Factors Associated with Adherence to Renal Diet among Dialysis Patients in Private Dialysis Center: A Cross-Sectional Study
Abstract
This study is aimed to assess the adherence status of renal diet, determine the association between sociodemographic characteristics, dietary knowledge, nutrition literacy, and perception of recommended diet and fluid, while also identifying significant factors that play a role in influencing adherence to the renal diet within this specific healthcare setting. This cross-sectional study with purposive sampling recruited 71 of Chronic Kidney Disease (CKD) patients attending private dialysis centers in Selangor. Information on sociodemographic data, the End Stage Renal Disease Adherence Questionnaire (ESRD-AQ), the Dialysis-Related Dietary Knowledge Questionnaire (DDKQ), and the Dialysis Specific Nutrition Literacy Scale (DSNLS) were collected. The findings revealed that renal diet adherence of the respondent was 50.7%. The number of comorbidities, perception of recommended diet, and difficulty in watching diet recommendations were associated with adherence to renal diet among the participants. Further analysis using multivariate logistic regression revealed that the number of comorbidities (AOR=9.22, 95% CI:2.10˗40.47) and the difficulty in watching diet recommendations (AOR=0.04, 95% CI:0.003˗0.13) were significant determinants of dietary adherence. Dialysis patients with a higher number of comorbidities have a stronger likelihood of dietary adherence, meanwhile those with difficulty in watching diet recommendations have a higher tendency to non-adherence to renal diet. Thus, the difficulty identified should be overcome to improve renal diet adherence in the future.
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References
Chan YM, Zalilah MS, Hii SZ. 2012. Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia. Plos One 7(8):e41362. https://doi.org/10.1371/journal.pone.0041362
Hershey K. Renal Diet. 2018. Nurs Clin North Am 53(4):481−489. https://doi.10.1016/j.cnur.2018.05.005
Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. 2021. Chronic kidney disease. The Lancet 398(10302):786–802. http://doi:10.1016/s0140-6736(21)00519-5
Kim Y, Evangelista LS, Phillips LR, Pavlish C, Kopple JD. The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in-center hemodialysis. Nephrol Nurs J 37(4):377−393.
Kovesdy CP. 2022. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplement 12(1):7–11. https://doi.org/10.1016/j.kisu.2021.11.003
Lambert K, Mullan J, Mansfield K. 2017. An integrative review of the methodology and findings regarding dietary adherence in end-stage kidney disease. BMC Nephrol 18(1). http://doi:10.1186/s12882-017-0734-z
Lim JH, Chinna K, Khosla P, Karupaiah T, Daud ZAM. 2020. Understanding how nutrition literacy links to dietary adherence in patients undergoing maintenance hemodialysis: A theoretical exploration using partial least squares structural equation modeling. Int J Environ Res Public Health 17(20):7479. https://doi.org/10.3390/ijerph17207479
Lynch R. 2018. Dialysis patients' perceptions of factors associated with the renal diet. J Kidney Care 3(3):142−155.
Naalweh KS, Barakat MA, Sweileh MW, Al-Jabi SW, Sweileh WM, Zyoud SEH. 2017. Treatment adherence and perception in patients on maintenance hemodialysis: a cross–sectional study from Palestine. BMC Nephrol 18:1−9.
Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Aboyans V, Adetokunboh O, Afshin A, Agrawal A, Ahmadi A. 2017. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet 390(10100):1151–1210. https://doi.org/10.1016/s0140-6736(17)32152-9
Opiyo RO, Nyasulu PS, Olenja J, Zunza M, Nguyen KA, Bukania Z, Nabakwe E, Mbogo A, Were AO. 2019. Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya: a mixed-methods survey. Ren Replace Ther 5(41). https://doi.org/10.1186/s41100-
Taghdir M, Honar N, Mazloomi SM, Sepandi M, Ashourpour M, Salehi M. 2016. Dietary compliance in Iranian children and adolescents with celiac disease. J Multidiscip Healthc 16(9):365−370. 019-0237-4 Kidney International, 84(5), 1034–1040. doi:10.1038/ki.2013.220 Epidemiology and Global Health. http://doi:10.1016/j.cegh.2018.05.003
Thamil AS, Hooi LS, Muhammad Fadhli MY, Ong LM, Bavanandan S, Rodzlan Hasani WS, Tan EZZ, Wong I, Rifin HM, Robert TG, Ismail H, Wong NI, Ahmad G, Ambak R, Othman F, Abd Hamid HA, Aris T. 2020. Prevalence of chronic kidney disease and its associated factors in Malaysia. Findings from a nationwide population-based cross-sectional study. BMC Nephrol 21:344 https://doi.org/10.1186/s12882-020-01966-8
Tonelli M, Wiebe N, Guthrie B, James MT, Quan H, Fortin M, Klarenbach SW, Sargious P, Straus S, Lewanczuk R, Ronksley PE, Manns BJ, Hemmelgarn BR. 2015. Comorbidity as a driver of adverse outcomes in people with chronic kidney disease. Kidney Int 88(4):859−866.
Vaidya SR, Aeddula NR. Chronic Renal Failure. 2022. StatPearls Publishing; 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK535404/
Vijay VR, Kang HK. 2021. The worldwide prevalence of non-adherence to diet and fluid restrictions among hemodialysis patients: A systematic review and meta-analysis. J Renal Nutr 32(6):658−669. https://doi.org.10.1053/j.jrn.2021.11.007
Viechtbauer W, Smits L, Kotz D, Budé L, Spigt M, Serroyen J, Crutzen R. 2015. A simple formula for the calculation of sample size in pilot studies. J Clin Epidemiol 68(11):1375–1379. https://doi.org/10.1016/j.jclinepi.2015.04.014
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