Opiyo Rose Okoyo, Nyasulu Peter Suwirakwenda, Olenja Joyce, Zunza Moleen, Nguyen Kim A, Bukania Zipporah, Nabakwe Esther, Mbogo Alexander, Were Anthony Omolo
School of Public Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
East African Kidney Institute, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
Ren Replace Ther. 2019 Sep 11;5(1). doi: 10.1186/s41100-019-0237-4. eCollection 2019 Dec.
Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis.
A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a + paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit "Collect software" while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, "adherence to diet prescription" was analyzed as a binary variable. values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed.
Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were "flexibility in the diets" (AOR 2.65, 95% CI 1.11-6.30, 0.028), "difficulties in following diet recommendations" (AOR 0.24, 95% CI 0.13-0.46, < 001), and "adherence to limiting fluid intake" (AOR 9.74, 95% CI 4.90-19.38, < 0.001).
For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones. Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based on the individual patient's usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet adherence messages should be integrated with fluid limitation messages. Further research on understanding patients' adherence to fluid restriction is also suggested.
众所周知，慢性肾病患者坚持饮食规定可预防肾功能恶化，并降低发病和死亡风险。本研究确定了接受血液透析的成年慢性肾病患者坚持饮食规定的相关因素。
2018年9月至2019年1月，在肯尼亚国家教学和转诊医院的肾脏诊所和透析单位进行了一项采用平行混合设计的混合方法研究。该研究遵循 + 范式，以定量调查为主要方法。对未进行肾移植的接受血液透析的成年慢性肾病患者进行目的抽样以进行定量调查。对成年患者及其护理人员的子样本进行目的抽样以进行定性调查。使用结构化的自填问卷通过Open Data Kit“Collect软件”收集数值数据，同时使用深入访谈指南和录音收集定性数据。对定量数据使用STATA软件进行分析，对定性数据使用NVIV0 12进行分析。将因变量“坚持饮食规定”作为二元变量进行分析。在单变量和多变量逻辑回归模型中，分别将 值<0.1和<0.05视为具有统计学意义。对定性数据进行主题分析。
只有36.3%的研究人群坚持其饮食规定。与坚持饮食规定独立相关的因素包括“饮食灵活性”（比值比2.65，95%置信区间1.11 - 6.30， = 0.028）、“遵循饮食建议困难”（比值比0.24，95%置信区间0.13 - 0.46， < 0.001）以及“坚持限制液体摄入”（比值比9.74，95%置信区间4.90 - 19.38， < 0.001）。
对于接受血液透析的慢性肾病患者，限制较少且所需额外努力和资源最少的饮食规定比限制性规定更有可能被遵守。容易坚持液体摄入限制的患者更容易遵循饮食规定。规定的饮食应基于个体患者的日常饮食习惯以及使用此类饮食所评估的挑战水平。此外，饮食坚持信息应与液体限制信息相结合。还建议进一步研究了解患者对液体限制的坚持情况。
