FLUID COMPLIANCE IN HEMODIALYSIS PATIENTS

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Fluid compliance is critically important to the continued health and well- being of hemodialysis patients. These patient must limit their fluid intake in order to improve quality of life and to avoid severe medical complications or premature death. There is, however, high rates of fluid noncompliance in this population. Most studies have considered fluid compliance to be a dichotomous variable, with individuals either compliant or noncompliant. The literature, however, suggests that stages of change may be used to categorize behaviors in a more complete way. Moreover, when intervening to promote complex behavior change, attending to the distinct differences in the stages may be important. Specifically, in the context of hemodialysis patients, identifying stage differences in relation to fluid compliance is important for developing interventions to improve such compliance. The central aim of the proposed study is to identify factors associated with stage of fluid compliance in hemodialysis patients. The factors to be explored include cognitive functioning (attention, language, construction, memory, calculations, and abstract reasoning), perceptions (benefits, barriers, seriousness, susceptibility, and self- efficacy), self-care strategies (use and perceived effectiveness of strategies to reduce fluid intake and relieve thirst), thirst, physiological variables (hemoglobin, serum albumin, serum glucose, adequacy of dialysis, and comorbid conditions), and demographic variables (age and gender). The sample will be 230 adults who receive out-patient hemodialysis therapy. Data will be collected two times over a four-month interval to (a) describe the distribution across stage of fluid compliance and the extent to which stage of fluid compliance changes over time and (b) identify the factors that are associated with stage of fluid compliance and the change in stage of fluid compliance over a four-month period, if a change exists. The participants will be 18 years of age or older, alert and oriented, English speaking, residing independently in the community, and receiving out-patient hemodialysis as their permanent end-stage renal disease treatment modality. Face-to-face interviews will be conducted with each participant to collect data on stage of fluid compliance, cognitive functioning, perceptions, thirst, and self-care strategies. Laboratory values and pre- and post-dialysis weights will be obtained from the clinical record. Data on comorbid conditions will be obtained from the attending nephrologist or nurse practitioner. The duration of the proposed study is 24 months. Refinement of scales will precede all other data analyses. Nonparametric and univariate statistical methods will be used to analyze the data. No previous studies have investigated all of these important variables together within the context of stage of fluid compliance in hemodialysis patients. Findings will greatly increase the understanding of fluid compliance in hemodialysis patients that is needed for the development of effective interventions.