Fluid distribution timetable on adherence to fluid restriction of patients with end‐stage renal disease undergoing haemodialysis: Single‐blind, Randomized‐Controlled Pilot Study

Promoting self-management in chronic disease: a systematic review and meta-analysis of behaviour change interventions for patients on dialysis

Given the importance of patients' ability to effectively self-manage their kidney disease, researchers have developed interventions focused on improving self-management for patients on dialysis. The review and meta-analysis aimed to evaluate the efficacy of these interventions and identify the characteristics of more effective interventions in this domain. A meta-analysis of randomised controlled trials to promote self-management in patients on dialysis (N = 4201, k = 45) evaluated: the effect of the interventions on psychological, behavioural, and physiological outcomes; the relationships between changes in outcomes; the moderation of outcomes by behaviour change techniques employed in the interventions; and intervention duration. The meta-analysis obtained moderate effect sizes, demonstrating improvement in behavioural (g = 0.50 to 0.65) and physiological health outcomes (g = -0.32 to -0.57). Fewer studies assessed psychological intervention targets, but large effects were obtained for knowledge change and quality of life (g = 0.65 and 1.17, respectively). Improved knowledge was positively associated with improved medication adherence, which in turn was associated with one physiological outcome. Interventions incorporating psychotherapeutic techniques such as CBT or rational emotive therapy achieved superior physiological outcomes, particularly when used in isolation. The findings support the interpretation that intervention strategies to enhance emotional self-management are effective in optimising outcomes for patients on dialysis.

Non-pharmacological interventions to reduce thirst in patients with heart failure or hemodialysis: A systematic review and meta-analysis

BACKGROUND

Thirst is a frequent and burdening symptom in many patients, especially in patients with chronic heart failure (CHF) and/or receiving hemodialysis (HD). As drug therapies are not feasible, non-pharmacological strategies are needed to reduce thirst and thirst-related burden.

OBJECTIVES

To identify non-pharmacological interventions aiming to reduce thirst in patients with CHF and/ or HD, to describe intervention components, and to evaluate the effectiveness of these interventions.

METHODS

In February 2024, we completed a systematic search in MEDLINE via PubMed, Livivo, CINAHL, Cochrane Library and Web of Science. Two reviewers independently screened titles, abstracts, and full texts, performed critical appraisal and data extraction. We checked risk of bias with the checklists of the Joanna Briggs Institute and the Cochrane Risk of Bias tool and calculated meta-analyses for sufficiently homogeneous studies using fixed-effects models.

RESULTS

We included 15 intervention studies applying non-pharmacological interventions including chewing gum (n = 8), low-sodium diet (n = 2), acupressure (n = 1), frozen strawberries (n = 1), fluid timetables (n = 1), ice cubes and mouthwash (n = 1), and a psychological intervention (n = 1). Sample sizes varied between 11 and 88 participants. Eleven intervention studies showed a reduction of thirst as intervention effect. Meta-analyses for chewing gum showed no significant effect on thirst using a visual analogue scale (IV: -2,32 [-10.37,5.73]; p = 0.57) or the dialysis thirst inventory (IV: -0.26 [- 1.83, 1.30]; p = 0.74). Quality of studies was moderate to low.

CONCLUSION

Results indicate that various non-pharmacological interventions could be helpful to reduce thirst in patients with CHF or HD, but important uncertainty remains.

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.

The Effect of Roy Adaptation Model Guided Education on Fluid Adherence and Disease Acceptance of Hemodialysis Patients: A Nonrandomized Interventional Study

Background and Purpose: Difficulty in acceptance of illness and adherence to fluid control are common in patients receiving haemodialysis treatment, and they are associated with higher morbidity and mortality. This study aims to identify the effects of the training based on the Roy Adaptation Model, which is given to patients receiving haemodialysis treatment on the acceptance of illness, and adherence to fluid control. Methods: The study was designed as a nonrandomised interventional study. This study was conducted with 81 patients, who received haemodialysis treatment. The experimental group was given training according to the Roy Adaptation Model for six months. Data were collected through the Patient Identification Form, Acceptance of Illness Scale, and Fluid Control Scale in Haemodialysis Patients. Results: While the difference between the experimental and control groups’ second interview Acceptance of Illness Scale mean score was not statistically significant, the difference between the score of Fluid Control Scale in Haemodialysis Patients were statistically significant. Conclusions: The training based on the Roy Adaptation Model given to the experimental group caused an increase in adherence to fluid control but had no effects on the acceptance of illness levels.

Effects of the Combination of Auricular Acupressure and a Fluid-Restriction Adherence Program on Salivary Flow Rate, Xerostomia, Fluid Control, Interdialytic Weight Gain, and Diet-Related Quality of Life in Patients Undergoing Hemodialysis

Adherence to fluid-restriction is a clinical priority in nephrology care. This study examines the effects of a combination of auricular acupressure (AA) and a fluid-restriction adherence program on the salivary flow rate, xerostomia, fluid control, interdialytic weight gain (IDWG), and diet-related quality of life (DQOL) among hemodialysis patients in South Korea. Using a quasi-experimental design, 84 hemodialysis patients were assigned to the experimental group (AA + fluid-restriction adherence program; n = 29), the comparison group (fluid-restriction adherence program; n = 27), and the control group (usual care; n = 28). The program lasted 6 weeks, and data were collected at baseline, immediately after the intervention, and 4 months post-intervention. There was a significant interaction between group and time for salivary flow rate, fluid control, IDWG, and DQOL (all p < 0.005). Compared with the control group, the experimental group had a significantly improved salivary flow rate, fluid control, IDWG, and DQOL at weeks 6 and 22, whereas the comparison group had improved fluid control and DQOL at week 6. The combination of AA and a fluid-restriction adherence program could be provided to hemodialysis patients as cost-effective, safe, and complementary interventions to promote sustainable patient adherence to fluid-restriction.

Health literacy as predictors of fluid management in people receiving hemodialysis in China: A structural equation modeling analysis

OBJECTIVES

To explore the impact of health literacy (HL) on perceived benefits of fluid restriction (PBFR), self-reported fluid restriction (SRFR) and relative-interdialytic weight gain (R-IDWG) in people receiving hemodialysis (HD).

METHODS

We conducted a cross-sectional study in two nephrology departments from two hospitals in Guangzhou, China (n = 226). The HL questionnaire, PBFR Subscale of Health Belief Model Constructs and Fluid Adherence Subscale of the HD Patients Therapy Adherence Scale were used. R-IDWG was calculated by the mean IDWG (from 3 consecutive HD), divided by the dry weight.

RESULTS

In structural equation modeling, three domains of the HL questionnaire, namely Actively Managing My Health, Social Support and Actively Engaging with Healthcare Providers (HCPs), were directly and positively associated with PBFR. Higher Actively Managing My Health predicted higher SRFR both directly and indirectly. Sufficient Social Support and adequate Actively Engaging with HCPs predicted higher SRFR indirectly. All three HL domains predicted R-IDWG indirectly.

CONCLUSION

Improving patients' HL could increase their understanding of PBFR and be more apt to follow fluid restrictions and reduce R-IDWG.

PRACTICE IMPLICATIONS

A better understanding of the relationships among HL, PBFR, SRFR and R-IDWG will allow for tailored interventions to decrease R-IDWG in people receiving HD.

La persona con enfermedad renal crónica: una revisión sistemática de las intervenciones de salud

Introducción: Existen intervenciones enfocadas a la educación y capacitación de las personas con enfermedad renal crónica sin embargo, muchas de ellas fragmentan a la persona al considerar sólo el incremento de conocimientos y/o conductas, por lo que al no existir una atención integral no se logran cambios favorables. Objetivo: identificar los aspectos teóricos y metodológicos considerados en el diseño e implementación de intervenciones de salud para las personas con enfermedad renal. Metodología: Se ha realizado una revisión sistemática a través de las bases de datos Biblioteca Virtual de la Salud y PubMed, analizando artículos en idioma inglés y español que hayan implementado una intervención a las personas con enfermedad renal crónica. Resultados: De un total de 218 artículos arrojados por las bases de datos sólo fueron seleccionadas 28 publicaciones. Para su análisis se consideró el tamaño de la muestra, el diseño y enfoque teórico de la intervención, los principales resultados y conclusiones. Existen investigaciones que involucran el aspecto psicológico, particularmente el área motivacional como eje central en el cambio conductual y consideran a Bandura como referente teórico, lo cual otorga mejoras en las conductas de salud de las personas con enfermedad renal. Conclusiones: Una intervención con bases teóricas definidas puede contribuir a la prevención en salud con un bajo costo y alto impacto en los estilos de vida de las personas. Además de ser un gran aporte al conocimiento de educación en salud y a la profesión como ciencia.