Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania; Department of Medicine, Penn Transplant Institute, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania.
Am J Kidney Dis. 2023 Oct;82(4):419-428. doi: 10.1053/j.ajkd.2023.02.005. Epub 2023 Apr 20.
RATIONALE & OBJECTIVE: Obesity is common among patients with end-stage kidney disease (ESKD) and is a pervasive barrier to kidney transplantation. Patient perspectives about barriers to weight loss and patient and health care professionals' viewpoints about optimal obesity management in ESKD are needed.
Qualitative study using a descriptive phenomenological approach to understand ESKD patients' lived experiences with obesity and weight loss and patients' and health professionals' perceptions about optimal obesity care for ESKD patients.
SETTING & PARTICIPANTS: Between October 2020 and December 2021, we conducted 90-minute semistructured interviews with 40 ESKD patients with obesity (body mass index [BMI] ≥30kg/m) and 60-minute interviews with 20 ESKD health care professionals.
Deductive and inductive thematic analysis of interviews.
Among patients with ESKD, the median age was 55 (IQR, 46-63) years, median BMI was 39.5 (IQR, 35.3-41.6) kg/m, and median dialysis vintage was 5 (IQR, 3-8) years; 58% were female, and 46% were non-Hispanic White. Among health care professionals, 50% were renal dietitians, 20% were nephrologists, and the remainder were transplant professionals (surgeons, nephrologists, and dietitians). ESKD patients described unique weight loss challenges, including (1) conflicting tenets of "kidney-friendly" versus popular diets, (2) fatigue due to dialysis that affects dietary choices, and (3) perceived pressure and unrealistic expectations from health professionals to lose weight for kidney transplantation. Professionals and patients described a lack of transparent and honest communication about obesity and unclear roles and responsibilities for obesity counseling.
Lack of caregiver perspectives and potential lack of transferability to overall dialysis population given overrepresentation of patients with severe obesity and previous weight loss surgery.
Obesity interventions for ESKD patients should be tailored to meet the unique challenges reported by patients with ESKD. Clarifying ESKD health professionals' roles and responsibilities for obesity care would help to ensure that patients have consistent and effective support to manage obesity.
PLAIN-LANGUAGE SUMMARY: Adults with coexisting obesity and end-stage kidney disease (ESKD) are often required to lose weight for kidney transplantation. Yet there is little knowledge about barriers to healthy weight loss in this population. In this study, we conducted interviews with 40 ESKD patients with coexisting obesity and 20 ESKD health care professionals to learn about opportunities to improve obesity-related health care in ESKD. Patients reported that fatigue and dialysis affected dietary choices, and fluid and food restrictions hampered weight loss. Professionals described a lack of training, comfort, and time to address obesity. Patients and professionals reported a lack of open communication about obesity management. Improving obesity-related education and clinical communication should be prioritized to improve care for patients with ESKD and obesity.
肥胖在终末期肾病（ESKD）患者中很常见，是阻碍肾脏移植的普遍障碍。需要了解患者对减肥障碍的看法以及患者和医疗保健专业人员对 ESKD 中最佳肥胖管理的观点。
使用描述性现象学方法的定性研究，以了解肥胖和减肥的 ESKD 患者的生活体验，以及患者和医疗保健专业人员对 ESKD 患者最佳肥胖护理的看法。
2020 年 10 月至 2021 年 12 月期间，我们对 40 名肥胖的 ESKD 患者（BMI≥30kg/m）进行了 90 分钟的半结构化访谈，并对 20 名 ESKD 医疗保健专业人员进行了 60 分钟的访谈。
对访谈进行演绎和归纳主题分析。
在 ESKD 患者中，中位年龄为 55 岁（IQR，46-63 岁），中位 BMI 为 39.5kg/m（IQR，35.3-41.6kg/m），中位透析时间为 5 年（IQR，3-8 年）；58%为女性，46%为非西班牙裔白人。在医疗保健专业人员中，50%是肾脏营养师，20%是肾病学家，其余是移植专业人员（外科医生、肾病学家和营养师）。ESKD 患者描述了独特的减肥挑战，包括（1）“对肾脏友好”与流行饮食之间的冲突原则，（2）透析引起的疲劳影响饮食选择，以及（3）来自医疗保健专业人员减肥以进行肾脏移植的感知压力和不切实际的期望。专业人员和患者描述了肥胖问题缺乏透明和诚实的沟通，肥胖咨询的角色和责任不明确。
缺乏护理人员的观点，并且由于肥胖和先前减肥手术的患者比例过高，可能缺乏对总体透析人群的可转移性。
ESKD 患者的肥胖干预措施应根据患者报告的独特挑战进行定制。明确 ESKD 医疗保健专业人员在肥胖护理方面的角色和责任将有助于确保患者获得一致且有效的支持，以管理肥胖。
同时患有肥胖症和终末期肾病（ESKD）的成年人通常需要减肥以进行肾脏移植。然而，关于肥胖人群的健康减肥障碍，人们知之甚少。在这项研究中，我们对 40 名同时患有肥胖症和 ESKD 的患者和 20 名 ESKD 医疗保健专业人员进行了访谈，以了解改善 ESKD 中肥胖相关医疗保健的机会。患者报告说，疲劳和透析会影响饮食选择，而液体和食物限制会阻碍减肥。专业人员描述了缺乏培训、舒适感和时间来解决肥胖问题。患者和专业人员报告说，肥胖管理方面缺乏公开沟通。应优先考虑改善肥胖相关教育和临床沟通，以改善肥胖和 ESKD 患者的护理。
