemodialysis patients. METHODS A quasi-experimental study design was used. The participants of this study were 84 hemodialysis patients (42 in the experimental group and 42 in the control group). The experimental group received the integrated self-management program for 8 weeks. The data were analyzed by using the independent t-test and Mann-Whitney U test to identify differences in self-efficacy, treatment compliance, the ratio of interdialytic weight gain to dry weight, and serum potassium and phosphorus levels between the experimental group and the control group at the end of the program. RESULTS The scores for self-efficacy and treatment compliance were significantly higher in the experimental group than in the control group. The ratio of interdialytic weight gain to dry weight significantly decreased in the experimental group, compared to the control group. The serum potassium and phosphorus levels in the experimental group were not significantly lower than those of the control group. CONCLUSION The findings suggest that the integrated self-management program that was implemented in this study could be a potentially effective intervention to improve the self-management of hemodialysis patients. Further research on various nursing intervention programs is warranted, including a mobile application program to improve hemodialysis patients' self-management.
Collapse
Affiliation(s)
- Ok Lae Park
- Department of Nursing, Wonkwang University Hospital, Iksan, South Korea
| | - Sung Reul Kim
- College of Nursing, Korea University, Seoul, South Korea
| |
Collapse
|
37
|
Tamaura Y, Nishitani M, Akamatsu R, Tsunoda N, Iwasawa F, Fujiwara K, Kinoshita T, Sakai M, Sakai T. Association Between Interdialytic Weight Gain, Perception About Dry Weight, and Dietary and Fluid Behaviors Based on Body Mass Index Among Patients on Hemodialysis. J Ren Nutr 2019; 29:24-32.e5. [DOI: 10.1053/j.jrn.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/10/2018] [Accepted: 04/21/2018] [Indexed: 12/19/2022] Open
|
38
|
Chilcot J, Hudson JL. Is successful treatment of depression in dialysis patients an achievable goal? Semin Dial 2018; 32:210-214. [PMID: 30418698 DOI: 10.1111/sdi.12755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo-controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.
Collapse
Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joanna L Hudson
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
39
|
Adherence to Hemodialysis and Associated Factors among End Stage Renal Disease Patients at Selected Nephrology Units in Rwanda: A Descriptive Cross-Sectional Study. Nurs Res Pract 2018; 2018:4372716. [PMID: 29973988 PMCID: PMC6008892 DOI: 10.1155/2018/4372716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/17/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Worldwide, End Stage Renal Disease (ESRD) has become a public health concern increasing the number of patients maintained on hemodialysis prior to renal transplantation. Nonadherence to hemodialysis continues to impact on the care of ESRD patients, causing high increase in morbidity and mortality. Purpose of the Study The purpose of this study was to determine the level of adherence to hemodialysis and the associated factors among End Stage Renal Disease (ESRD) patients in selected nephrology units in Rwanda. Methods This was a descriptive cross-sectional design involving 41 participants. Participants were recruited using a purposive sampling technique. Demographic and adherence to hemodialysis data were collected with the use of structured interview schedules. Descriptive statistics were used to describe the demographic variables and the level of adherence to hemodialysis. Inferential statistics of chi-square was used to establish factors associated with adherence to hemodialysis. Results Twenty-one (51%) of ESRD participants adhered highly (scores < 80%) to HD. Seventeen (42%) adhered moderately (70–79%) to HD while three (7%) had low level of adherence to HD (below 70%). The factors associated with adherence to hemodialysis were age (mean = 27; 95% CI 26.76–29, 17; p = 038) and religion (95% CI 26.29–60.12, p = 003). Frequencies of education of health care workers about the importance of not missing dialysis (95% CI 26.71–42.56, p = .000), perceived relative importance of hemodialysis (95% CI 20.44–27.76, p = .020), and experiencing difficulties during the procedure (95% CI 20.80–28.36, p = .004) were significantly associated with adherence to hemodialysis. Conclusion. Adherence to hemodialysis is still a public health concern in Rwanda. Health care providers and particularly nurses should continue to advocate for adherence to HD for better health outcomes. Further research is needed to identify the barriers to HD in Rwanda.
Collapse
|
40
|
Duong TV, Wong TC, Su CT, Chen HH, Chen TW, Chen TH, Hsu YH, Peng SJ, Kuo KL, Liu HC, Lin ET, Yang SH. Associations of dietary macronutrients and micronutrients with the traditional and nontraditional risk factors for cardiovascular disease among hemodialysis patients: A clinical cross-sectional study. Medicine (Baltimore) 2018; 97:e11306. [PMID: 29953017 PMCID: PMC6039668 DOI: 10.1097/md.0000000000011306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/07/2018] [Indexed: 01/18/2023] Open
Abstract
The current study was to examine the association of adequate intake of macronutrients and micronutrients with traditional and nontraditional cardiovascular risk factors in hemodialysis patients.A clinical cross-sectional study was conducted between September 2013 and April 2017 on 492 hemodialysis patients aged 20 years and above, received thrice-weekly hemodialysis treatment for at least 3 months, adequate dialysis quality (equilibrated Kt/V ≥ 1.2 g/kg/d) from 7 hospital-based hemodialysis centers in Taiwan. The dietary intake was evaluated by the 3-day dietary record, and a 24-hour dietary recall. Biochemical parameters were archived from laboratory tests. The cardiovascular disease (CVD) risk factors were defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. The adequate dietary intake of macronutrients and micronutrients was recommended by the European Best Practice Guidelines, K/DOQI, and Institute of Medicine guidelines. Logistic regression analysis was used.All hemodialysis patients had CVD risks, the lowest proportion of patients with adequate intake of macronutrients and micronutrients were 8.7% and 1.8%, respectively. The adequate dietary intake associated with lower likelihood of having CVD risks in hemodialysis patient by 47% to 84%, including 39% to 58% lower hypertension, 37% to 50% lower dyslipidemia, 42% to 63% diabetes mellitus, 44% to 84% lower obesity, 58% lower low calcium, 38% lower hyperparathyroidism, 47% to 64% lower hyperhomocysteinemia, and 41% to 67% lower inflammation, 63% to 74% lower hypoalbumin, 73% lower inadequate normalized protein nitrogen appearance.Adequate dietary nutrients intake may reduce the cardiovascular risks factors, in turn, to prevent the cardiovascular morbidity and mortality.
Collapse
Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University
| | - Chien-Tien Su
- School of Public Health, Taipei Medical University
- Department of Family Medicine
| | - Hsi-Hsien Chen
- Department of Nephrology, Taipei Medical University Hospital
- School of Medicine, Taipei Medical University
| | | | - Tso-Hsiao Chen
- School of Medicine, Taipei Medical University
- Department of Nephrology, Taipei Medical University-Wan Fang Hospital
| | - Yung-Ho Hsu
- School of Medicine, Taipei Medical University
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Taipei Medical University
| | | | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi Hospital, Taipei
| | | | - En-Tsu Lin
- Department of Nephrology, Lotung Poh-Ai Hospital, Yilan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University
- Nutrition Research Center, Taipei Medical University Hospital
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
41
|
Hwang HC, Kim HR, Han DH, Hong JS, Jeong SH, Shin JH, Kim SH, Hwang JH, Kim SM. Influence of Major Coping Strategies on Treatment Non-adherence and Severity of Comorbid Conditions in Hemodialysis Patients. J Korean Med Sci 2018; 33:e148. [PMID: 29760606 PMCID: PMC5944213 DOI: 10.3346/jkms.2018.33.e148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/26/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Non-adherence and comorbidities are prevalent among hemodialysis patients and are associated with increased mortality and financial burden. We aimed to investigate the influence of major coping strategies (CSs) on non-adherence and comorbidities in hemodialysis patients. METHODS A total of 49 patients were enrolled. We collected participant data including CS measured by a Korean version of the ways of coping questionnaire (K-WCQ), comorbidities measured by age-adjusted Charlson comorbidity index (CCI), and adherence measured by the 8-item Morisky medication adherence scale (MMAS-8). RESULTS Regarding major CS, 61.2% of participants reported use of support-seeking CS (SUP group), 14.3% reported use of problem-focused CS (PRO group), and 24.5% reported use of hopeful-thinking CS (HOP group). The mean MMAS-8 score was higher in the PRO group than in the HOP group (P = 0.024). The mean CCI score was lower in the PRO group than in the HOP group (P = 0.017). In the HOP group, the severity of somatic symptoms was positively correlated with the scores for the emotion-focused CS subscale (r = 0.39, P = 0.029) and the hopeful-thinking CS subscale (r = 0.38, P = 0.036) of the K-WCQ. The level of life satisfaction positively correlated with the score for the problem-focused CS subscale in the HOP group (r = 0.40, P = 0.027). CONCLUSION We should pay more attention to the CSs of hemodialysis patients and provide interventions that promote problem-focused CSs, especially for nonadherent patients with high comorbidity rates who mainly use a hopeful-thinking CS.
Collapse
Affiliation(s)
- Hyun Chan Hwang
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - Hye Ri Kim
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - Ji Sun Hong
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - So-hee Jeong
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jung-ho Shin
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Su-Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin Ho Hwang
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| |
Collapse
|
42
|
Chilcot J, Guirguis A, Friedli K, Almond M, Day C, Da Silva-Gane M, Davenport A, Fineberg NA, Spencer B, Wellsted D, Farrington K. Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specific Outcome Analysis. Ann Behav Med 2018; 52:1-8. [PMID: 28762106 PMCID: PMC6367894 DOI: 10.1007/s12160-017-9918-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Depression is common in haemodialysis (HD) patients and associated with poor outcomes. Purpose To evaluate whether depression symptoms predict survival and transplantation in a large sample of haemodialysis patients using cause-specific survival models. Methods Survival data was collected between April 2013 and November 2015, as part of the screening phase of a multicentre randomised placebo-controlled trial of sertraline in HD patients. Depression was measured using the Beck Depression Inventory-II (BDI-II) and the Patient Health Questionnaire-9 (PHQ-9). Demographic and clinical data were collected via a self-report questionnaire and medical records. Competing risk survival analysis involved cause-specific and subdistribution hazard survival models. All models were adjusted for appropriate covariates including co-morbidity and C-reactive protein (CRP) in a subanalysis. Results Of 707 cases available for analysis, there were 148 deaths. The mean survival time was 787.5 days. Cumulative survival at 12 months was 88.5%. During the study follow-up period, there were 92 transplants. The cumulative transplant event rate at 12 months was 7.8%. In separate adjusted models, depression symptoms predicted mortality (BDI-II HR = 1.03 95% CI 1.01, 1.04; PHQ-9 HR = 1.04 95% CI 1.01, 1.06). With respect to screening cut-off scores, a PHQ-9 ≥ 10 was associated with mortality (HR = 1.51 95% CI 1.01, 2.19) but not a BDI-II ≥ 16. Depression symptoms were not associated with time to transplantation in either cause-specific or subdistribution model. Conclusions Consistent with past findings in HD patients, depression symptoms predicted survival but were not associated with kidney transplantation. Suitable treatments for depression need further evaluation, and their impact upon quality of life and clinical outcomes determined. Trial Registration Number (ISRCTN06146268).
Collapse
Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ayman Guirguis
- Renal Unit, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK
- Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Karin Friedli
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Michael Almond
- Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-On-Sea, Essex, UK
| | - Clara Day
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Maria Da Silva-Gane
- Renal Unit, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK
- Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Benjamin Spencer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Weston Education Centre, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK
| | - David Wellsted
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK
- Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, UK
| |
Collapse
|
43
|
Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol 2017; 18:318. [PMID: 29061163 PMCID: PMC5653982 DOI: 10.1186/s12882-017-0734-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. METHODS The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. RESULTS Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. CONCLUSION Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
Collapse
Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Level 5, Block C, Crown Street, Wollongong, NSW 2500 Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, Wollongong, New South Wales 2522 Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
| |
Collapse
|
44
|
Chia BY, Cheen MHH, Gwee XY, Chow MMY, Khee GY, Ong WC, Choong HL, Lim PS. Outcomes of pharmacist-provided medication review in collaborative care for adult Singaporeans receiving hemodialysis. Int J Clin Pharm 2017; 39:1031-1038. [DOI: 10.1007/s11096-017-0528-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
|
45
|
Domenick Sridharan N, Fish L, Yu L, Weisbord S, Jhamb M, Makaroun MS, Yuo TH. The associations of hemodialysis access type and access satisfaction with health-related quality of life. J Vasc Surg 2017; 67:229-235. [PMID: 28822665 DOI: 10.1016/j.jvs.2017.05.131] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/29/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE In addition to age and comorbidities, health-related quality of life (HRQOL) is known to predict mortality in hemodialysis (HD) patients. Understanding the association of vascular access type with HRQOL can help surgeons to provide patient-centered dialysis access recommendations. We sought to understand the impact of HD access type on HRQOL. METHODS We conducted a cross-sectional prospective study of community-dwelling prevalent HD patients in Pittsburgh, Pennsylvania. We assessed patient satisfaction with their access using the Vascular Access Questionnaire (VAQ) and HRQOL with the Short Form Health Survey. We compared access satisfaction and HRQOL across access types. We used logistic regression modeling to evaluate the association of access type with satisfaction and multivariate analysis of variance to evaluate the association of both of these variables on HRQOL. RESULTS We surveyed 77 patients. The mean age was 61.8 ± 15.9 years. Arteriovenous fistula (AVF) was used by 62.3%, tunneled dialysis catheter (TDC) by 23.4%, and arteriovenous graft (AVG) by 14.3%. There was a significant difference in satisfaction by access type with lowest median VAQ score (indicating highest satisfaction) in patients with AVF followed by TDC and AVG (4.5 vs 6.5 vs 7.0; P = .013). Defining a VAQ score of <7 to denote satisfaction, AVF patients were more likely to be satisfied with their access, compared with TDC or AVG (77% vs 56% vs 55%; P = NS). Multivariate regression analysis yielded a model that predicted 46% of the variance of VAQ score; important predictors of dissatisfaction included <1 year on dialysis (β = 3.36; P < .001), increasing number of access-related hospital admissions in the last year (β = 1.69; P < .001), and AVG (β = 1.72; P = .04) or TDC (β = 1.67; P = .02) access. Mean physical and mental QOL scores (the composite scores of Short Form Health Survey) were not different by access type (P = .49; P = .41). In an additive multivariate analysis of variance with the two composite QOL scores as dependent variables, 25.8% of the generalized variance in HRQOL (effect size) was accounted for by access satisfaction with only an additional 3% accounted for by access type. CONCLUSIONS HD patients experience greatest satisfaction with fistula, and access satisfaction is significantly associated with better HRQOL. Controlling for access satisfaction, there is no significant independent association of access type on HRQOL. Future research should investigate the relationship between access satisfaction, adherence to dialysis regimens, mortality, and the consequent implications for patient-centered care.
Collapse
Affiliation(s)
| | - Larry Fish
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Lan Yu
- University of Pittsburgh, Institute for Clinical Research, Pittsburgh, Pa
| | - Steven Weisbord
- Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Manisha Jhamb
- Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel S Makaroun
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Theodore H Yuo
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| |
Collapse
|
46
|
Shimoishi K, Anraku M, Uto A, Iohara D, Hirayama F, Kadowaki D, Zingami S, Maruyama T, Otagiri M. A Comparison of the Phosphorus Content in Prescription Medications for Hemodialysis Patients in Japan. YAKUGAKU ZASSHI 2017; 137:903-908. [PMID: 28674306 DOI: 10.1248/yakushi.17-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A high dietary intake of phosphorus is considered to be a significant health threat for hemodialysis (HD) patients. Prescription medications, which might be a major source of phosphorus, is largely unrecognized in Japan. However, the amount of phosphorus indicated on the package label, is not quantified. In this study, the phosphorus content of 22 of the most widely prescribed medications that are used in conjunction with HD therapy were examined and differences between branded and generic prescription medications were compared. All samples were selected from medications that are typically prescribed for HD patients. The samples were ground prior to analysis. Phosphorus was measured using the Wako L-Type Phosphate method. All instruments used in the study were calibrated according to the manufacturers' specifications. Amlodipine (15 mg/tablet) and paroxetine (30.0 mg/tablet) were found to contain higher contents of phosphorus than the medications tested. Differences in phosphorus content between branded and generic drugs was also determined. The phosphorus content of all generic paroxetine preparations was significantly lower than the values for identical branded medications. On the other hand, the phosphorus content of several generic amlodipine preparations were significantly different from those of similar, branded preparations. Specific information regarding the phosphorus content of prescribed medications used by HD patient needs to be made available to the dialysis community.
Collapse
Affiliation(s)
| | | | | | | | | | - Daisuke Kadowaki
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University
| | - Sachiko Zingami
- Department of Pharmacy, Japanese Red Cross Kumamoto Hospital
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University
| | | |
Collapse
|
47
|
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.
Collapse
|
48
|
Oquendo LG, Asencio JMM, de las Nieves CB. Contributing factors for therapeutic diet adherence in patients receiving haemodialysis treatment: an integrative review. J Clin Nurs 2017; 26:3893-3905. [DOI: 10.1111/jocn.13804] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Lissete González Oquendo
- Department of Nursing; Faculty of Health Sciences, based Fuerteventura; University of Las Palmas de Gran Canaria; Las Palmas Spain
| | | | | |
Collapse
|
49
|
Naalweh KS, Barakat MA, Sweileh MW, Al-Jabi SW, Sweileh WM, Zyoud SH. Treatment adherence and perception in patients on maintenance hemodialysis: a cross - sectional study from Palestine. BMC Nephrol 2017; 18:178. [PMID: 28558719 PMCID: PMC5450383 DOI: 10.1186/s12882-017-0598-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/19/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adherence to diet recommendations, fluid restriction, prescribed medications, and attendance at hemodialysis (HD) sessions are essential for optimal and effective treatment of patients with end-stage renal disease. No data regarding this issue are available from Palestine. Therefore, this study was carried out to assess adherence to diet, fluid restriction, medications, and HD sessions. METHODS A cross-sectional study of HD patients at An-Najah National University Hospital was carried out during summer, 2016. Self-reported adherence behavior was obtained using a valid and reliable questionnaire (End-Stage Renal Disease Adherence Questionnaire: ESRD-AQ). Predialytic serum levels of potassium and phosphate were obtained as clinical indicator of diet and medication adherence respectively. In addition, interdialytic body weight (IDW) was also obtained from medical records and analyzed in relation to reported adherence of fluid restriction. RESULTS A total of 220 patients answered all questions pertaining to ESRD-AQ. The mean age ± standard deviation of participants was 56.82 ± 14.51 years. Dietary adherence was observed in 24% while that of fluid restriction adherence was observed in 31% of studied patients. Reported adherence to HD sessions was 52% while that for medications was 81%. Overall, 122 (55.5%) patients had good adherence, 89 (40.5%) had moderate adherence, and 9 (4.1%) had poor adherence behavior. Male patients had significantly higher overall adherence scores than females (p = 0.034). A significant correlation between reported diet adherence and serum pre-HD potassium level (p < 0.01) was observed. A significant correlation between reported fluid restriction adherence and IDW (p < 0.01) was also found. However, no significant correlation between reported adherence and pre-HD phosphate level. There was significant correlation between overall perception and overall adherence score (p < 0.001). Counselling of patients regarding importance of adherence modalities was lowest for "staying for the entire dialysis time". Multivariate analysis indicated that elderly male patients who were city residents had higher odds of having higher adherence score. CONCLUSIONS There was a good percentage of patients who had overall moderate or poor adherence. ESRD-AQ could be used to assess some aspects of HD adherence. Counselling and education of patients on HD are important to improve therapeutic outcome.
Collapse
Affiliation(s)
- Karam Sh. Naalweh
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Mohammad A. Barakat
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Moutaz W. Sweileh
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samah W. Al-Jabi
- 0000 0004 0631 5695grid.11942.3fDivision of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Waleed M. Sweileh
- 0000 0004 0631 5695grid.11942.3fDepartment of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fDivision of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| |
Collapse
|
50
|
Meuleman Y, Hoekstra T, Dekker FW, Navis G, Vogt L, van der Boog PJ, Bos WJW, van Montfrans GA, van Dijk S, van Dijk S, Meuleman Y, Dekker FW, Hoekstra T, Navis G, Vogt L, van der Boog PJ, Bos WJW, van Montfrans GA, Boeschoten EW, Verduijn M, ten Brinke L, Spijker A, Kwakernaak AJ, Humalda JK, van Hirtum T, Bokelaar R, Loos ML, Bakker-Edink A, Poot C, Ciere Y, Zwaard S, Veldscholte G, Heuveling L, Storm M, Prantl K. Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support. Am J Kidney Dis 2017; 69:576-586. [DOI: 10.1053/j.ajkd.2016.08.042] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/25/2016] [Indexed: 11/11/2022]
|