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Patients following a renal diet say conflicting advice, social issues can impact success
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While patients on hemodialysis understand the value and intent of following a renal diet to reduce the risk of morbidity and mortality, outside influences, including conflicting information from other sources about what to eat and drink while on dialysis, can often disrupt efforts to succeed, an Australian survey shows.
Jessica Stevenson, MNutrDiet, and colleagues from the University of Sydney and the Children's Hospital at Westmead in Sydney conducted semi-structured interviews with 35 patients on hemodialysis in six dialysis units on dietary experiences and fluid management. Participants were selected to cover a range of age groups (minimum of 18 years old), genders, cultural backgrounds, type of hemodialysis (hospital, community or home) and location. Interviews were conducted while patients were on dialysis.
Results of the surveys showed five major themes, according to the researchers. Two themes reflected barriers to dietary change, including exacerbating disruption and losing control, and three themes represented “enablers for dietary change,” attaining health benefits from following the renal diet, such as avoiding medical catastrophes by enhancing benefits of dialysis and alleviating and managing symptoms, as well as achieving treatment goals and succeeding with support from family and trusting expert guidance.
“Patients on hemodialysis perceived their dietary restrictions to be complex and at times contradictory to their perceptions of healthy eating, cultural norms, social functioning
and their sense of control,” the authors wrote. “Particularly when commencing hemodialysis, patients felt overwhelmed and unprepared for the invasive and grueling nature of the treatment and felt they were unable to give adequate attention to dietary control.”
At times, patients felt they were “losing control and experienced shifts between feeling unable to manage their diet due to various environmental, social and medical stressors with feelings of empowerment over managing their diet and the symptomatic benefit they reaped from maintaining dietary control,” the authors wrote.
The impact of these issues on patients attempting to adhere to a renal diet suggests clinicians need to be more consistent in their message about the value of the dietary guidelines and the potential risks if the patient does not follow these.
“Patients on hemodialysis believe dietary control helps to reduce symptom burden and enhance general health and well-being, but competing medical and social issues coupled with contradictory and/or irrelevant dietary advice prevents them from implementing diet and fluid restrictions,” the researchers wrote. “Interventions involving collaborative multidisciplinary care including clinicians with dietetic expertise, and consistent information that addresses cultural and personal circumstances, may support adherence to dietary recommendations and improve outcomes.”
Disclosure s : Stevenson is supported by a National Health and Medical Research Council Better Evidence and Translation in Chronic Kidney Disease (BEAT-CKD) Program grant
(1092579). All other authors report no relevant financial disclosures.
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