The worldwide prevalence of non-adherence to diet and fluid restrictions among hemodialysis patients: A systematic review and meta-analysis

Psychometric properties of the Turkish version of the Fluid Intake Appraisal Inventory in adults receiving hemodialysis

INTRODUCTION

Effective self-management of fluid intake in hemodialysis relies on self-efficacy. Although regular assessments with valid tools are crucial, no suitable measurement exists for the Turkish population. This study evaluates the reliability, validity, and interpretability of the Turkish version of the Fluid Intake Appraisal Inventory.

METHODS

This cross-sectional study collected data from December 2021 to November 2022. It analyzed reliability, validity, and interpretability.

RESULTS

The 202 adults receiving hemodialysis were evaluated. The scale showed high internal consistency with Cronbach α = 0.954 and good test-retest reliability with intraclass correlation coefficients = 0.975, 95% confidence interval: 0.786-0.992, and no measurement error. It demonstrated excellent content validity with scale level content validity index ≥0.90 and good construct validity with a negative moderate correlation to interdialytic weight gain. For structural validity, the model fit indices were χ2/df = 5.7, root mean square error of approximation = 0.15, goodness of fit indexes = 0.58, Tucker-Lewis Index = 0.57, comparative fit index = 0.6, and standardized root mean square residual = 0.10.

CONCLUSION

This inventory is a valid and reliable tool for assessing self-efficacy in fluid intake among the Turkish hemodialysis population.

Navigating strategies used to manage fatigue by patients undergoing hemodialysis: a qualitative exploratory design

BACKGROUND

Fatigue among patients with end-stage kidney disease (ESKD) undergoing hemodialysis significantly impacts quality of life and anticipated treatment results. This study explores how Omani patients undergoing hemodialysis manage their fatigue.

METHODS

A qualitative design was employed. Data were collected from 25 participants through semi-structured interviews, which were transcribed verbatim and analyzed using thematic analysis. Data management, memo creation, and annotation were completed using NVivo 11.

RESULTS

Findings highlighted one main overarching theme, Self-initiated management strategies, outlining the coping mechanisms patients used to reduce fatigue and adapt their daily activities to its ongoing presence. This overarching theme encapsulates six subthemes that describe patients' self-initiated strategies to manage fatigue, which include (1) self-regulating weight gain and negotiating accumulated fluid removal with healthcare providers (HCPs); (2) Increased appetite and desire for rest; (3) expanding self-awareness for change; (4) engaging in regular physical activity; (5) seeking deeper understanding and support from others and (6) immersing in faith and religious practices.

CONCLUSIONS

The study findings emphasize that patients used several management strategies to manage both physical and mental fatigue and improve their quality of daily living. Although these techniques used to manage fatigue by patients were helpful, healthcare professionals must provide a holistic approach to support the patient's self-initiated fatigue management strategies. Therefore, further studies would be required both within nationally and internationally to validate study findings, and find methods to promote the positive coping techniques used.

CLINICAL TRIAL NUMBER

Not applicable.

Predictors of self-management behaviors among patients undergoing hemodialysis

Inadequate self-management has a significant impact on the mortality and morbidity of patients undergoing hemodialysis. The capacity for self-management is contingent on demographic, clinical, psychosocial, and cognitive factors. In particular, the role of family support and quality social interactions in this process is significant. The Individual and Family Self-Management Theory (IFSMT) emphasizes the integration of self-management into the lifestyles of the individual and family. Therefore, this study aimed to investigate the factors that affect self-management in patients undergoing hemodialysis based on IFSMT. Data were collected from three tertiary-level hospitals in Korea from May to October 2021. A total of 140 patients with chronic kidney disease undergoing hemodialysis completed a structured self-report questionnaire comprising questions on general characteristics, complexity of disease management, accessibility to healthcare services, health literacy, family functioning, self-efficacy, self-regulation, social support, and self-management behaviors. Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA with Scheffé test as post-hoc analysis, Pearson's correlation analysis, and hierarchical multiple regression analysis. The study found that self-management in patients undergoing hemodialysis was influenced by "health literacy" contextual factor and "self-efficacy," "self-regulation," and "social support" process factors, based on the IFSMT framework. These factors accounted for 45.0% of the variance in self-management. These findings highlight the importance of the IFSMT in predicting self-management behavior in patients undergoing hemodialysis. It is essential to develop a comprehensive intervention that incorporates these contextual and process factors within the family setting, and future research should evaluate its effectiveness.

Effects of motivational interviewing and an education programme based on Watson's theory of human caring on adults receiving haemodialysis: randomised controlled trial

Background

Effective haemodialysis management is crucial, and behavioural change interventions are essential for good haemodialysis self-management. However, no study explores the effects of Watson's theory such as the humanistic approach to behavioural change in haemodialysis.

Aims

To evaluate the effects of motivational interviewing and an education programme based on Watson's theory on adherence to treatment, satisfaction and health-related quality of life (HRQOL) on haemodialysis.

Methods

This study was conducted in Turkey. Intervention group received four sessions of motivational interviewing and an education programme based on Watson's theory, and the control group received routine care. The primary outcomes were adherence to fluid intake, diet and medication, attendance at haemodialysis sessions, satisfaction and HRQOL. The secondary outcomes were laboratory parameters.

Results

Participants were randomly assigned to the intervention (n = 32) or the control group (n = 28). There were statistically significant between-group differences in adherence to fluid intake, diet and medication, and the kidney disease burden sub-dimension of HRQOL, with medium to large effect sizes. There was no difference in laboratory parameters. Participants showed high levels of satisfaction with this programme.

Conclusions

This study provides evidence for nurses regarding Watson's theory-based programme in a haemodialysis population. Results will help nurses to develop and practice customised effective interventions for haemodialysis.

How to Limit Interdialytic Weight Gain in Patients on Maintenance Hemodialysis: State of the Art and Perspectives

Background: Interdialytic weight gain (IDWG), defined as the accumulation of salt and water intake between dialysis sessions, is a critical parameter of fluid management and a marker of adherence to dietary and fluid restrictions in hemodialysis patients. Excessive IDWG has been strongly associated with increased cardiovascular risk, including left ventricular hypertrophy, cardiac dysfunction, and cerebrovascular complications. Additionally, it necessitates more aggressive ultrafiltration, potentially compromising hemodynamic stability, impairing quality of life, and escalating healthcare costs. Despite international guidelines recommending an IDWG target of <4-4.5% of body weight, many patients struggle to achieve this due to barriers in adhering to dietary and fluid restrictions. This review explores the current state-of-the-art strategies to mitigate IDWG and evaluates emerging diagnostic and therapeutic perspectives to improve fluid management in dialysis patients. Methods: A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify studies on IDWG in hemodialysis. Keywords and MeSH terms were used to retrieve peer-reviewed articles, observational studies, RCTs, meta-analyses, and systematic reviews. Non-English articles, case reports, and conference abstracts were excluded. Study selection followed PRISMA guidelines, with independent screening of titles, abstracts, and full texts. Data extraction focused on IDWG definitions, risk factors, clinical outcomes, and management strategies. Due to study heterogeneity, a narrative synthesis was performed. Relevant data were synthesized thematically to evaluate both established strategies and emerging perspectives. Results: The current literature identifies three principal strategies for IDWG control: cognitive-behavioral interventions, dietary sodium restriction, and dialysis prescription adjustments. While educational programs and behavioral counseling improve adherence, their long-term effectiveness remains constrained by patient compliance and logistical challenges. Similarly, low-sodium diets, despite reducing thirst, face barriers to adherence and potential nutritional concerns. Adjustments in dialysate sodium concentration have yielded conflicting results, with concerns regarding hemodynamic instability and intradialytic hypotension. Given these limitations, alternative approaches are emerging. Thirst modulation strategies, including chewing gum to stimulate salivation and acupuncture for autonomic regulation, offer potential benefits in reducing excessive fluid intake. Additionally, technological innovations, such as mobile applications and telemonitoring, enhance self-management by providing real-time feedback on fluid intake. Biofeedback-driven dialysis systems enable dynamic ultrafiltration adjustments, improving fluid removal efficiency while minimizing hemodynamic instability. Artificial intelligence (AI) is advancing predictive analytics by integrating wearable bioimpedance sensors and dialysis data to anticipate fluid overload and refine individualized dialysis prescriptions, driving precision-based volume management. Finally, optimizing dialysis frequency and duration has shown promise in achieving better fluid balance and cardiovascular stability, suggesting that a personalized, multimodal approach is essential for effective IDWG management. Conclusions: Despite decades of research, IDWG remains a persistent challenge in hemodialysis, requiring a multifaceted, patient-centered approach. While traditional interventions provide partial solutions, integrating thirst modulation strategies, real-time monitoring, biofeedback dialysis adjustments, and AI-driven predictive tools represent the next frontier in fluid management. Future research should focus on long-term feasibility, patient adherence, and clinical efficacy, ensuring these innovations translate into tangible improvements in quality of life and cardiovascular health for dialysis patients.

Behavioral interventions targeting treatment adherence in chronic kidney disease: A systematic review and meta-analysis

Adherence to dialysis, medication regimens and dietary and fluid intake recommendations can improve quality of life and survival in chronic kidney disease, but non-adherence is prevalent. This review and meta-analysis investigated the effects of behavioral interventions on treatment adherence in chronic kidney disease and examined intervention characteristics (Behavior Change Techniques and delivery methods) associated with direct and indirect measures of adherence. Literature searches in five databases identified 149 eligible studies (255 study arms; 15878 patients). Random-effects meta-analyses revealed mostly small and statistically significant beneficial effects on outcomes, ranging from g = 0.27 (95% CI [0.03, 0.50]; p = 0.02) for dialysis adherence to g = 0.84 (95% CI [0.23, 1.45]; p = 0.01) for sodium. Moderator analyses revealed 16 Behavior Change Techniques and 12 delivery related moderators associated with improvements in adherence. These included intervention methods targeting behavioral regulation, health beliefs and knowledge, social support, and involving a dietitian or a nurse. The Behavior Change Techniques 'instructions on how to perform the behavior, 'information about antecedents', 'information about health consequences', 'social support (unspecified)', and 'goal setting (behavior)' were associated with beneficial changes in several adherence outcomes. These results can be used to inform the development of new interventions to improve chronic kidney disease treatment adherence.

A survey on medication adherence and influencing factors among 226 peritoneal dialysis patients in a primary hospital in China

PURPOSE

To investigate the current status of medication adherence among peritoneal dialysis (PD) patients in a primary hospital and to explore the influencing factors of medication adherence among PD patients.

METHODS

The author used the Chinese version of the Morisky Medication Compliance Scale to evaluate the medication compliance of 226 PD patients in a single centre. Univariate analysis and logistic regression were used to analyse the factors influencing medication compliance in patients.

RESULTS

Among 226 PD patients, 196 had moderate/high drug adherence (86.73%), and 36 had low medication adherence (15.93%). Univariate analysis showed that there was a statistically significant difference between groups in age (χ2 = 3.990, P = 0.020), PD vintage (t = 2.068, P = 0.040), presence of anaemia (t = -2.750, P = 0.006), PD operator (χ2 = 3.110, P = 0.047), SDS scores (t = 2.818, P = 0.005). Binary logistic regression analysis demonstrated that age (OR = 1.037, 95% CI: 1.005-1.070; P = 0.037), SDS scores (OR = 0.940, 95% CI: 0.900-0.982; P = 0.005) are factors affecting patient drug compliance.

CONCLUSIONS

In summary, this study found that age and depressive symptoms were the main factors affecting drug compliance in PD patients, providing a basis for specifying specific measures to improve patient medication adherence. With the help of information technology and a novel exercise method, the medical staff could carry out various forms of health education and activity to improve the medication compliance of PD patients.

The effects of death anxiety on diet-fluid restriction non-adherence in hemodialysis patients

INTRODUCTION

The study was performed to examine the effects of death anxiety on diet-fluid restriction non-adherence in hemodialysis patients.

METHODS

This descriptive, cross-sectional, and correlational study was performed with 118 hemodialysis patients who received treatment in the dialysis unit of a university hospital and a state hospital in Elazığ, eastern Turkey. The study data were obtained with the "Descriptive Data Form", "Death Anxiety Scale", and "Dietary and Fluid Restriction Non-Adherence Scale".

FINDINGS

The average Death Anxiety Scale total score of the patients was 10.00 ± 4.75. The "Duration of non-adherence with diet" mean score was 1.66 ± 1.70, "Degree of non-adherence with diet" mean score was 1.24 ± 1.19, "Duration of non-adherence with fluid restriction" mean score was 1.61 ± 1.71, and "Degree of non-adherence with fluid restriction" mean score was 1.16 ± 1.13. The independent variable Death Anxiety Scale significantly and negatively affected the dependent variable "Duration of non-adherence with diet", "Degree of non-adherence with diet", "Duration of non-adherence with fluid restriction", and "Degree of non-adherence with fluid restriction".

DISCUSSION

Hemodialysis patients face serious death anxiety, their degree of non-adherence with diet-fluid restriction was low as death anxiety scores increased, and the degree of non-adherence with diet-fluid restriction decreased.

Habitual Dietary Patterns of Maintenance Haemodialysis Patients and the Relationship Between Malnutrition Risk-A Multicentre Cross-Sectional Diet Survey

AIMS

To identify habitual dietary patterns in maintenance haemodialysis patients and analyse their association with malnutrition.

DESIGN AND METHODS

A multicentre cross-sectional dietary survey was conducted among 232 maintenance haemodialysis patients from three centres. A 3-day 24-h diet recall and demographic, clinical and therapeutic information were collected. Factor analysis was used to identify the major dietary patterns among haemodialysis patients. Logistic regression analysis was used to assess the relationship between dietary patterns and malnutrition risk.

RESULTS

Three dietary patterns were identified in this study and differed in age, gender and diabetes. An 'animal foods and refined grains' dietary pattern meets guideline requirements. A 'fresh fruits and nuts' dietary pattern had insufficient daily energy and protein intake with the lowest carbohydrates, lipids and minerals intake among haemodialysis patients. A 'dairy products' dietary pattern characterised by low calorie and moderate protein was found to be associated with malnutrition.

CONCLUSIONS

Habitual dietary patterns of maintenance haemodialysis patients were associated with personal characteristics, specifically age, gender and diabetes. Patients with habitual 'dairy products' dietary patterns may have poor nutritional status.

PRACTICAL APPLICATIONS

Educating haemodialysis patients about their daily diet pattern, rather than focusing on nutrients, is crucial and will help them to understand it better. Clinical staff can recognise patients at risk of malnutrition by a dietary pattern of lower intake of certain foods. They can recommend a balanced nutritional pattern that increases calories in the total diet and meets protein requirements.

Treatment Adherence and Factors Influencing It in End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Study From a Tertiary Care Hospital in North India

Background Chronic kidney disease (CKD) has become a significant global health concern, making its effective management crucial. Patients with end-stage renal disease (ESRD) often require multiple medications, restriction of fluid and diet intake, and maintenance hemodialysis (HD) to manage their condition, which together makes it difficult to maintain adherence to treatment. This study aimed to evaluate the prevalence of treatment adherence among ESRD patients and to identify influencing factors, addressing the lack of such data from Northern India. Methods This cross-sectional study was conducted at a tertiary care hospital in Northern India. ESRD patients on maintenance HD for at least three months were recruited from the outpatient and dialysis units of the hospital. Patients were interviewed using a validated and reliable tool, the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ). The primary objective was to assess the prevalence of treatment adherence among ESRD patients on HD who presented to the hospital, and the secondary objective was to evaluate various factors influencing treatment adherence among these patients. Results A total of 199 patients were enrolled, with a mean age ± standard deviation of 44.34 ± 13.7 years. Among the patients, 51.76% (n = 103) demonstrated good adherence (adherence score >1000), 41.71% (n = 83) showed moderate adherence (adherence score 700-999), and 6.53% (n = 13) exhibited poor adherence (adherence score <700). A significant association was found between adherence scores and patients' perception of treatment regimens (p < 0.0001 for each of the four treatment adherence domains, namely, HD, medication, fluid restriction, and diet restriction) and between adherence scores and the frequency of counseling by medical professionals (p = 0.106, 0.037, 0.014, and 0.002 for HD, medication, fluid restriction, and diet restriction, respectively). Individuals with graduate-level education or higher exhibited significantly better adherence scores than those with education levels below graduation (p = 0.044). However, age, sex, marital status, area of residence, employment status, mode of transportation, and the presence of family members accompanying patients to HD sessions were not significantly associated with treatment adherence. Conclusion Approximately half of the study population exhibited moderate-to-poor adherence, emphasizing the need for substantial improvement in adherence levels. These findings suggest that more frequent and effective counseling is necessary, as low adherence scores were significantly associated with infrequent counseling and poor patients' perceptions of the importance of treatment regimens.

Association between health-related hope and distress from restrictions in chronic kidney disease and dialysis

BACKGROUND

In chronic kidney disease (CKD), the durability of patient adherence to fluid and dietary restrictions may depend on the degree to which they have hope that they will enjoy life. Previous cross-sectional studies have shown that higher hope was associated with lower distress from fluid and dietary restrictions and better adherence in the short term. In this study, we aimed to examine the long-term relationship of hope with distress from fluid and dietary restrictions.

METHODS

This prospective observational cohort study included 444 patients with CKD undergoing dialysis in one of five Japanese nephrology centers. Hope as a predictor was measured using an 18-item health-related hope scale. Outcomes were two-item measures of distress from fluid and dietary intake restrictions using the Japanese version of the Kidney Disease Quality of Life Short Form, Version 1.3 (higher scores indicate lower levels of distress). Multivariate linear mixed models were used to estimate the association of baseline health-related hope with distress from fluid and dietary restrictions at baseline and follow-up.

RESULTS

The mean age of the participants was 67 years, and 31.1% of them were females. In total, 124, 98, and 222 had non-dialysis CKD, peritoneal dialysis, and hemodialysis, respectively. Higher levels of baseline health-related hope were associated with lower levels of distress from fluid restriction after one year (per 10-point increase, 2.6 points (95% confidence interval, 1.0 to 4.1)); whereas the baseline score was not associated with the distress from fluid restriction at 2 years. Similarly, higher levels of baseline health-related hope were associated with lower levels of distress from dietary restriction after one year (per 10-point increase, 2.0 points (95% confidence interval, 0.3 to 3.6)); whereas the baseline score was not associated with the distress from dietary restriction at 2 years.

CONCLUSIONS

Health-related hope, regardless of depression, can potentially mitigate long-term distress from fluid and dietary restrictions in patients with a wide range of CKD severities.

TRIAL REGISTRATION

UMIN000054710.

Social Support and Adherence to Treatment Regimens among Patients Undergoing Hemodialysis

BACKGROUND/OBJECTIVES

Following recommended treatment plans is essential to the success of the treatment. In hemodialysis, adherence to the treatment regimen remains a challenge in many healthcare settings. Many factors, including the patient's level of social support, influence treatment adherence, but few studies have addressed these relationships.

METHODS

A correlational cross-sectional design was used to assess the relationship between perceived social support and adherence to treatment regimens among patients undergoing hemodialysis. Self-reported surveys were used to collect data.

RESULTS

One hundred and twenty-one hemodialysis patients were recruited from two dialysis centers. Overall, 45.5% of participants demonstrated good adherence, 47.9% had moderate adherence, and 6.6% had poor adherence. Specifically, 76% of participants consistently took their prescribed medications, 75% regularly attended hemodialysis sessions, 67.8% adhered to dietary restrictions, and 62% followed fluid-intake guidelines. Perceived social support was reported as highest from family members (89.3%), followed by significant others (62.8%) and friends (49.6%). There were significant correlations between perceived social support and overall adherence to treatments among hemodialysis patients.

CONCLUSIONS

This study provides evidence for positive relationships between perceived social support and adherence to treatment regimens among hemodialysis patients. It is recommended that professional caregivers intervene with clients and their families, prepare recreational and educational programs for patients undergoing hemodialysis, and inspire other researchers to suggest different social support models and approaches.

Exploring Healthcare Paradoxes in Hospital Haemodialysis-A Qualitative Study

INTRODUCTION

The complex logics of healthcare systems inherit paradoxes that can lead to interpersonal conflicts impacting both patients and professionals. In this study, we aimed to identify and explore tensions and conflicts arising from paradoxes within hospital haemodialysis.

METHODS

We conducted a secondary supplementary analysis to previously collected qualitative data, including individual interviews with 11 patients and 10 nephrologists and focus groups involving a total of 13 haemodialysis nurses. Data were collected in Norway through three primary studies focused on exploring experiences of patient participation. For the current study, we employed thematic analysis.

RESULTS

Patient-professional conflicts emerged in three fundamental areas: (1) the hospital haemodialysis treatment, in which patients' views of treatment diverged from those of professionals, (2) patient-professional responsibility that became a negotiation point, with differing views on responsibilities, and (3) time, in which professional time took precedence over patients' time, indirectly impacting patients due to resource allocation. These conflicts stemmed from paradoxes driven by unevenly validated principles, conflict of interest, and conceptual ambiguity.

CONCLUSION

Altering healthcare logics by bringing in new perspectives or clarifying conceptual ambiguity could mitigate patient-professional conflicts. However, changing existing healthcare logics may give rise to new paradoxes and conflicts, which health services at various levels must address.

PATIENT OR PUBLIC CONTRIBUTION

This secondary analysis utilized previously collected data from a project that did not involve patient or public contribution.

Dietary Restriction, Socioeconomic Factors, Access to Kidney Transplantation, and Waitlist Mortality

INTRODUCTION

Dietary restrictions for patients with end-stage kidney disease (ESKD) are burdensome. Kidney transplantation (KT) candidates who lack neighborhood resources and are burdened by dietary restrictions may have decreased access to KT.

METHODS

In our two-center prospective cohort study (2014-2023), 2471 ESKD patients who were evaluated for KT (candidates) reported their perceived burden of dietary restrictions (not at all, somewhat/moderately, or extremely bothered). Neighborhood-level socioeconomic factors were derived from residential ZIP codes. We quantified the association of perceived burden of the dietary restrictions with a chance of listing using Cox models and risk of waitlist mortality using competing risks models. Then we tested whether these associations differed by neighborhood-level socioeconomic factors.

RESULTS

At evaluation, 18% of KT candidates felt extremely bothered by dietary restrictions. Those who felt extremely bothered were less likely to be listed for KT (adjusted hazard ratio [aHR] = 0.75, 95% confidence interval [CI]: 0.64-0.87); this association did not differ by neighborhood-level socioeconomic factors. Overall, the burden of dietary restrictions was not associated with waitlist mortality (p = 0.62). However, among candidates living in high food insecurity neighborhoods, those who felt extremely bothered had higher waitlist mortality (adjusted subhazard ratio [aSHR] = 2.07, 95% CI: 1.14-3.75, p[interaction] = 0.02). The association between dietary burden and waitlist mortality did not differ by neighborhood-level healthy food access.

CONCLUSION

The perceived burden of dietary restrictions is associated with a lower chance of listing for KT, and higher waitlist mortality only among candidates residing in neighborhoods with high food insecurity. Transplant centers should identify vulnerable patients and support them with nutrition education and access to food assistance programs.

The Usability and Feasibility of a Dietary Intake Self-Monitoring Application in a Population with Varying Literacy Levels

OBJECTIVES

Our aim was to study how hemodialysis patients with varying levels of literacy would use a diet and fluid intake monitoring mobile application (DIMA-P) and what would be its impact on their dietary behaviors.

MATERIALS AND METHODS

We developed a mobile application using user-centered methods and informed by the Integrated Theory of Health Behavior Change (ITHBC). Eight hemodialysis patients were recruited to use the application to record and monitor their diet and fluid intakes for a 6-week study. Overall, the participants had low literacy, numeracy, and technical skills. We collected the data on application usage and administered usability and context-of-use questionnaires to gain insights into the participants' interaction with the application. The participants' portion estimation skills and dietary self-regulation self-efficacy were assessed using various tests. In addition, interdialytic weight gain data were collected to assess the impact of app usage on the participants' health outcomes.

RESULTS

The application usage patterns varied, with a general trend towards frequent use (n = 5) correlating with engagement in self-monitoring. The participants gave high comprehensibility, user-friendliness, satisfaction, and usefulness ratings, suggesting that the app was well designed and the target users could easily navigate and interact with the features. While the participants improved in estimating portion sizes, the impact on measuring skills was variable. There was also an improvement in the participants' dietary self-regulation self-efficacy post-study. The interdialytic weight gain trends indicated a slight improvement in fluid and diet management.

CONCLUSION

People with different literacy skills can effectively use icon-based interfaces for portion size estimation and develop personalized usage patterns to self-regulate their fluid and dietary intakes. Moreover, they can experience an enhancement in their dietary self-efficacy skills by using a mobile application aimed at providing nutritional feedback. Furthermore, this research shows that the constructs of the ITHBC are effective in promoting dietary behavior change in a population with varying literacy skills. The target users can benefit from explicitly visualizing the relationship between their health outcomes and the factors influencing those outcomes. These user ambitions could be supported by developing machine learning models. Future research should also focus on enhancing the mechanisms by which technology can further enhance each component of the ITHBC framework.

Predictors of excess fluid volume in hemodialysis patients: an observational study

OBJECTIVES

to assess risk factors for excess fluid volume in hemodialysis patients.

METHODS

a retrospective case-control study was conducted. A total of 392 patients (196 cases and 196 controls) from two hemodialysis centers were included. Sociodemographic data and 23 risk factors for excess fluid volume were assessed using a data collection form. Data were analyzed using a multivariate logistic regression model.

RESULTS

the insufficient knowledge (OR=2.06), excessive fluid intake (OR=2.33), inadequate fluid removal during hemodialysis (OR=2.62) and excessive sodium intake (OR=1.91) risk factors may increase the chance of occurrence of excess fluid volume in hemodialysis patients by approximately two times. Education level (OR=0.95) and age (OR=0.97) are protective factors for excessive fluid volume.

CONCLUSIONS

knowing these risk factors may help nurses with accurate and rapid diagnostic inference of the risk of excessive fluid volume.

Association between home meal preparers and salt intake in haemodialysis patients: a cross-sectional study

OBJECTIVES

This study aimed to examine the association between home meal preparer and salt intake among haemodialysis patients, including daily dietary status. We hypothesised that salt intake is higher among individuals who rely on meal preparation from others than those who prepare meals by themselves.

DESIGN

Cross-sectional study.

SETTING

Two medical facilities in Fukushima Prefecture, Japan.

PARTICIPANTS

237 haemodialysis outpatients who visited one of the medical facilities between February 2020 and August 2021 and were diagnosed with anuria, defined as urination of <100 mL/day, were the potential participants of the present study. Finally, 181 participants (131 male and 50 female) were included in the analysis.

OUTCOME MEASURE

Salt intake amount was calculated from the results of predialysis and postdialysis blood draws, using Watson's formula based on predialysis weight, predialysis serum sodium level, postdialysis weight and serum sodium level at the end of dialysis.

RESULTS

Salt intake was significantly higher in participants who relied on meal preparation from others ('relying on others') than those who prepared meals by themselves ('self-prepared') (B=1.359; 95% CI: 0.495 to 2.222). No statistical difference was found between individuals who ate out or ate takeout ('outsourcing') and those who prepared their own meals ('self-prepared'). These results were robust after adjustment for confounding factors.

CONCLUSIONS

The present study revealed an association between self-preparation of meals at home and reduced salt intake among dialysis patients. Our findings suggest that whoever is the home meal preparer is possibly a social determinant of salt intake. To improve the prognosis of haemodialysis patients, actively reaching out to the family and assessing their social environment, such as identifying the home meal preparer and, if the patient relies on others for meal preparation, conducting nutritional/dietary guidance for that person, are effective in enhancing salt reduction.

Adaptive Nutrition Intervention Stabilizes Serum Phosphorus Levels in Hemodialysis Patients: A Multicenter Decentralized Clinical Trial Using Real-World Data

OBJECTIVE

This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis (HD) in a routine care setting, using real-world data from electronic health records.

METHODS

Decentralized clinical trial of seven HD facilities recruited patients who have been on HD for over 3 months (N = 153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and premade meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed.

RESULTS

Meal intervention statistically significantly stabilized serum phosphorus level (β = -0.81 mg/dL, 95% confidence interval = [-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (odds ratio = 1.21, 95% confidence interval = [1.04, 1.40]). Meal group showed better nutritional status (MIS = 3.65) than the education group (MIS = 5.10) at week 8 (adjusted p < .05). No significant changes were observed in serum potassium level, depression, and self-efficacy.

CONCLUSION

It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on HD, without negative effect on depression levels or self-efficacy. More work is needed to develop an effective educational intervention.

Improving kidney care for people with severe mental health difficulties: a thematic analysis of twenty-two healthcare providers' perspectives

Introduction

People with severe mental health difficulties (SMHDs) and concurrent kidney disease have less access to quality kidney care and worse clinical outcomes. Our research investigates the barriers and facilitators to effective kidney care for people with SMHDs, and how care might be improved for this underserved population.

Methods

We conducted semi-structured interviews with twenty-two physical (n = 14) and mental (n = 8) healthcare professionals with experience working with people with SMHDs and concurrent kidney disease. Interview data were analysed and interpreted using reflexive thematic analysis.

Results

Four themes were generated from the data: 1. "It's about understanding their limitations and challenges, without limiting their rights" describes how some people with SMHDs need additional support when accessing kidney care due to challenges with their mental state, motivation, cognitive difficulties, or mistrust of the healthcare system. 2. "There are people falling through the cracks" describes how the separation of physical and mental healthcare, combined with under-resourcing and understaffing, results in poorer outcomes for people with SMHDs. 3. "Psychiatry is a black spot in our continuing medical education" describes how many renal healthcare providers have limited confidence in their understanding of mental health and their ability to provide care for people with SMHDs. 4. "When they present to a busy emergency department with a problem, the staff tend to go '…psych patient"" describes how stigma towards people with SMHDs can negatively impact quality of care.

Conclusion

Healthcare professionals accounts' describe how people with SMHDs and kidney disease can have favourable outcomes if they have appropriate hospital, community and social supports. Findings indicate that effective management of kidney disease for people with SMHDs requires integrated physical and mental health care, which takes an individualised "whole person" approach to addressing the interaction between kidney disease and mental health.

Interdialytic weight gain is not associated with symptoms of depression or apathy in patients on chronic hemodialysis

PURPOSE

Little is known about the relationships between apathy, depressive symptoms and interdialytic weight gain (IDWG) in patients on chronic hemodialysis. Aim of the present study is to investigate the association between IDWG and symptoms of depression and apathy in hemodialysis patients.

METHODS

A total of 139 chronic patients of the HD units between January 2020 and December 2021 were included in the present cross-sectional study. IDWG was calculated as the difference between the pre-HD weight and the weight registered after the previous session; the average of the sessions in a month was registered. Apathy Evaluation Scale (AES) was adopted to evaluate apathy. Depression was assessed by Beck Depression Inventory (BDI).

RESULTS

Ninety-three patients had IDWG% ≤ 4 and 46 had an IDWG% > 4. Correlation between IDWG% and BDI as well that between IDWG% and AES were not statistically significant. Median BDI and mean AES did not differ significantly between the groups. In addition, 104 patients had a BDI < 16 and 35 had a BDI ≥ 6. Seventy-five patients had an AES score ≤ 35 and 63 had a AES score > 35. The IDWG (kg) and the IDWG% did not differ significantly between the two groups.

CONCLUSION

IDWG is not associated with symptoms of depression or apathy in hemodialysis patients. Thus, these results may question if the use of behavioral intervention aimed at improving motivation is warranted in the hemodialysis population to reduce the IDWG.

Interdialytic weight gain and educational/cognitive, counseling/behavioral and psychological/affective interventions in patients on chronic hemodialysis: a systematic review and meta-analysis

BACKGROUND

This work aimed to shed light on the notorious debate over the role of an educational/cognitive/behavioral or psychological approach in the reduction of interdialytic weight gain (IDWG) in patients on chronic hemodialysis.

METHODS

Searches were run from 1975 to January 2022 on Medline, PubMed, Web of Science, and the Cochrane Library. The search terms included "hemodialysis/haemodialysis" AND "adherence" AND ("fluid intake" OR "water intake") AND ("weight gain" OR "interdialytic weight gain" OR "IDWG") AND "patient-level interventions. Randomized controlled studies were eligible if they were in English, published in a peer-reviewed journal and regarded adults patients with on chronic hemodialysis for at least 6 months; compared educational/cognitive and/or counseling/behavioral or psychological interventions to no intervention on interdialytic weight gain. Outcome of interest was interdialytic weight gain. The review was registered on the International Prospective Register of Systematic Reviews in Health and Social Care (PROSPERO, ID number CRD42022332401).

RESULTS

Eighteen studies (1759 patients) were included in the analysis. Compared to the untreated group, educational/cognitive and/or counseling/behavioral interventions significantly reduced interdialytic weight gain with a pooled mean difference of - 0.15 kg (95% CI - 0.26, 30-0.05; P = 0.004). On the other hand, psychological/affective interventions reduced interdialytic weight gain with a pooled mean difference of - 0.26 kg (95% CI - 0.48, - 0.04; P = 0.020).

CONCLUSIONS

Educational/cognitive, counseling/behavioral or psychological/affective interventions significantly reduced the interdialytic weight gain in patients on chronic hemodialysis, although such reduction did not appear to be clinically relevant on hard outcomes.

The role of clinical pharmacist in enhancing hemodialysis patients' adherence and clinical outcomes: a randomized-controlled study

BACKGROUND

Adherence to treatment recommendations is challenging in hemodialysis (HD) patients, yet it has been found to be extremely crucial in obtaining positive clinical and health outcomes.

AIM

To evaluate the influence of implementing an educational process provided by the clinical pharmacist on HD patients' adherence to treatment recommendations and clinical outcomes.

METHOD

A randomized controlled trial was conducted in which patients from three HD units in Jordan were randomly allocated to either an intervention (n = 60) or a control group (n = 60). During a three-month period, the intervention group received a monthly educational approach from a clinical pharmacist with recommendations for improving medication, nutrition, and fluid adherence, whereas the control received standard medical care. The primary outcome was patient adherence to HD-related recommendations. Quality of life (QOL), disease awareness, hospitalization, and changes in biochemicals were secondary outcomes.

RESULTS

The final analysis included 114 patients (n = 57/group). In the intervention group, there was a significant improvement in total adherence score versus control (1170.6 ± 44.1 vs. 665.8 ± 220.7, p < 0.001), and adherence to various aspects including episodes/duration of shortening HD, dietary guidelines, fluid restriction, and prescription medications. The clinical pharmacist intervention enhanced patients' QOL and improved awareness and perspective of the disease. Following the intervention, laboratory values for urea, creatinine, phosphorus, and hemoglobin were considerably improved. Additionally, the intervention group had fewer hospitalizations than the control group (0.54 ± 0.07 vs. 0.78 ± 0.26, p < 0.001).

CONCLUSION

Providing clinical pharmacy education to HD patients improved adherence behavior and clinical outcomes. This illustrates the importance of clinical pharmacists as interdisciplinary team members in dialysis care. Trial registration This trial has been registered in ISRCTN Register (ISRCTN75517095). https://clinicaltrials.gov/ct2/show/ISRCTN75517095.