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Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self-regulation of Fluid Intake
Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.ORCID iD: 0000-0003-1289-9896
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective.

The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate.

The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings.

Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake.

In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload.

This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2010. , p. 89
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 551
Keywords [en]
Behavioural medicine, fluid overload, adherence, haemodialysis, self-efficacy, attentional style, depressive symptomatology, cluster analysis, tailored treatment, quasi-experimental single-case design, Fluid Intake Appraisal Inventory (FIAI), renal nursing
National Category
Urology and Nephrology Nursing
Research subject
Medical Science; Caring Sciences
Identifiers
URN: urn:nbn:se:hig:diva-12752ISBN: 978-91-554-7782-0 (print)OAI: oai:DiVA.org:hig-12752DiVA, id: diva2:548745
Public defence
2010-05-19, Sal IV, Universitetshuset, Övre Slottsgatan 2, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-08-31 Created: 2012-08-31 Last updated: 2018-03-13Bibliographically approved
List of papers
1. Interdialytic weight gain and ultrafiltration rate in hemodialysis: lessons about fluid adherence from a national registry of clinical practice
Open this publication in new window or tab >>Interdialytic weight gain and ultrafiltration rate in hemodialysis: lessons about fluid adherence from a national registry of clinical practice
2009 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, no 2, p. 181-188Article in journal (Refereed) Published
Abstract [en]

Excessive interdialytic weight gain (IWG) and ultrafiltration rates (UFR) above 10 mL/h/kg body weight imply higher morbidity and mortality. This study aimed to estimate the prevalence of high fluid consumers, describe UFR patterns, and describe patient characteristics associated with IWG and UFR. The Swedish Dialysis DataBase and The Swedish Renal Registry of Active Treatment of Uremia were used as data sources. Data were analyzed from patients aged ≥18 on regular treatment with hemodialysis (HD) and registered during 2002 to 2006. Interdialytic weight gain and dialytic UFR were examined in annual cohorts and the records were based on 9693 HD sessions in 4498 patients. Differences in proportions were analyzed with the chi-square test and differences in means were tested using the ANOVA or the t test. About 30% of the patients had IWG that exceed 3.5% of dry body weight and 5% had IWG ≥5.7%. The volume removed during HD was >10 mL/h/kg for 15% to 23% of the patients, and this rate increased during the first dialytic year. Patient characteristics associated with fluid overload were younger age, lower body mass index, longer dialytic vintage, and high blood pressure. By studying IWG and dialytic UFR as quality indicators, it is shown that there is a potential for continuing improvement in the care of patients in HD settings, i.e., to enhanced adherence to fluid restriction or alternatively to extend the frequency of dialysis for all patients, e.g., by providing daily treatment.

National Category
Urology and Nephrology
Identifiers
urn:nbn:se:hig:diva-5335 (URN)10.1111/j.1542-4758.2009.00354.x (DOI)000265425700008 ()19432692 (PubMedID)
Available from: 2009-09-07 Created: 2009-09-07 Last updated: 2018-03-13Bibliographically approved
2. Fluid Intake Appraisal Inventory: development and psychometric evaluation of a situation-specific measure for haemodialysis patients' self-efficacy to low fluid intake.
Open this publication in new window or tab >>Fluid Intake Appraisal Inventory: development and psychometric evaluation of a situation-specific measure for haemodialysis patients' self-efficacy to low fluid intake.
2007 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 63, no 2, p. 167-73Article in journal (Refereed) Published
Abstract [en]

Objective: Self-efficacy is an important determinant of health behaviour and reflects a person's belief about their capability to complete a given task. The relationship between self-efficacy and fluid adherence has been investigated, although limited attention has been given to measurement issues. The purpose of this study was to develop a measure of situation-specific self-efficacy for constructive fluid intake behaviour in haemodialysis patients, the Fluid Intake Appraisal Inventory (FIAI). Methods: Items were generated from an analysis of empirical studies available in the literature and exposed to an interpretability critique before haemodialysis patients confirmed sufficiency of each item. In a multi-centre study, data from 144 haemodialysis patients were collected regarding general self-efficacy, situation-specific self-efficacy, and estimated fluid consumption. Internal consistency, criterion-related validity, and structural validity were tested. Results: The FIAI was found to have high internal consistency (Cronbach alpha 0.96) and the theoretical assumptions for criterion-related validity and known-group validity were supported. Structural validity was not confirmed, however, because the theoretically hypothesized four-factor model was not the prime structure. Conclusion: The FIAI was revealed to have satisfactory psychometric properties. The scale may be used in research or in clinical settings to study the mediating effects of self-efficacy or to modify haemodialysis patients' fluid-intake behaviour. Although this first validity study is promising, further validation focusing on reliability and cultural validity is needed.

Keywords
chronic renal failure; Fluid Intake Appraisal Inventory; fluid restriction; psychometric properties; reliability/validity; self-efficacy
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-5331 (URN)10.1016/j.jpsychores.2007.03.013 (DOI)000248644300009 ()17662753 (PubMedID)
Available from: 2009-09-07 Created: 2009-09-07 Last updated: 2018-03-13Bibliographically approved
3. Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach.
Open this publication in new window or tab >>Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach.
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 21-22, p. 2997-3005Article in journal (Refereed) Published
Abstract [en]

AIMS: To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain varies between patients in groups with different cognitive profiles.

BACKGROUND: Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control, and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions.

DESIGN: Explorative cross-sectional multicentre survey.

METHODS: The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One-way analysis of variance (anova) or Pearson's chi-square test was used for comparing subgroups.

RESULTS: Three distinct subgroups were found and subsequently labelled: (1) low self-efficacy, (2) distraction and depressive symptoms and (3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output or in receiving any fluid intake advice.

CONCLUSIONS: Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms.

RELEVANCE TO CLINICAL PRACTICE: Based on this study, we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient's fluid control, is introduced.

National Category
Nursing Urology and Nephrology
Identifiers
urn:nbn:se:hig:diva-12637 (URN)10.1111/j.1365-2702.2010.03372.x (DOI)000282874400006 ()21040006 (PubMedID)
Available from: 2012-08-21 Created: 2012-08-21 Last updated: 2018-03-13Bibliographically approved
4. A behavioural nursing intervention for reduced fluid overload in haemodialysis patients: Initial results of acceptability, feasibility and efficacy
Open this publication in new window or tab >>A behavioural nursing intervention for reduced fluid overload in haemodialysis patients: Initial results of acceptability, feasibility and efficacy
2011 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 3, no 2, p. 87-98Article in journal (Refereed) Published
Abstract [en]

Aim.  To describe and perform a tailored treatment programme based on a behavioural medicine approach to enhance haemodialysis patients’ self-management of fluid restriction.

Background.  Haemodialysis patients are required to manage dietary restrictions within a framework of adequate nutrition. Adherence to limited fluid allotment is important but difficult to accomplish. Pragmatic and effective ways of helping patients with fluid management are lacking.

Methods.  Cognitive-behavioural techniques were used in four quasi-experimental case studies. Central features in the programme were individual analysis of dietetic knowledge and fluid intake, setting goals, self-monitoring and prevention of relapse. Fluid overload was continuously assessed. Data were collected from September 2009–March 2010.

Findings.  Acceptability and feasibility of the intervention was satisfactory. A clear reduction of fluid overload was shown. Some problems related to treatment fidelity were identified.

Conclusions.  The behavioural medicine approach resulted in a clear reduction of fluid overload in each of the four cases included.

Relevance to clinical practice.  This approach could be used as a method for tailoring interventions targeted to fluid intake behaviour in a heterogeneous group of HD patients with excessive fluid overload. Such treatment should take account of individual cognitive-behavioural patterns and include self-efficacy to low fluid intake. The efficacy of the tailored approach in regular practice has to be further tested in controlled trials.

Keywords
Behavioural nursing strategies, fluid overload, haemodialysis, self-efficacy, self-management, single-case design
National Category
Nursing Urology and Nephrology
Identifiers
urn:nbn:se:hig:diva-12640 (URN)10.1111/j.1752-9824.2011.01093.x (DOI)
Available from: 2012-08-21 Created: 2012-08-21 Last updated: 2018-03-13Bibliographically approved

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