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Dsouza B, Prabhu R, Unnikrishnan B, Ballal S, Mundkur SC, Chandra Sekaran V, Shetty A, Moreira P. Effect of Educational Intervention on Knowledge and Level of Adherence among Hemodialysis Patients: A Randomized Controlled Trial. GLOBAL HEALTH 2023; 2023:4295613. [PMID: 37033597 PMCID: PMC10081894 DOI: 10.1155/2023/4295613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
Purpose. The purpose of the study was to assess the impact of an educational intervention on the level of knowledge and adherence to the treatment regimen among hemodialysis (HD) patients as well as to describe the association between these variables. Methods. In this randomized controlled trial, 160 HD patients at an HD centre of a 2030-bed tertiary teaching hospital in Southern India were randomly assigned into intervention (N = 80, received education and a booklet) and control (N = 80, received standard care) groups. Knowledge and adherence were measured preintervention and postintervention using a validated questionnaire for knowledge and the ESRD-AQ (End-Stage Renal Disease Questionnaire) for the level of adherence. The statistical analysis of the data was performed with the help of the Statistical Program SPSS version 19.0. The statistical significance level was set at 0.05. Results. The increase in knowledge on disease management, fluid adherence, and dietary adherence in the intervention group was significantly higher compared to the control group. There was no significant correlation between knowledge and adherence. Adherence improved for all the domains, i.e., dialysis attendance, episodes of shortening, adherence to medication, fluid restriction, and dietary restriction. Adherence to fluid and dietary restriction was statistically significant. This trail is registered with https://clinicaltrials.gov/ct2/show/CTRI/2018/05/014166.
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Affiliation(s)
- Brayal Dsouza
- Department of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ravindra Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - B. Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sudarshan Ballal
- Manipal Hospitals, Manipal Health Enterprises Pvt Ltd, Bengaluru, India
| | - Suneel C. Mundkur
- Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Varalakshmi Chandra Sekaran
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Avinash Shetty
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Paulo Moreira
- International Healthcare Management Research and Development Center (IHM-RDC), Shandong Qianfoshan Provincial Hospital, Shandong Medical University, Jinan, Shandong, China
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Perdana M, Yen M. Factors Associated With Adherence to Fluid Restriction in Patients Undergoing Hemodialysis in Indonesia. J Nurs Res 2021; 29:e182. [PMID: 34593720 DOI: 10.1097/jnr.0000000000000457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The factors related to fluid intake adherence among patients undergoing hemodialysis have been explored in many studies. However, most of these were conducted in Western countries and have produced inconsistent results. A study of this issue in Indonesia, a tropical country with strong herbal medicine traditions, may show different results. In addition to demographic characteristics, self-efficacy is a standard measurement used in chronic care management activities such as hemodialysis treatment. Understanding the reasons behind patient nonadherence in Indonesia may help nurses better manage the fluid intake of patients. PURPOSE This study was designed to determine the factors that predict patient adherence to fluid intake restrictions. METHODS A cross-sectional study was conducted on 153 patients undergoing hemodialysis at two hospitals. Intradialytic weight gain over a 1-month period was recorded to assess the participants' adherence to fluid intake restrictions. Intradialytic weight gains of more than 2 kg was considered to be nonadherent. A daily urine output and level of thirst were also recorded. The participants completed an adapted self-efficacy questionnaire, Swedish Fluid Intake Appraisal Inventory, and the data were analyzed together with demographic characteristic and clinical parameters using hierarchical multiple regression. RESULTS The results revealed that most of the respondents did not adequately adhere to fluid intake restrictions (59.5%). Intradialytic weight gain was shown to strongly correlate with self-efficacy (p < .05, β = -.201), gender (p < .05, β = -.179), educational background (p = .05, β = .159), and urine output (p < .05, β = -.168). Demographic characteristic explained 10.6% and self-efficacy explained 3.9% of the variance in fluid adherence. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Female participants with higher self-efficacy scores reported the lowest average level of intradialytic weight gain, indicating better adherence to fluid intake restrictions. Several demographic factors as well as self-efficacy were identified as potential predictors of fluid intake restriction adherence. Therefore, measuring self-efficacy periodically is a good initial step toward detecting those patients who are at higher risk of noncompliance with fluid intake restrictions.
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Affiliation(s)
- Melyza Perdana
- MS, Lecturer, Department of Medical Surgical Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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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.
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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
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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.
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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
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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.
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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
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Başer E, Mollaoğlu M. The effect of a hemodialysis patient education program on fluid control and dietary compliance. Hemodial Int 2019; 23:392-401. [DOI: 10.1111/hdi.12744] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Esra Başer
- Internal Medicine Nursing, Department of Nursing, Faculty of Health Science; Sivas Cumhuriyet University; Sivas Turkey
| | - Mukadder Mollaoğlu
- Internal Medicine Nursing, Department of Nursing, Faculty of Health Science; Sivas Cumhuriyet University; Sivas Turkey
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The impact of education on knowledge, adherence and quality of life among patients on haemodialysis. Qual Life Res 2018; 28:73-83. [PMID: 30178430 DOI: 10.1007/s11136-018-1989-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of the study was to assess the impact of an educational intervention on the level of knowledge, quality of life (QoL) and adherence to the treatment regimen among haemodialysis (HD) patients as well as to describe the association between these variables. METHODS In this quasi-experimental interventional study, 50 HD patients at a HD centre in Western Attica were randomly assigned into intervention (N = 25, received education and a booklet) and control (N = 25, received only the booklet) groups. Knowledge, adherence and quality of life were measured pre- and post-intervention using the Kidney Disease Questionnaire, the GR-Simplified Medication Adherence Questionnaire-HD and Missoula Vitas Quality of Life Index-15, respectively. The statistical analysis of the data was performed with the help of the Statistical Program SPSS version 19.0. The statistical significance level was set up at 0.05. RESULTS The increase of knowledge, adherence and QoL levels in the intervention group was significantly higher compared to the control group. There was no significant correlation between knowledge and adherence scores after the intervention. However, a significant positive correlation was found between the change in the overall QoL and the changes in the total adherence score as well as the adherence to the fluids and dietary behaviour. CONCLUSIONS An educational intervention can improve knowledge, adherence and QoL among HD patients. The increase of knowledge level is not associated with increased adherence. However, the increase of adherence may improve some dimensions of QoL.
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Plantinga LC, King LM, Masud T, Shafi T, Burkart JM, Lea JP, Jaar BG. Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study. Nephrol Dial Transplant 2017; 33:1215-1223. [DOI: 10.1093/ndt/gfx335] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura C Plantinga
- Department of Medicine, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Laura M King
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tahsin Masud
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Tariq Shafi
- 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
| | - John M Burkart
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Janice P Lea
- Department of Medicine, 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
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Kumar S, Bogle R, Banerjee D. Why do young people with chronic kidney disease die early? World J Nephrol 2014; 3:143-155. [PMID: 25374808 PMCID: PMC4220347 DOI: 10.5527/wjn.v3.i4.143] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/19/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease poses the greatest risk of premature death seen among patients with chronic kidney disease (CKD). Up to 50% of mortality risk in the dialysis population is attributable to cardiovascular disease and the largest relative excess mortality is observed in younger patients. In early CKD, occlusive thrombotic coronary disease is common, but those who survive to reach end-stage renal failure requiring dialysis are more prone to sudden death attributable mostly to sudden arrhythmic events and heart failure related to left ventricular hypertrophy, coronary vascular calcification and electrolyte disturbances. In this review, we discuss the basis of the interaction of traditional risk factors for cardiovascular disease with various pathological processes such as endothelial dysfunction, oxidative stress, low grade chronic inflammation, neurohormonal changes and vascular calcification and stiffness which account for the structural and functional cardiac changes that predispose to excess morbidity and mortality in young people with CKD.
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