Factors influencing fluid restriction non-compliance amongst patients undergoing chronic haemodialysis and peritoneal dialysis at Steve Biko Academic Hospital.
Ndhlovu, Tebogo
Ndhlovu, Tebogo
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Abstract
Objectives: The aim of the study was to investigate factors that influenced fluid restriction non-compliance amongst patients undergoing chronic haemodialysis and peritoneal dialysis, and to ascertain the detrimental effects of fluid restriction non-adherence within the dialysis patients population and how serious these impact on the quality of life of the patients by comparing the results between the two dialysis groups of patients in the two different types of dialysis modalities. Design: A descriptive, mixed methods (quantitative and qualitative) research design, utilising purposive sampling was used to compare factors that influenced fluid non-compliance between a group of haemodialysis and peritoneal dialysis patients. Data collection was conducted through a questionnaire which comprised of a combination of two internationally published and widely used questionnaires, the SF 36 - Quality of Life Tool and End Stage Renal Disease Adherence Questionnaire. SETTING: Dialysis unit at Steve Biko Academic Hospital in Pretoria, Gauteng Province, South Africa. Participants: 90 participants: 45 haemodialysis & 45 peritoneal dialysis patients (60% males, 40% females) aged 18-60 years receiving maintenance haemodialysis and peritoneal dialysis with end stage renal disease.
Main outcome measure: Self-efficacy for restricting fluids as per prescribed treatment recommendations. The participants were recruited on the basis of willingness to participate in the study, having been on dialysis for at least three months, receiving haemodialysis three times a week and those on peritoneal dialysis were performing regular exchanges as per recommendations. Non-compliance was defined and associated with a track record of intra-dialytic weight gain in the past three months consecutively with more than 5.8% of the dry weight or intra-dialytic weight gain of more than 2.5 kg in between the haemodialysis sessions and those on peritoneal dialysis with persistent signs of pulmonary oedema and pedal and facial oedema. Results: Difficulty in managing their fluid allotments were reported by 60% of male participants, with low self-efficacy for restricting fluid intake when compared to the female counterparts. Irrespective of the demographic characteristics, social status, psychological status of all the participants, fluid restrictions as per prescribed recommendations remained a challenge as the general population reported 67% non-compliance. Conclusion: The study findings suggested that the majority of patients encountered difficulty adhering to the dialysis regimen, irrespective of the dialysis modality. There may be a need to reinforce educational interventions, offering intense counseling for each individual. Further investigations are needed to understand the independent psychological effects on adherence to prescribed dialysis fluid restriction recommendations and perceived self-motivation.
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Submitted in partial fulfilment of the requirements for the degree, Master of Technologiae, Clinical Technology, Department of Biomedical Sciences, Faculty of Science at the Tshwane University
Date
2021-01
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Tshwane University of Technology
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Keywords
Adherence, Compliance, Sel-efficacy, Haemodialysis, Peritoneal dialysis