Experience of Managing ESRD Dietary Modications

血液透析、腹膜透析和肾移植是终末期肾病（ESRD）患者的唯一治疗选择。尽管白人占ESRD患者的大多数，但非洲裔美国人和社会经济地位较低的个体（SES）的生存率不成比例地较差。自我管理饮食钠和液体限制是至关重要的，以确保积极的 需要血液透析的ESRD患者的健康结局，尽管不容易实现。针对如何帮助非裔美国人/低SES患者实现这些目标的研究主要集中在液体限制，而不是饮食钠限制，很少有人探讨社会人口因素如何影响饮食调整的成功。基于这些观察结果，本混合方法研究的目的是探索社会人口统计学和经济特征对试图达到血液透析饮食目标的饮食模式的影响。具体目标是：1.充分探索不同血液透析患者人群在尝试遵循血液透析饮食时所感知的问题和障碍，特别关注非裔美国人/低SES患者; 2.描述血液透析患者的饮食模式（特别是钠摄入量）和IDWG模式;以及3.探索饮食变化、透析间期体重增加（IDWG）、经历的问题、障碍和自我效能感与社会人口学和经济特征之间的关联。受试者将是从匹兹堡大学医学中心肾脏网络招募的患者，这些患者至少年满18岁，居住在社区，并接受至少3个月的维持透析治疗。排除标准为：不能读或写;不会说英语、打算在6个月内更换透析中心、身患绝症或预期寿命不到12个月、计划接受活体供体移植、缺乏饮食决策权。研究定量部分的受试者将是入组正在进行的R 01（NR 010135）的受试者。定性部分的受试者将使用有目的和理论抽样从完成定量测量的受试者中选择。拟议的研究将是少数几个全面检查患者对透析饮食调整的看法的研究之一，重点是社会人口统计学差异。这项研究将提供必要的证据，帮助患者实现饮食目标。在修改后的模型的指导下，该研究将使用混合方法设计，以允许研究人员利用患者在标准化工具和每个患者独特的饮食体验的探索访谈中表达的经验。 公共卫生相关性：慢性肾脏病和终末期肾脏病（ESRD）是全球健康问题。通过促进实现膳食钠摄入和液体限制目标的行为的干预措施，可能会改善患者的预后。很少有研究探讨ESRD患者在减少膳食钠摄入方面面临的挑战，也没有发现社会人口统计学和经济特征对饮食模式的影响。

Hemodialysis, peritoneal dialysis, and kidney transplant are the only treatment options available for patients with end-stage renal disease (ESRD). Despite the fact that Caucasians comprise the majority of ESRD patients, African Americans and individuals of lower socioeconomic status (SES) have disproportionately poorer survival. Self-management of dietary sodium and fluid restriction are critical to ensuring positive health outcomes for ESRD patients requiring hemodialysis, though not easily achieved. Studies targeting ways to assist African American/low SES patients to achieve these goals primarily focus on fluid restriction, rather than dietary sodium restriction, and few have explored how sociodemographic factors influence dietary modification success. Building on these observations, the purpose of this mixed-methods study is to explore the impact of sociodemographic and economic characteristics on dietary patterns when attempting to meet dietary goals for hemodialysis. The specific aims are to: 1. fully explore the problems and barriers perceived by a diverse hemodialysis patient population in their attempts to follow the hemodialysis diet, with specific attention to African American/low SES patients; 2. describe dietary patterns (in particular sodium intake) and patterns of IDWG among hemodialysis patients; and 3. explore associations between variations in diet, interdialytic weight gain (IDWG), problems experienced, barriers and perceived self-efficacy and sociodemographic and economic characteristics. Subjects will be patients recruited from University of Pittsburgh Medical Center Renal Network who are: a minimum of 18 years of age, community dwelling, and on maintenance dialysis therapy for at least 3 months. Exclusion criteria are: inability to read or write; non-English speaking, intent to change dialysis center within 6 months, terminal illness or life expectancy of less than 12 months, planned receipt of living donor transplant, and lack of authority in dietary decision making. Subjects in the quantitative portion of the study wil be participants enrolled in an ongoing R01 (NR010135). Subjects in the qualitative portion will be selected using purposive and theoretical sampling from the participants who completed quantitative measures. The proposed study will be one of few to comprehensively examine patient's perceptions of dialysis dietary modification with emphasis on sociodemographic variations. The study will provide the essential evidence needed to assist patients to achieve dietary goals. Guided by a modified model, the study will use a mixed methods design to permit the researcher to capitalize on patient experiences expressed in both standardized instruments and probing interviews of each patient's unique dietary experience. PUBLIC HEALTH RELEVANCE: Chronic Kidney Disease and ultimately, end stage renal disease (ESRD) is a global health concern. Improved patient outcomes can potentially be achieved through interventions that promote behaviors that achieve dietary sodium intake and fluid restriction goals. Few studies have explored challenges faced by ESRD patients in terms of reduction in dietary sodium intake and none were identified that addressed the influence of sociodemographic and economic characteristics on dietary patterns.