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

Abstract

Introduction: Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis. Methods: A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit "Collect software" while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, "adherence to diet prescription" was analyzed as a binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed. Results: Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were "flexibility in the diets" (AOR 2.65, 95% CI 1.11-6.30, P 0.028), "difficulties in following diet recommendations" (AOR 0.24, 95% CI 0.13-0.46, P < 001), and "adherence to limiting fluid intake" (AOR 9.74, 95% CI 4.90-19.38, P < 0.001).

Perceptions on Adherence to Dietary Prescriptions for Adults with Chronic Kidney Disease on Hemodialysis: A Qualitative Study

“…The perception of the renal diets “good for health and kidneys” as a health benefit by all participants suggested that it was a motivation to adhere to the diets. However, adherence to diet prescription among this patient population in Kenya is low despite awareness of the dietary restriction [ 12 ]. It is, therefore, possible that study participants made judgment on the renal diet recommendations based on their perceived health benefits of the food.…”

“…The diet restrictions are viewed as complex and at times contradictory to perceived healthy eating, cultural norms, social functioning, and individuals’ sense of control [ 16 ]. The prescribed diets are considered stressful and expensive because the foods and cooking methods are different from the household members’ usual meal requirements as well as difficult and frustrating to integrate into usual diet and eating habits [ 12 , 31 ]. Similar sentiments were also expressed by Chironda and Bhengu [ 20 ] who concur that CKD and its treatments can indeed restrict daily activities, employment, family life, and social relationships, often leading to feelings of isolation that might induce stress and anxiety.…”

“…Although nutrition is one of the modifiable lifestyle factors in management of CKD [ 7 , 8 , 9 ] adherence to dietary prescriptions is a challenge for more than half of adult patients globally [ 10 , 11 ]. In Kenya, the only study on adherence to diet prescriptions also indicate that more than half of adults on hemodialysis at national referral hospitals do not adhere to their diet prescriptions [ 12 ]. For the patients with CKD on hemodialysis, Medical Nutrition Therapy entails dietary restrictions to control accumulation of metabolic wastes and development of comorbidities [ 13 , 14 ].…”

“…Whereas the available research evidence on diet and CKD prevention may not be convincing, it is possible that adherence to diet prescriptions may prevent complications associated with the disease and contribute to improvement in patients’ quality of life [ 14 , 19 ]. Research findings from Kenya indicate that diet prescriptions with foods that are considered less restrictive are more likely to be adhered to than the ones that do not match with the patient’s other ways of eating as well as food preparation methods [ 12 ]. These perceptions, in the context of the multi-dimensional nature of factors, including poor motivation, contribute to non-adherence to therapies [ 20 , 21 ] and are more likely to exacerbate the non-adherence to dietary prescriptions and contribute to rapid progression of CKD among patients.…”

“…There are limited studies on perceptions to dietary restrictions among adults with CKD from African countries [ 22 , 23 , 24 ] where regional variations exist in the health care systems as well as household food security that shape individual’s perceptions on adherence to prescribed diets. In Kenya, there is minimal documented evidence on adherence to CKD diet prescriptions [ 12 ].…”