Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross‐sectional study from Australia

Abstract

The impact of disparities in the cognitive capabilities identified in this study are likely to be far reaching. Tailoring of education and self-management programmes to the cognitive deficits of individuals is required.

How do patients and carers make sense of renal dietary advice? A qualitative exploration

“…In addition to the complexity of the diet, patients and carers in the current study described receiving renal diet information that was confusing and contradictory. Some of the difficulties experienced by patients when interpreting messages on diet sheets, could be attributed to the high level of cognitive impairment in patients with CKD (Lambert et al ); as well as low health literacy experienced among this patient population (Lambert et al . ; Taylor et al .…”

“…In addition to the complexity of the diet, patients and carers in the current study described receiving renal diet information that was confusing and contradictory. Some of the difficulties experienced by patients when interpreting messages on diet sheets, could be attributed to the high level of cognitive impairment in patients with CKD (Lambert et al 2016); as well as low health literacy experienced among this patient population (Lambert et al 2015;Taylor et al 2017). To address potential barriers to sensemaking and difficulties with the interpretation and application of the renal diet that may be due to inadequate health literacy, we recommend incorporating several rounds of teachback (Dinh et al 2016) during education sessions to evaluate recall, and to ascertain understanding of important or complex concepts (Gibbs & Chapman-Novakofski 2012;Negarandeh et al 2013;Dantic 2014;Porter et al 2016;Gibbs 2017).…”

Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet

“…From a theoretical perspective, the pedagogical approaches to renal diet education should be revisited. It is suggested that the educational strategies used by dietitians take into consideration the concurrent high rates of cognitive impairment and low health literacy in patients with ESKD. For example, motivational interviewing, a popular behaviour change technique used by dietitians, may not be appropriate or effective for patients who have cognitive impairment or inadequate executive function, attention and memory, as is common among many patients with ESKD …”

“…5,6 However, the process of educating ESKD patients about their renal diet is complicated by the need to modify many nutrients simultaneously, as well as ongoing changes to the diet prescription over time. Other factors likely to negatively impact on a patient's ability to comprehend and self-manage their diet include; the presence of cognitive impairment, 7,8 inadequate health literacy, 9 fatigue 10 and depression. 11 A recent review of 60 studies in adults with ESKD found that adherence to the renal diet was as low as 31.5%.…”

A practical guide for the use of very low calorie diets in adults with chronic kidney disease

“…The first step in the assessment of these individuals would be to ascertain their motivation and readiness to change. Given that cognitive impairment and low health literacy are also common in end stage kidney disease it would be important to ascertain how well each patient understands what is being recommended and what the implications of the VLCD prescription will be. Given Patient 1 has a history of noncompliance it would be pertinent to explore what the challenges to compliance may be.…”