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Prevalence of adherence to fluid restriction in kidney patients in haemodialysis: objective indicator and perceived compliance.
Nefrologia. 2012 Jul 17; 32(4):477-85.N

Abstract

INTRODUCTION

Studies of adherence to fluid restriction show high variability in prevalence data, as different methods of measuring IWG (interdialysis weight gain) and cut-off criteria are used.

OBJECTIVES

To describe the prevalence of adherence to fluid restriction using daily IWG (criterion: ≤1 Kg) and daily IWG adjusted for dry weight (DW) (cut-off point adjusted criterion: DW<70 kg, IWG=1 kg/day; DW>70 kg and ≤80 kg, IWG=1.1 kg/day; DW>80 kg and ≤90 kg, IWG=1.2 kg/day; DW>90 kg, IWG=1.3 kg/day) and to study the association between this objective indicator and adherence behaviour as reported by patient.

PATIENTS AND METHOD

Our study included a total of 146 patients with a mean age of 66 years (SD: 13.6 years; range: 25-88 years), 66% of which were male. Ours was a longitudinal study with one month of follow-up. We collected both sociodemographic and clinical variables and mean daily IWG. Patient-reported adherence behaviour was assessed through an interview by a trained staff member from outside the department who asked the following question: "In order to avoid complications between haemodialysis sessions: during the last month, how many days did you ingest less than 1 litre of fluid per day?" (0= no days; 10= every day). A score ≤5 led to categorisation of patients as compliant with treatment. Statistical analysis included descriptive analysis, correlation test, chi-square and Crosstabs, ROC curve and logistic regression procedures.

RESULTS

Prevalence of "objective" adherence to fluid restriction was 61% (mean daily IWG≤1kg) and 73% (mean daily IWG adjusted for dry weight). Reported adherence (prevalence: 56.2%) was associated with IWG adjusted for weight (chi-square =31.34; P=.000). In patients with objective adherence adjusted for weight, the prevalence of reported adherence was 1.65 times that of non-adherence (PR=1.65; 95% CI: 1.29-2.11). The final model for estimating the association between reported adherence behaviour and daily adjusted IWG included: age (higher), dry weight (lower), potassium (lower), time on haemodialysis treatment (less) and its interaction with reported behaviour (F=50.70; P=.000; R2=44%). The sensitivity of reported adherence behaviour for detecting objective adherence adjusted for dry weight was 89%; specificity was 58%, and the overall classification power was 85% (AUC=.85; 95% CI: 0.78-0.92). The probability of objective adherence adjusted for weight in patients who claimed proper adherence was 9 times higher than in non-compliant patients in patients who had been on HD for 2.3 years (PORp25=9.16; 95% CI: 2.58-32.51); 6 times higher in patients on HD for 4.7 years (PORP50=6.16; 95% CI: 2.1217.92); and 3 times higher in those on HD for 8.2 years (PORp75=3.44; 95% CI: 1.32-8.96).

CONCLUSIONS

Prevalence of adherence to fluid restriction was 73% and 16% depending on daily IWG adjusted/not adjusted for dry weight, respectively. Absolute daily IWG adjusted for weight seems a good indicator of adherence, as it allows for a personalised fluid restriction regimen. Significant association between this objective indicator and reported adherence behaviour supports a combination of patient approach and objective data, which can help with the adjustment of the individual cut-off for daily IWG. This also provides useful information for designing intervention strategies to maintain and increase adherence.

Authors+Show Affiliations

Unidad de Hemodiálisis, Clínica Vistahermosa, Avda. Dénia, 103, 03015 Alicante, Spain. iborreta2005@yahoo.esNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng spa

PubMed ID

22806282

Citation

Iborra-Moltó, Carmelo, et al. "Prevalence of Adherence to Fluid Restriction in Kidney Patients in Haemodialysis: Objective Indicator and Perceived Compliance." Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, vol. 32, no. 4, 2012, pp. 477-85.
Iborra-Moltó C, López-Roig S, Pastor-Mira Mde L. Prevalence of adherence to fluid restriction in kidney patients in haemodialysis: objective indicator and perceived compliance. Nefrologia. 2012;32(4):477-85.
Iborra-Moltó, C., López-Roig, S., & Pastor-Mira, M. d. e. . L. (2012). Prevalence of adherence to fluid restriction in kidney patients in haemodialysis: objective indicator and perceived compliance. Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, 32(4), 477-85. https://doi.org/10.3265/Nefrologia.pre2012.Feb.11236
Iborra-Moltó C, López-Roig S, Pastor-Mira Mde L. Prevalence of Adherence to Fluid Restriction in Kidney Patients in Haemodialysis: Objective Indicator and Perceived Compliance. Nefrologia. 2012 Jul 17;32(4):477-85. PubMed PMID: 22806282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of adherence to fluid restriction in kidney patients in haemodialysis: objective indicator and perceived compliance. AU - Iborra-Moltó,Carmelo, AU - López-Roig,Sofía, AU - Pastor-Mira,M de Los Ángeles, PY - 2012/02/19/accepted PY - 2012/7/19/entrez PY - 2012/7/19/pubmed PY - 2012/12/12/medline SP - 477 EP - 85 JF - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia JO - Nefrologia VL - 32 IS - 4 N2 - INTRODUCTION: Studies of adherence to fluid restriction show high variability in prevalence data, as different methods of measuring IWG (interdialysis weight gain) and cut-off criteria are used. OBJECTIVES: To describe the prevalence of adherence to fluid restriction using daily IWG (criterion: ≤1 Kg) and daily IWG adjusted for dry weight (DW) (cut-off point adjusted criterion: DW<70 kg, IWG=1 kg/day; DW>70 kg and ≤80 kg, IWG=1.1 kg/day; DW>80 kg and ≤90 kg, IWG=1.2 kg/day; DW>90 kg, IWG=1.3 kg/day) and to study the association between this objective indicator and adherence behaviour as reported by patient. PATIENTS AND METHOD: Our study included a total of 146 patients with a mean age of 66 years (SD: 13.6 years; range: 25-88 years), 66% of which were male. Ours was a longitudinal study with one month of follow-up. We collected both sociodemographic and clinical variables and mean daily IWG. Patient-reported adherence behaviour was assessed through an interview by a trained staff member from outside the department who asked the following question: "In order to avoid complications between haemodialysis sessions: during the last month, how many days did you ingest less than 1 litre of fluid per day?" (0= no days; 10= every day). A score ≤5 led to categorisation of patients as compliant with treatment. Statistical analysis included descriptive analysis, correlation test, chi-square and Crosstabs, ROC curve and logistic regression procedures. RESULTS: Prevalence of "objective" adherence to fluid restriction was 61% (mean daily IWG≤1kg) and 73% (mean daily IWG adjusted for dry weight). Reported adherence (prevalence: 56.2%) was associated with IWG adjusted for weight (chi-square =31.34; P=.000). In patients with objective adherence adjusted for weight, the prevalence of reported adherence was 1.65 times that of non-adherence (PR=1.65; 95% CI: 1.29-2.11). The final model for estimating the association between reported adherence behaviour and daily adjusted IWG included: age (higher), dry weight (lower), potassium (lower), time on haemodialysis treatment (less) and its interaction with reported behaviour (F=50.70; P=.000; R2=44%). The sensitivity of reported adherence behaviour for detecting objective adherence adjusted for dry weight was 89%; specificity was 58%, and the overall classification power was 85% (AUC=.85; 95% CI: 0.78-0.92). The probability of objective adherence adjusted for weight in patients who claimed proper adherence was 9 times higher than in non-compliant patients in patients who had been on HD for 2.3 years (PORp25=9.16; 95% CI: 2.58-32.51); 6 times higher in patients on HD for 4.7 years (PORP50=6.16; 95% CI: 2.1217.92); and 3 times higher in those on HD for 8.2 years (PORp75=3.44; 95% CI: 1.32-8.96). CONCLUSIONS: Prevalence of adherence to fluid restriction was 73% and 16% depending on daily IWG adjusted/not adjusted for dry weight, respectively. Absolute daily IWG adjusted for weight seems a good indicator of adherence, as it allows for a personalised fluid restriction regimen. Significant association between this objective indicator and reported adherence behaviour supports a combination of patient approach and objective data, which can help with the adjustment of the individual cut-off for daily IWG. This also provides useful information for designing intervention strategies to maintain and increase adherence. SN - 1989-2284 UR - https://www.unboundmedicine.com/medline/citation/22806282/Prevalence_of_adherence_to_fluid_restriction_in_kidney_patients_in_haemodialysis:_objective_indicator_and_perceived_compliance_ L2 - http://www.revistanefrologia.com/es/linksolver/ft/ivp/0211-6995/32/477 DB - PRIME DP - Unbound Medicine ER -