Perceived Barriers and Support Strategies for Reducing Sodium Intake in Patients with Chronic Kidney Disease: a Qualitative Study

ObjectivesTo support the adaptation and translation of an evidence-based chronic kidney disease (CKD) self-management intervention to the Chinese context, we examined the beliefs, perceptions and needs of Chinese patients with CKD and healthcare professionals (HCPs) towards CKD self-management.DesignA basic interpretive, cross-sectional qualitative study comprising semistructured interviews and observations.SettingOne major tertiary referral hospital in Henan province, China.Participants11 adults with a diagnosis of CKD with CKD stages G1–G5 and 10 HCPs who worked in the Department of Nephrology.ResultsFour themes emerged: (1) CKD illness perceptions, (2) understanding of and motivation towards CKD self-management, (3) current CKD practice and (4) barriers, (anticipated) facilitators and needs towards CKD self-management. Most patients and HCPs solely mentioned medical management of CKD, and self-management was largely unknown or misinterpreted as adherence to medical treatment. Also, the majority of patients only mentioned performing disease-specific acts of control and not, for instance, behaviour for coping with emotional problems. A paternalistic patient–HCP relationship was often present. Finally, the barriers, facilitators and needs towards CKD self-management were frequently related to knowledge and environmental context and resources.ConclusionsThe limited understanding of CKD self-management, as observed, underlines the need for educational efforts on the use and benefits of self-management before intervention implementation. Also, specific characteristics and needs within the Chinese context need to guide the development or tailoring of CKD self-management interventions. Emphasis should be placed on role management and emotional coping skills, while self-management components should be tailored by addressing the existing paternalistic patient–HCP relationship. The use of electronic health innovations can be an essential facilitator for implementation.

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Siblings of children with chronic kidney disease: A qualitative study of everyday life experiences

Journal of Renal Care ◽

10.1111/jorc.12400 ◽

2021 ◽

Vol 47 (4) ◽

pp. 219-219

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Qualitative Study ◽

Everyday Life ◽

Life Experiences

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Variation in Sodium Intake and Intra-individual Change in Blood Pressure in Chronic Kidney Disease

Journal of Renal Nutrition ◽

10.1053/j.jrn.2017.07.002 ◽

2018 ◽

Vol 28 (2) ◽

pp. 125-128

Author(s):

Chetna M. Pathak ◽

Joachim H. Ix ◽

Cheryl A.M. Anderson ◽

Tyler B. Woodell ◽

Gerard Smits ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Individual Change

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Exploring health literacy in patients with chronic kidney disease: a qualitative study

BMC Nephrology ◽

10.1186/s12882-020-01973-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Une Elisabeth Stømer ◽

Astrid Klopstad Wahl ◽

Lasse Gunnar Gøransson ◽

Kristin Hjorthaug Urstad

Keyword(s):

Chronic Kidney Disease ◽

Health Literacy ◽

Kidney Disease ◽

Qualitative Study

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Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01689-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Esmaeel Toni ◽

Habibollah Pirnejad ◽

Khadijeh Makhdoomi ◽

Azam Mivefroshan ◽

Zahra Niazkhani

Keyword(s):

Chronic Kidney Disease ◽

Health Literacy ◽

Kidney Disease ◽

Qualitative Study ◽

Personal Health Record ◽

Self Management ◽

Personal Health ◽

Health Record ◽

User Centered Design ◽

Electronic Personal Health Record

Abstract Background To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use. Methods A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology. Results Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use. Conclusions We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption.

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The Fluid Management Experience in Patients with Chronic Kidney Disease Undergoing Hemodialysis in Indonesia: A Qualitative Study

Nurse Media Journal of Nursing ◽

10.14710/nmjn.v11i3.38838 ◽

2021 ◽

Vol 11 (3) ◽

pp. 389-403

Author(s):

Fitri Mailani ◽

Rahmi Muthia ◽

Yelly Herien ◽

Emil Huriani ◽

Chong Mei Chan ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Qualitative Study ◽

Fluid Management ◽

Phenomenological Approach ◽

Tertiary Hospital ◽

Structured Education ◽

Personal Approach ◽

Management Experience ◽

Control Fluid

Background: Fluid management can reduce mortality, severe comorbidities, and debilitating symptoms in patients on hemodialysis. Therefore, a restricted fluid intake plan is crucial for patients with chronic kidney disease (CKD). Little evidence has been found to date on exploring the experience in fluid management of CKD patients in Indonesia.Purpose: This study aimed to explore the fluid management experience of adults with chronic kidney disease participating in hemodialysis treatment in Indonesia.Methods: A qualitative study with a phenomenological approach was conducted. Purposive sampling was used to recruit 14 adults patients with chronic kidney disease undergoing hemodialysis in a tertiary hospital in Padang between July and September 2020. Manual content analysis using the Colaizzi approach was used to identify themes.Results: Data analysis revealed four themes with 12 sub-themes. The four major themes include the challenge of thirst control, fluid/diet restriction management, inadequate information, and the support system.Conclusions: The result showed the severe suffering and sadness experienced by CKD patients who conform to fluid restrictions. It is important to provide clear information on the fluid prescription or the exact consumable amount per day. Structured education with a personal approach is recommended to ensure detailed information regarding "fluid prescribing". The support obtained from family, friends, and dialysis staff is a significant factor in promoting acceptance and adherence.

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Benefits and Risks of Lowering Sodium Through Potassium-enriched Salt Substitution for Patients with Chronic Kidney Disease in China: A Modelling Study (OR25-05-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.or25-05-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Matti Marklund ◽

Gitanjali Singh ◽

Raquel Greer ◽

Frederick Cudhea ◽

Kunihiro Matsushita ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Population Level ◽

Sensitivity Analyses ◽

Net Benefit ◽

Uncertainty Interval ◽

Potassium Intake ◽

Primary Model ◽

Cvd Mortality

Abstract Objectives Population-level replacement of discretionary (i.e, table/cooking) salt with potassium-enriched salt substitutes is a promising strategy to reduce blood pressure (BP) and prevent cardiovascular disease (CVD). This may be particularly impactful in countries like China where sodium intake is high, mainly from discretionary salt use, and where potassium intake low. However, hyperkalemia resulting from potassium-enriched substitutes and its adverse CVD consequences are of concern for those with chronic kidney disease (CKD). We aimed to estimate the benefits and risks of nationwide replacement of discretionary salt with potassium-enriched salt substitute on CVD mortality in Chinese CKD patients. Methods We used a comparative risk assessment framework and incorporated existing data and corresponding uncertainties from randomized trials, the China National Survey of CKD, the Global Burden of Disease study, and the CKD Prognosis Consortium. We estimated averted CVD mortality from reduced BP subsequent to salt substitution in CKD patients (defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2) stratified by age and sex. Additional CVD deaths from hyperkalemia due to salt substitution were modelled in CKD patients stratified by kidney function. The robustness of the primary model was evaluated in a series of sensitivity analyses where key model assumptions and inputs were altered. Results Nationwide implementation of potassium-enriched salt substitution would prevent an estimated 29,735 (95% uncertainty interval: 13,018–50,403) CVD deaths/year among CKD patients by reducing BP, while the increased potassium intake could potentially produce an estimated 9791 (6078–15,941) additional hyperkalemia-related deaths (Table). The net effect would be 19,558 (3430–37,959) fewer CVD deaths/year, corresponding to 7.4% (1.4–13.4) of annual CVD deaths in Chinese CKD patients. Net benefits were consistent in sensitivity analyses (Table). Conclusions Despite the risks of hyperkalemia, nationwide potassium-enriched salt substitution in China would result in significant net benefit among CKD patients. Funding Sources This analysis was conducted in collaboration with Resolve to Save Lives, an initiative of Vital Strategies. Resolve to Save Lives is funded by Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation. Funding for this work was also provided by the National Health and Medical Research Council and UNSW Sydney. Supporting Tables, Images and/or Graphs

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