Haemodialysis prescription, adherence and nutritional indicators in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis. Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients The effects of a cognitive behavioural therapy programme for self-care on haemodialysis patients. An international study of patient compliance with hemodialysis. Group intervention to improve quality of life in haemodialysis patients. Effects of an adaptation training programme for patients with end-stage renal disease. The effect of diet education on the laboratory values and knowledge of hemodialysis patients with hyperphosphatemia. Can a nutrition intervention improve albumin levels among hemodialysis patients? A pilot study. The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial. The life readiness program: a physical rehabilitation program for patients on hemodialysis. Empowerment of patients with end-stage renal disease--a randomized controlled trial. Health-related quality of life among dialysis patients on three continents: the Dialysis Outcomes and Practice Patterns Study. A cognitive behavioral group approach to enhance adherence to hemodialysis fluid restrictions: a randomized controlled trial. Teaching program effects on high phosphorus levels in patients receiving hemodialysis. A randomized controlled trial of an educational intervention to improve phosphate levels in hemodialysis patients. Self-efficacy training for patients with end-stage renal disease. Anxiety disorders in adults treated by hemodialysis: a single-center study. The effect of a self-monitoring tool on self-efficacy, health beliefs, and adherence in patients receiving hemodialysis. Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Dietary and fluid compliance: an educational intervention for patients having haemodialysis. Evaluation of a hemodialysis patient education and support program. Impact of stepped verbal and written reinforcement of fluid balance advice within an outpatient haemodialysis unit: a pilot study. Patient Education: An Efficient Adjuvant Therapy for Hyperphosphatemia in Hemodialysis Patients
BACKGROUND The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) is a prospect i ve , observational study design ed to evaluate practice patterns in r and om sample s of haemodialysis facilities and patients across three continents . Participating countries include France , Germany , Italy , Spain and the UK ( Euro-DOPPS ) , Japan and the USA . DOPPS data collection has used the same question naires and protocol s across all participating countries to assess components of dialysis therapy and outcomes . This study focuses on dialysis prescription , adherence and nutrition among the Euro-DOPPS countries . METHODS In each Euro-DOPPS country , patients were selected r and omly from 20 - 21 representative facilities . Simple means and frequencies were calculated to compare relevant data elements to gain insights into differences in therapeutic aspects among nationally representative patients . Participants entering the study within 90 days of beginning dialysis therapy were excluded from these analyses . RESULTS Among the five countries , mean delivered dose as measured by normalized urea clearance ( Kt/V ) varied from 1.28 to 1.50 and was accompanied by differences in dialysis prescription components , including blood flow rates , treatment times , and dialyser membrane and flux characteristics . By country , a nearly 2-fold difference was observed in indicators of patient adherence and management ( skipping and shortening dialysis , hyperkalaemia , hyperphosphataemia and high interdialytic weight gain ) . Indicators of malnutrition varied substantially . CONCLUSIONS This study demonstrates differences in the management of haemodialysis patients across Euro-DOPPS and offers opportunities for improving dialysis dose , adherence and nutrition . Correlation of differences in practice patterns at the dialysis unit level with patient outcomes will offer new insights into improving dialysis therapy The present study examined the efficacy of a behavioral intervention design ed to increase adherence to fluid-intake restrictions among hemodialysis patients . Twenty intervention-group patients were compared with 20 matched control patients on an indicator of fluid-intake adherence at 3 time points . The Group x Time interaction was significant , indicating that patients in the 2 groups exhibited a differential pattern of change in fluid-intake adherence across the follow-up period . The intervention and control groups did not differ significantly in terms of adherence at the initial postintervention period but did differ at the 8-week follow-up . The observed group differences were , in part , due to a trend toward increasingly better adherence in the intervention group and poorer adherence in the control group across the follow-up period This research examined the relative efficacies of three intervention strategies design ed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients . The interventions examined included behavioral contracting ( with or without the involvement of a family member or friend ) and weekly telephone contacts with patients . Compliance was assessed with regard to following dietary restrictions and limiting fluid intake . Data were collected from 116 patients drawn from two outpatient clinics . Within clinics , patients were r and omly assigned either to an intervention program or to a control group . The study employed a pretest-posttest control group design . Patients were interviewed before the intervention programs began ( T1 ) , after a 6-week intervention period ( T2 ) , and 3 months after completion of the intervention period ( T3 ) . Results showed that the interventions achieved substantial reductions in patients ' serum potassium levels and in weight gains between dialysis treatments between T1 and T2 . In general , however , these program effects tapered off to preintervention levels between T2 and T3 . The findings thus indicate a need for long-term intervention programs A nurse-delivered haemodialysis patient education programme incorporating cognitive behavioural therapy ( CBT ) was developed . The effects of the CBT programme were compared with those of a st and ard patient education ( SPE ) programme on patients ' salt intake and weight gain using a quasi-experimental design . There were 22 participants ( 11 CBT , 11 SPE ) undergoing outpatient haemodialysis therapy at one clinic .  Daily weight gain rates decreased in the intervention period compared with the baseline period in both the CBT and SPE groups . This effect lasted for 12 weeks in the CBT group but for only eight weeks in the SPE group . In addition , daily salt intake decreased in the intervention period compared with the baseline period in both the CBT and SPE groups , persisting for 12 weeks . From these results , both programmes were shown to be effective , but CBT had a longer effect CONTEXT International differences in compliance of patients undergoing hemodialysis  are poorly characterized and could contribute to international survival differences . OBJECTIVE To compare international differences in patient compliance with hemodialysis treatments . DESIGN A prospect i ve observational study of patients undergoing hemodialysis in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996 . SETTING AND PATIENTS Four dialysis centers in the southeastern United States with 415 patients undergoing hemodialysis , 1 center in Sweden with 84 patients , and 4 centers in Japan with 194 patients participated in the prospect i ve observational study . In the cross-sectional survey , nurses and nephrologists from the United States ( n = 49 ) , Japan ( n = 21 ) , and Sweden ( n = 16 ) responded to questions regarding the compliance of their patients undergoing hemodialysis . MAIN OUTCOME MEASURES Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments . RESULTS Of 415 US patients , 147 missed 699 treatments over a 6-month period ( 28.1 missed treatments per 100 patient-months or 2.3 % of all prescribed treatments ) . During a 3-month period , there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 patient-months for patients from Sweden ( P<.001 ) . In the cross-sectional survey , the mean ( SD ) estimated percentage of patients missing a treatment per month was 4 % ( 3 % ) for the United States , 0 % for Japan , and 0.1 % ( 3 % ) for Sweden ( P<.001 ) . CONCLUSIONS Noncompliance is much more common in US patients undergoing hemodialysis than Swedish and Japanese patients . The implication s of these results for international differences in survival deserve further study AIM AND OBJECTIVE The purpose of this study was to investigate the effects of group intervention on depression , self-efficacy and quality of life in haemodialysis patients . BACKGROUND Chronic renal failure and haemodialysis treatment is a long-term process ; patients need to have an appropriate adaptive strategy to confront the stress stemming from the disease and subsequent haemodialysis treatment . The application of group intervention for haemodialysis patients has been limited . DESIGN This study applied an experimental design methodology . Patients were selected at two haemodialysis units of major medical centres in northern Taiwan . METHODS Out of 60 original patients r and omly assigned into experimental or control groups , 48 completed the study . Twenty patients in the experimental group received group psychosocial intervention . The therapy ran for two hours per week for two months . Twenty-eight patients in the comparison group received routine unit care and a self-care booklet . Instruments included the Strategies Used by People to Promote Health , the Beck Depression Inventory and the Short Form-36 . Data were collected at pretest and one month following the therapy . RESULTS The findings demonstrated that self-care self-efficacy , depression and quality of life significantly improved statistically for patients in the therapy group , compared with patients in the comparison group . CONCLUSIONS The study indicated that group psychosocial intervention significantly reduced depression , improved self-care self-efficacy and quality of life in haemodialysis patients . RELEVANCE TO CLINICAL PRACTICE The present study was conducted with a group of out patients , did not require expensive re sources and was not time intensive , making it a viable therapy , clinical ly suitable for haemodialysis patients AIMS This paper reports a study investigating the effectiveness of an adaptation training programme ( ATP ) to help patients with end-stage renal disease ( ESRD ) to cope with illness-related stresses and , thus , to alleviate depression and improve quality of life . BACKGROUND Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors . The ability of these patients to cope with and adapt to these stresses , whether related to their medical regimen or to the dem and s of daily life , has an important influence on physical and psychological well-being . METHODS The study was a r and omized controlled trial using a convenience sample of 57 eligible , fully informed and consenting patients with ESRD who were assigned to experimental ( ATP plus usual care ) or control ( usual care ) groups . Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors . A clinical nurse specialist and an experienced psychotherapist led them in three small groups ( 8 - 10 per group ) . Participants in the usual care group received routine care . Instruments comprised the Haemodialysis Stressor Scale , Beck Depression Inventory and Medical Outcomes Study SF-36 . Data were collected at baseline and at three months following the intervention . RESULTS The major stressors for these patients were limitations on time and place related to employment , limitations on fluid intake , transport difficulties , loss of bodily function , length of dialysis treatment , and limitation of physical activities . The ATP had a beneficial effect on perceived stress ( P = 0.005 ) , depression ( P = 0.001 ) and quality of life ( P = 0.02 ) 3 months after the intervention . CONCLUSIONS This study supports the effectiveness of an ATP to decrease stress and depression levels , and to improve the quality of life of ATP patients receiving haemodialysis OBJECTIVE The purpose of this study was to evaluate the effectiveness of 20 to 30 minutes per month of additional diet education on monthly laboratory values ( phosphorus , calcium , parathyroid hormone , and calcium/phosphorus product ) and knowledge of dietary phosphorus management in hemodialysis patients with hyperphosphatemia . DESIGN A quasi-experimental design . SETTING Three outpatient dialysis centers owned by the same corporation in 1 southern state . PATIENTS Based on a 3-month average serum phosphorus > 6.0 mg/dL , 70 patients were selected for participation ; 63 dialysis patients completed the study , 32 in the experimental group and 31 in the control group . INTERVENTION All patients completed a before- and -after knowledge test and had monthly blood sample s drawn . Each month , the same registered dietitian provided the routine laboratory results review with control group . The experimental group received the routine laboratory review plus 20 to 30 minutes of additional diet education specifically targeting phosphorus . Main outcome measures Before- and -after knowledge test results and baseline and final serum calcium , phosphorus , parathyroid hormone , and calcium/phosphorus product levels . RESULTS At baseline , there were no significant differences in any of the laboratory values , but the knowledge level of the experimental group was greater ( P < .05 ) After 6 months , gains in knowledge were significantly higher in the intervention group , and the serum phosphorus and calcium/phosphorus product levels were significantly lower ( P < .01 ) than in the control group . CONCLUSION Based on this research , those patients who received extra education monthly showed positive changes , which may be beneficial in reducing hyperphosphatemia OBJECTIVE To determine the effect of a tailored intervention on albumin levels among hemodialysis patients . DESIGN R and omized controlled trial . SETTING Eight freest and ing chronic hemodialysis units in northeast Ohio . SUBJECTS Eighty-three r and omly selected adult patients who had been on dialysis for at least 6 months and had a mean albumin < 3.7 g/dL ( bromcresol green method ) or < 3.4 g/dL ( bromcresol purple method ) for the last 3 months . To better eluci date the feasibility and outcomes of the intervention , we selected more intervention than control patients . INTERVENTION Dietitians of the 52 intervention patients determined whether any of the following potential barriers to adequate protein nutrition were present for each patient : ( 1 ) poor knowledge of protein-containing foods , ( 2 ) poor appetite , ( 3 ) needing help shopping or cooking , ( 4 ) low fluid intake , and ( 5 ) inadequate dialysis . Depending on the specific barriers present , the dietitians ( 1 ) educated patients on protein-containing foods , ( 2 ) recommended snacks for which patients had preserved appetite , ( 3 ) helped set up social supports , ( 4 ) provided recommendations on fluid intake , and /or ( 5 ) arranged for improved dialysis . Dietitians of the 31 control patients continued to provide usual care . MAIN OUTCOME MEASURES Change in albumin after 6 months , stratified as minimal change ( less than.25 g/dL increase or decrease ) , moderate improvement ( .25 to.49 g/dL increase ) , and large improvement ( increase of .50 g/dL or more ) . To examine the role of inflammatory states , we also determined serum C-reactive protein levels at the beginning and end of the trial . RESULTS Among intervention patients , 29 % had a minimal change in albumin , 44 % had a moderate improvement , and 27 % had a large improvement . Among control patients , 74 % had a minimal change in albumin , 19 % had a moderate improvement , and 6 % had a large improvement ( P < .001 for comparison of intervention and control subjects ) . About 60 % of subjects had high baseline C-reactive protein levels ( > 10 mg/L ) . However , there was little relationship between change in albumin and either baseline C-reactive protein levels or changes in C-reactive protein levels ( P = .83 ) . CONCLUSION A nutrition intervention tailored to patient-specific barriers result ed in improved albumin levels even among patients with high C-reactive protein levels . Further work is needed to refine and test this intervention on a larger sample OBJECTIVES The purpose of this study is to determine whether a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling could improve behavioural change , physical fitness , physiological condition and health-related quality of life of sedentary haemodialysis patients in The Netherl and s. METHODS Ninety-six haemodialysis patients of the Groningen Dialysis Center were r and omized into an exercise group ( n = 53 ) and a control group ( n = 43 ) . The exercise programme consists of cycling during dialysis together with a pre-dialysis strength training programme lasting 12 weeks . The intensity of the exercise programme is condition level 12 - 16 according to the rate of perceived exertion ( RPE ) . Motivational interviewing techniques were used for exercise counselling . Before and after the intervention , both groups were tested on behavioural change and physical fitness components such as reaction time , manual dexterity , lower extremity muscle strength and VO2 peak . Physiological conditions such as weight , blood pressure , haemoglobin and haematocrit values , cholesterol and Kt/V were obtained from the medical records . Health-related quality of life assessment included R AND -36 scores , symptoms and depression . RESULTS A group x time analysis with MANOVA ( repeated measures ) demonstrates that participation in a low-to-moderate intensity exercise programme linked with exercise counselling yields a significant increase in behavioural change , reaction time , lower extremity muscle strength , Kt/V and three components of quality of life , and no significant effects in the control group . CONCLUSION Participating in a low-to-moderate intensity pre-conditioning exercise programme showed beneficial effects on behavioural change , physical fitness , physiological conditions and health-related quality of life Patients with end-stage renal disease ( ESRD ) undergoing hemodialysis ( HD ) are typically sedentary and functionally limited as a consequence of their condition . The purpose of this study is to test the effect of a lifestyle physical rehabilitation program ( The Life Readiness Program ) on physical function in patients with ESRD undergoing HD .  Physical function was measured by the Kidney Disease Quality of Life Short Form ( KDQOL-SF ) physical function score ( range , 0 to 100 ) . Eighty-two patients were r and omly assigned to a 6-month rehabilitation program ( intervention ; n = 39 ) or to st and ard clinical management alone ( control ; n = 43 ) . The groups were frequency matched by age , sex , ethnicity , and diabetes as the cause of ESRD . General linear modeling of the change in physical function score was used for multivariate analysis . Physical function scores were not different between groups at baseline . Change in physical function score increased significantly in the intervention group compared with the control group when data were adjusted for the matching variables and adequacy of dialysis ( 3.2 , -3.6 ; P = 0.04 ) . Additionally , the control group reported more problems with work or daily functions because of emotional problems ( P : < /= 0.05 ) . In this brief 6-month intervention , The Life Readiness Program showed the therapeutic benefit of a  lifestyle rehabilitation program  on functional outcomes and health-related quality of life for patients with ESRD undergoing hemodialysis The purpose of the study is to investigate the effectiveness of an empowerment program on empowerment level , self-care self-efficacy and depression in patients with end-stage renal disease . The study was a r and omized controlled trial ; qualified patients in two dialysis centers of major hospitals in southern Taiwan were r and omly assigned into an empowerment group ( n=25 ) and a control group ( n=25 ) . The empowerment program included identification of problem areas for self-management ; exploration of emotions associated with these problems ; development of a set of goals and strategies to overcome these problems to achieve these goals ; creation and implementation of behavioral change plans ; and stress management . The outcomes measured were the Empowerment Scale , the Strategies Used by People to Promote Health and the Beck Depression Inventory . Data were collected at baseline and 6 weeks following intervention . Primary statistical analysis was by means of t-test and analysis of covariance . The results indicated that scores of the empowerment ( t(48)=6.54 , p<0.001 ) , self-care self-efficacy ( F(1,47)=10.82 , p=0.002 ) and depression ( t(48)=2.49 , p=0.03 ) in the empowerment group have a significantly greater improvement than the control group BACKGROUND Assessing health-related quality of life ( HRQOL ) can provide information on the types and degrees of burdens that afflict patients with chronic medical conditions , including end-stage renal disease ( ESRD ) . Several studies have shown important international differences among ESRD patients treated with hemodialysis  , but no studies have compared these patients ' HRQOL . Our goal was to document international differences in HRQOL among dialysis patients and to identify possible explanations of those differences . METHODS We examined data from the Dialysis Outcomes and Practice Patterns Study ( DOPPS ) , a prospect i ve , observational , international study of hemodialysis patients . We performed a cross-sectional analysis of DOPPS data from the United States , five countries in Europe ( France , Germany , Italy , Spain , and the United Kingdom ) , and Japan . Linear mixed models were used to analyze differences in HRQOL , using the KDQOL-SFTM . Norm-based scores were used to minimize cultural response bias . Linear regression analysis was used to adjust for confounding factors . Other variables included demographic variables , comorbidities , primary cause of ESRD , complications of ESRD and treatment , and socioeconomic status . RESULTS In all generic HRQOL subscales , patients on all three continents had much lower scores than their respective population norm values . Patients in the United States had the highest scores on the mental health subscale and the highest mental component summary scores .  Japanese patients reported better physical functioning than did patients in the United States or Europe , but they also reported the greatest burden of kidney disease . Overall , these differences remained even after adjusting for possible confounders . CONCLUSION On all three continents , ESRD and hemodialysis profoundly affect HRQOL . In the United States , the effects on mental health are smaller than in other countries . Japanese hemodialysis patients perceived that their kidney disease imposes a greater burden , but their physical functioning was significantly higher . Different distributions of socioeconomic factors and major comorbid conditions could explain little of this difference in physical functioning . Other possible factors , such as quality of dialysis and related health care , deserve careful study BACKGROUND Adhering to fluid restrictions represents one of the most difficult aspects of the hemodialysis treatment regimen . This report describes a r and omized controlled trial of a group-based cognitive behavioral intervention aim ed at improving fluid-restriction adherence in patients receiving hemodialysis . It was hypothesized that the intervention would improve adherence , measured by means of interdialytic weight gain ( IWG ) , without impacting negatively on psychosocial functioning . METHODS Fifty-six participants receiving hemodialysis from 4 renal outpatient setting s were r and omly assigned to an immediate-treatment group ( ITG ; n = 29 ) or deferred-treatment group ( DTG ; n = 27 ) . Participants were assessed at baseline , posttreatment , and follow-up stages . Treatment consisted of a 4-week intervention using educational , cognitive , and behavioral strategies to enhance effective self-management of fluid consumption . RESULTS No significant difference in mean IWGs was found between the ITG and DTG during the acute-phase analysis ( F(1,54 ) = 0.03 ; P > 0.05 ) . However , in longitudinal analysis , there was a significant main effect for mean IWG ( F(1.76,96.80 ) = 9.10 ; P < 0.001 ) and a significant difference between baseline and follow-up IWG values ( t55 = 3.85 ; P < 0.001 ) , reflecting improved adherence over time . No adverse effects of treatment were indicated through measures of psychosocial functioning . Some significant changes were evidence d in cognitions thought to be important in mediating behavioral change . CONCLUSION The current study provides evidence for the feasibility and effectiveness of applying group-based cognitive behavior therapy to enhance adherence to hemodialysis fluid restrictions . Results are discussed in the context of the study 's method ological limitations OBJECTIVE The objective was to determine the effect of a patient education intervention on decreasing serum phosphorus levels , increasing calcium levels , and increasing knowledge in hemodialysis patients with abnormally high phosphorus levels ( n = 29 ) . SAMPLE / SETTING Study subjects were ( a ) on hemodialysis at least 3 months , ( b ) English speaking , ( c ) mentally alert , ( d ) not under constant nursing care , and ( e ) hyperphosphatemic . The study was conducted at two suburban dialysis units in the Chicago Metropolitan area . DESIGN This study had a one group , pretest-posttest design , using subjects as their own controls . METHODS The intervention was a one-on-one education session performed by a nephrology nurse using a teaching booklet , an Osteodystrophy Tool , and a medication diary . RESULTS The mean change score for phosphorus did not reach significance ( t [ 28 ] = .68 , p = .50 ) . The change in mean phosphorus levels was not related to gender , education , or dialysis unit . There was a weak relationship between a decrease in phosphorus and an increase in knowledge about phosphorus ( r = 0.21 ) . However , calcium levels improved significantly after the teaching intervention ( t [ 28 ] = 3.23 , p = 0.003 ) . Mean overall scores for knowledge about phosphorus control increased significantly also ( t [ 28 ] = 2.60 , p = < 0.01 ) . CONCLUSION The findings of this study demonstrated that an education session can have an effect on patients ' knowledge and compliance OBJECTIVE To determine the effect of a dietetic educational intervention on phosphate and calcium levels of hemodialysis patients . DESIGN Parallel-group r and omized controlled trial . SETTING Teaching hospital hemodialysis unit in London , Engl and . PATIENTS Fifty-six stable adult hemodialysis patients with hyperphosphatemia . INTERVENTION An educational intervention and one-to-one teaching session given by a renal dietitian , attempting to improve patients ' knowledge of phosphate management and their compliance with diet and medication . OUTCOME MEASUREMENT Patients ' serum phosphate , calcium , and calcium x phosphate products in the 3 months after the intervention , compared with those before the intervention . Results were also compared with a control group that had not undergone the intervention . RESULTS In the intervention group , serum phosphate was significantly reduced after the education session , as compared with the results previously . In the control group , there was no significant change in serum phosphate level . The improved results were sustained over a period of 3 months . Serum calcium increased in the intervention group , but this result was not significant . There was an improvement in the calcium-phosphate product in the intervention group , but again this was not significant . CONCLUSION Dietetic educational intervention can favorably alter patients ' serum phosphate levels , with potential impact on morbidity and mortality BACKGROUND Patients with end-stage renal disease often fail to follow a prescribed diet and fluid regimen , which undermines the effectiveness of care and leads to unpredictable progression of the disease and greater likelihood of complications . AIM The purpose of this r and omized controlled study was to examine the effectiveness of self-efficacy training on fluid intake compliance . METHODS This study took place in northern Taiwan . Eligible patients were receiving routine haemodialysis ; 20 - 65 years of age ; living in a community setting ; able to read and write ; and willing to participate . Sixty-two end-stage renal disease patients participated in the study . Those in the experimental group ( n = 31 ) received 12 sessions of structured self-efficacy training ; the control group patients ( n = 31 ) received only routine care . The intervention was based on B and ura 's theory and included an educational component , performance mastery , experience sharing , and stress management . The outcome measure was the mean body weight gain between dialysis sessions . Data were collected at baseline , 1 , 3 and 6 months following the intervention and analysed by a descriptive and repeated- measures anova . RESULTS Experimental group mean weight gains decreased gradually following self-efficacy training . However , control group mean weight gains decreased only slightly over time . These results were statistically significant when baseline differences controlled for ( P < 0.05 ) . CONCLUSIONS The study supports the effectiveness of the self-efficacy training in controlling mean body weight gains of end-stage renal disease patients receiving haemodialysis BACKGROUND Anxiety is a complicating comorbid diagnosis in many patients with medical illnesses . In patients with end-stage renal disease ( ESRD ) , anxiety disorders often are perceived to represent symptoms of depression rather than independent conditions and therefore have been relatively understudied in this medical population . STUDY DESIGN To evaluate the psychosocial impact of anxiety disorders on patients with ESRD , we sought to identify the rates of these disorders in a sample of patients receiving hemodialysis at a single center by using a structured clinical interview . We also compared a commonly used screening measure , the  Hospital Anxiety and Depression Scale  ( HADS ) , with these clinical diagnoses to determine the measure 's criterion validity or ability to predict a psychiatric diagnosis in ESRD population s. Finally , we examined the relationship between anxiety diagnosis and perceptions of quality of life ( QOL ) and health status . SETTING & PARTICIPANTS A sample of 70 r and omly selected hemodialysis patients from an urban metropolitan center . PREDICTOR Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) Axis I Diagnosis ( SCID-I ) . OUTCOMES HADS and Kidney Disease Quality of Life Short Form . RESULTS Using the SCID , 71 % of the sample received a DSM-IV Axis I diagnosis , with 45.7 % of subjects meeting criteria for an anxiety disorder and 40 % meeting criteria for a mood disorder . The concordance between DSM-IV anxiety disorders and anxiety scores acquired by using the HADS was not significant . Thus , although the HADS may provide an acceptable measure of overall " psychic distress " compared against the SCID-I , it has poor predictive power for anxiety diagnoses in patients with ESRD . Additionally , the presence of an anxiety disorder was associated with an overall perceived lower QOL ( t = 2.4 ; P < 0.05 ) . LIMITATIONS Single-center study and a population not representative of US demographics . CONCLUSIONS A substantial proportion of participating patients met criteria for an anxiety disorder . The utility of the HADS as a screening tool for anxiety in patients with ESRD should be question ed . The finding that anxiety disorders negatively impact on QOL and are not merely manifestations of depression in patients with ESRD emphasizes the importance of accurate diagnosis and effective treatment . Strategic options are necessary to improve the diagnosis of anxiety disorders , potentially enhancing QOL and medical outcome in patients with ESRD OBJECTIVE Assess the effectiveness of a self-monitoring tool on perceptions of self-efficacy , health beliefs , and adherence in patients receiving hemodialysis . DESIGN A monthly intervention using a pretest , posttest design over a 6-month period . Both the treatment and control groups were r and omly selected and received surveys to assess health beliefs , perceptions of self-efficacy for performing specific healthful behaviors , and renal diet knowledge at baseline , before intervention , and 6 months later . The treatment group also received monthly feedback of monthly phosphorus levels and interdialytic weight gains . SETTING A university hospital-based 43-chair ambulatory dialysis center . SUBJECTS Forty patients with end-stage renal disease ( 25 men and 15 women , age 26 to 78 years ) , on chronic hemodialysis for at least 2 months and with a history of noncompliance with phosphorus and /or fluid restrictions for 1 or more months . MAIN OUTCOME MEASURES Self-efficacy , health beliefs , knowledge , biochemical , and demographic variables were analyzed . Analysis of variance tests of repeated measures were used to examine relationships between adherence with phosphorus and fluid restrictions to health beliefs and perceptions of self-efficacy after training in self-monitoring . RESULTS Overall , there were no significant improvements in adherence with phosphorus and fluid restrictions between the two groups , although a comparison within the groups revealed the treatment group had a statistically significant decrease in mean phosphorus levels of 7.14 to 6.22 mg/dL ( P = .005 ) from baseline to month 3 . However , because this value was not maintained , it was not statistically significant . No significant differences existed between the two groups for health beliefs and perceptions of self-efficacy . Knowledge scores in the treatment group , however , improved significantly as compared to the control group ( P = .008 ) and was a significant increase from baseline ( P = . 002 ) . In the control group , all scores fell slightly but this difference was not significant . CONCLUSIONS The benefits of patient self-monitoring and behavioral contracting upon adherence in patients on hemodialysis are inconclusive , as serum phosphorus and interdialytic weight gains did not differ between the two groups . The interventional tools also appeared to have little effect on perceptions of self-efficacy and health beliefs . Trends of improvement , however , did exist for phosphorus within the treatment group and subjects in this group had a statistically significant increase in knowledge scores over time . Additional research using repeated measures design is needed to explore the effects of increased frequency and duration of an intervention on the attainment of patient clinical outcome measures BACKGROUND Nonadherence  among hemodialysis patients compromises dialysis delivery , which could influence patient morbidity and mortality . The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) provides a unique opportunity to review this problem and its determinants on a global level . METHODS Nonadherence was studied using data from the DOPPS , an international , observational , prospect i ve hemodialysis study . Patients were considered nonadherent if they  skipped one or more sessions per  month , shortened one or more sessions by more than 10 minutes per month , had a serum potassium level openface>6.0 mEq/L , a serum phosphate level openface>7.5 mg/dL ( > 2.4 mmol/L ) , or interdialytic weight gain (IDWG)>5.7 % of body weight . Predictors of nonadherence were identified using logistic regression . Survival analysis used the Cox proportional hazards model adjusting for case-mix . RESULTS Skipping treatment was associated with increased mortality [ relative risk ( RR ) = 1.30 , P = 0.01 ] , as were excessive IDWG ( RR = 1.12 , P = 0.047 ) and high phosphate levels ( RR = 1.17 , P = 0.001 ) . Skipping also was associated with increased hospitalization ( RR = 1.13 , P = 0.04 ) , as were high phosphate levels ( RR = 1.07 , P = 0.05 ) . Larger facility size ( per 10 patients ) was associated with higher odds ratios ( OR ) of skipping ( OR = 1.03 , P = 0.06 ) , shortening ( OR = 1.03 , P = 0.05 ) , and IDWG ( OR = 1.02 , P = 0.07 ) . An increased percentage of highly trained staff hours was associated with lower OR of skipping ( OR = 0.84 per 10 % , P = 0.02 ) ; presence of a dietitian was associated with lower OR of excessive IDWG ( OR = 0.75 , P = 0.08 ) . CONCLUSION Nonadherence was associated with increased mortality risk ( skipping treatment , excessive IDWG , and high phosphate ) and with hospitalization risk ( skipping , high phosphate ) . Certain patient/facility characteristics also were associated with nonadherence Functional capacity of end-stage renal disease patients is dramatically impaired . Although exercise training programs appear to have beneficial morphological , functional and psychosocial effects in end-stage renal disease patients on hemodialysis ( HD ) , the adherence rate is high . The purpose of this study was to compare the effects of three modes of exercise training on aerobic capacity and to identify the most favourable , efficient and preferable to patients on HD with regard to functional improvements and participation rate in the programs . Fifty-eight volunteer patients were screened for low-risk status and selected from the dialysis population . The 48 patients who completed the study protocol were r and omly assigned either to one of the three training groups or to a control group .  Sixteen of them ( Group A - mean age 46.4+/-13.9 years ) completed a 6-month supervised outpatient exercise renal rehabilitation program consisting of three weekly sessions of aerobic and strengthening training on the non-dialysis days ; 10 ( Group B - mean age 48.3+/-12.1 years ) completed a 6-month exercise program during HD ; 10 ( Group C - mean age 51.4+/-12.5 years ) followed an unsupervised moderate exercise program at home , and 12 patients ( Group D-mean age 50.2+/-7.9 years ) were used as patient controls . The level of anemia , the medications and the HD prescription remained stable during the study . Fifteen sex- and age-matched sedentary individuals ( Group E - mean age 46.9+/-6.4 years ) comprised a healthy control group for baseline data . All subjects at the beginning and end of the study underwent clinical examination , laboratory tests and a treadmill exercise test to fatigue endpoints with direct measurement of aerobic capacity . Group A had a higher dropout rate ( 24 % ) compared to groups B ( 17 % ) and C ( 17 % ) . Peak oxygen consumption ( VO2 peak ) increased by 43 % ( p < 0.05 ) , anaerobic threshold ( VO2AT ) by 37 % ( p < 0.05 ) and exercise time by 33 % ( p < 0.05 ) after training in Group A ; by 24 % ( p < 0.05 ) , 18 % ( p < 0.05 ) and 22 % ( p < 0.05 ) , respectively , in B ; and by 17 % ( p < 0.05 ) , 8 % ( p < 0.05 ) and 14 % ( p < 0.05 ) , respectively , in C ; while both remained almost unchanged in Group D. These results demonstrate that intense exercise training on non-dialysis days is the most effective way of training , whereas exercise during HD is also effective and preferable AIM This paper is a report of a study conducted to determine the effect of an educational intervention on dietary and fluid compliance in patients having haemodialysis . BACKGROUND Many of the clinical problems experienced by patients having haemodialysis are related to their failure to eat appropriate foods and restrict their fluid intake . Educational intervention in patients having haemodialysis to improve their compliance with dietary and fluid restrictions appears to be effective . METHODS Sixty-three patients having haemodialysis in three general hospitals in Tehran , Iran , were allocated into two groups at r and om for oral and /or video education . They were asked to give demographic and medical data . Bimonthly average values of serum potassium , sodium , calcium , phosphate , albumin , creatinine , uric acid , and blood urea nitrogen and interdialytic weight gain were measured before and after the teaching programmes . The data were collected in 2007 . FINDINGS Compliance in terms of biochemical parameters and interdialytic weight gain was observed in 63.5 % and 76.2 % of patients in the oral and video teaching groups respectively . Statistically significant correlations were observed between demographic variables ( age , educational level and occupation ) and dietary and fluid compliances ( P < 0.001 ) . There was no difference between the effectiveness of two educational interventions . CONCLUSION Nurses should emphasize sodium compliance in patients having haemodialysis and explain its adverse effects , such as excessive weight gain , hypertension , and peripheral oedema This study examined the effects of a  hemodialysis educational and support program ( HESP )  on patients ' physical and psychosocial adaptations to end stage renal disease . The study employed a pretest/posttest modified Solomon experimental design with control group . Data were collected at 3-month intervals following the educational intervention . Results of the study indicated that nurses can have an impact on the patient learning experience by providing support and one-to-one teaching sessions , and actively involving patients in their own care . Additionally , nurses can facilitate active patient learning through enhanced teaching methods BACKGROUND The present pilot study assesses a programme of verbal and written fluid balance advice within an out-patient haemodialysis unit . METHODS Twenty-one haemodialysis patients were followed over three separate 6-week periods . Each 6-week period assessed dietetic and nursing educational input using a stepped approach with interdialytic weight gain ( IDWG ) as a barometer of patient compliance . Weight gain was statistically examined using the non-parametric Friedman test . RESULTS Forty-eight per cent of the sample group demonstrated an overall improvement in mean weight gain ; however , this was not statistically significant ( P=0.504 ) . CONCLUSION The pilot study suggests that further studies with greater numbers and a control group would have a useful contribution to make in this field Background . Hemodialysis and phosphate ( P ) binder therapy are the major methods to reduce the phosphate level in dialysis patients . However , dietary P restriction is necessary for adequate control . The successful dietary control is based on patient compliance . Patient education is the best method to assure the knowledge and drive of dietary control , which are the key features for patient compliance . The aim of the study is to investigate quantitatively the effect of patient education on serum P levels in hyperphosphatemic hemodialysis patients . Methods . We conducted a prospect i ve self-control study . Fifty hemodialysis patients with a pre-dialysis serum P level greater than 6.0 mg/dL were studied .  Intensified patient education was given . Serum P , calcium ( Ca ) , and intact parathyroid hormone ( iPTH ) were evaluated before and one month after patient education . Results . Thirty-six ( 72 % ) patients had improved pre-dialysis P level ( pre-education : 7.50 ± 1.33 ; post-education : 5.85 ± 1.20 mg/dL , p < 0.001 ) and Ca × P product ( pre-education : 68.17 ± 12.70 ; post-education : 54.70 ± 11.87 mg2/dL2 , p < 0.001 ) . The effect lasted for at least three months . There is no significant change on calcium levels . The only predictor of a successful patient education is the iPTH level ( improved : 348.8 ± 277.6 ; non-improved : 668.0 ± 674.1 ng/mL , p = 0.021 ) . Conclusions . Patient education could be helpful and efficient in hyperphosphatemic control in dialysis patients . The patient education should be given before the serum iPTH level getting high
OBJECTIVE This review examined the impact of  Therapeutic Patient Education ( TPE ) programs in hemodialysis and the assessment of these programs .
TPE is a global management method based on both the physiological and the psychological well-being of the patient .