Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study

Rivera, Eleanor; Clark-Cutaia, Maya N.; Schrauben, Sarah J.; Townsend, Raymond R.; Lash, James P.; Hannan, Mary; Jaar, Bernard G.; Rincon-Choles, Hernan; Kansal, Sheru; He, Jiang; Chen, Jing; Hirschman, Karen B.

doi:10.1016/j.xkme.2022.100545

Cited by 4 publications

(5 citation statements)

References 52 publications

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“…The remaining 303 eligible patients refused the agreement and/or were reluctant to research procedures because they participated in many research studies [ 47 ] without substantial results. In another clinical trial, of 56 estimated participants, only 32 agreed to participate and completed their interview (57%) [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, a recent qualitative study including patients with CKD in stages 2–4, conducted by Rivera et al [ 48 ], reported multiple factors correlated with treatment adherence. First, patient factors, which include numerous comorbidities, chronic diseases, motivation, and outlook.…”

Section: Resultsmentioning

confidence: 99%

“…Third, treatment planning factors: lack of a clear plan, proactive and dynamic research, provider-focused treatment objectives, and shared decision-making. As a result, the response of a CKD patient could be very different: positive feedback, lack of information, perceived capability deficit, and disagreement with treatment [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series

Moroșan

Popovici

Elian

et al. 2023

IJERPH

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The treatment and interdisciplinary management of patients with chronic kidney disease (CKD) continue to improve long-term outcomes. The medical nutrition intervention’s role is to establish a healthy diet plan for kidney protection, reach blood pressure and blood glucose goals, and prevent or delay health problems caused by kidney disease. Our study aims to report the effects of medical nutrition therapy—substituting foods rich in phosphorus-containing additives with ones low in phosphates content on phosphatemia and phosphate binders drug prescription in stage 5 CKD patients with hemodialysis. Thus, 18 adults with high phosphatemia levels (over 5.5 mg/dL) were monitored at a single center. Everyone received standard personalized diets to replace processed foods with phosphorus additives according to their comorbidities and treatment with prosphate binder drugs. Clinical laboratory data, including dialysis protocol, calcemia, and phosphatemia, were evaluated at the beginning of the study, after 30 and 60 days. A food survey was assessed at baseline and after 60 days. The results did not show significant differences between serum phosphate levels between the first and second measurements; thus, the phosphate binders’ initial doses did not change. After 2 months, phosphate levels decreased considerably (from 7.322 mg/dL to 5.368 mg/dL); therefore, phosphate binder doses were diminished. In conclusion, medical nutrition intervention in patients with hemodialysis significantly reduced serum phosphate concentrations after 60 days. Restricting the intake of processed foods containing phosphorus additives—in particularized diets adapted to each patient’s comorbidities—and receiving phosphate binders represented substantial steps to decrease phosphatemia levels. The best results were significantly associated with life expectancy; at the same time, they showed a negative correlation with the dialysis period and participants’ age.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series

Moroșan

Popovici

Elian

et al. 2023

IJERPH

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“…[17][18][19] Moreover, patients with chronic kidney disease may experience difficulties in managing medications due to their health status, leading to reduced adherence. [20][21][22][23] Socioeconomic status was another predictor of DAPT noncompliance, with patients in the low socioeconomic category having higher noncompliance rates compared to those in the high socioeconomic category. [1] Financial constraints and limited access to healthcare resources in low-income groups may contribute to non-adherence, highlighting the importance of addressing socioeconomic disparities in medication adherence.…”

Section: Discussionmentioning

confidence: 99%

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES

Iftikhar,

Rana,

Naeem

et al. 2024

Medicine

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This retrospective study aims to explore the sex disparity in dual antiplatelet therapy (DAPT) noncompliance among left main stem percutaneous coronary intervention (PCI) patients with drug-eluting stent (DES) and identify predictors associated with non-adherence. Data were collected from the medical records of 1585 patients, including 1104 males and 481 females, who underwent left main stem PCI with DES. Baseline characteristics, angiographic features, and DAPT compliance rates at 1 month and 12 months were analyzed. Univariate logistic regression was used to identify predictors of DAPT noncompliance. The overall DAPT noncompliance rate at 1 month was 8.5%, increasing to 15.5% at 12 months. Females exhibited slightly higher noncompliance rates than males at both 1 month (15.6% vs 14.5%) and 12 months (28.1% vs 19.0%), although the difference was not statistically significant. Smoking status showed a modest impact on non-adherence, with current smokers exhibiting a lower noncompliance rate (14.9% at 1 month). Prior coronary artery disease history was associated with increased noncompliance at 12 months (18.9%). Angiographic characteristics, including lesion location and Syntax score, had no consistent association with DAPT noncompliance. This study highlights sex disparity in DAPT noncompliance among patients undergoing left main stem PCI with DES. Comorbidities, socioeconomic status, smoking status, and prior coronary artery disease history were identified as predictors of non-adherence.

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“…When viewed holistically, the study findings lend increasing evidence to decision-making and treatment adherence literature, demonstrating a direct connection to knowledge, resource utilization and positive provider factors that can improve decision conflict and enhance trust for future decisions in CKD and other serious illnesses. 13,37,44,45 Supportive caregivers and a trusted relationship with their clinician were presented as mechanisms supporting decision-making. While this supports decision-making literature, highlighting that discussions should be bidirectional, this study emphasizes the importance of including caregivers in the conversation.…”

Section: Discussionmentioning

confidence: 99%

Exploring the health‐related decision‐making experiences of people with chronic kidney disease and their caregivers: A qualitative study

Gazaway,

Gutierrez,

Wells

et al. 2023

Health Expectations

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BackgroundThis study aimed to explore the decision‐making experience of patients with chronic kidney disease (CKD) and their caregivers.MethodsThis was a qualitative descriptive study of the decision‐making experiences of individuals with stage 3—end‐stage CKD and their family caregivers. One‐on‐one, semistructured interviews were conducted using a guide developed and approved by a community advisory group. Data were analyzed using thematic analysis.ResultsThree themes were identified: (1) decisions triggered by declining health and broad in scope, (2) challenges to decision‐making and (3) factors influencing decision‐making. Participants' experiences with health‐related decision‐making demonstrated that decisions were triggered when health declined. Yet, decisions that impact disease progression were being made in stage 3. Decision‐making was made difficult due to lack of information, complex co‐morbidities, and poor resource utilization. However, the structure and nature of the medical appointment, supportive caregivers, and resources served to remove challenges.ConclusionDecision‐support interventions must train patients and caregivers to be empowered participants in answer‐seeking behaviours upstream of advanced illness.Public ContributionsThis work was conducted in full collaboration with a community advisory board consisting of patients with CKD, caregivers and clinicians. These members are noted in the acknowledgement section, and those who worked with the team to develop the interview guide, study protocols, and manuscript preparation are included as authors. As part of their role, advisory members met monthly, providing input on recruitment, study progress, inclusion of diverse voices and added relevance to study findings.

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Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study

Cited by 4 publications

References 52 publications

The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series

The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES

Exploring the health‐related decision‐making experiences of people with chronic kidney disease and their caregivers: A qualitative study

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