FLUID COMPLIANCE IN HEMODIALYSIS PATIENTS

液体顺应性对血液透析患者的持续健康和福祉至关重要。这些患者必须限制他们的液体摄入，以提高生活质量，避免严重的医疗并发症或过早死亡。然而，在这一人群中，液体不依从性的比率很高。大多数研究认为液体顺应性是一个二分变量，个体要么顺从，要么不顺从。然而，文献表明，改变的阶段可能被用来以更完整的方式对行为进行分类。此外，在进行干预以促进复杂的行为改变时，注意不同阶段的明显差异可能是重要的。具体地说，在血液透析患者的情况下，确定与液体顺应性有关的阶段差异对于制定干预措施以改善这种顺应性非常重要。这项拟议研究的中心目的是确定与血液透析患者液体顺应性阶段相关的因素。要探索的因素包括认知功能(注意力、语言、结构、记忆、计算和抽象推理)、感知(益处、障碍、严重性、易感性和自我效能)、自我护理策略(减少液体摄入和解渴策略的使用和感知有效性)、口渴、生理变量(血红蛋白、血清白蛋白、血清葡萄糖、透析充分性和合并症)以及人口变量(年龄和性别)。样本将是230名接受门诊血液透析治疗的成年人。将在四个月的间隔内收集两次数据，以(A)描述流体顺应性阶段的分布以及流体顺应性阶段随时间的变化程度，以及(B)确定与流体顺应性阶段相关的因素以及四个月期间流体顺应性阶段的变化(如果存在变化)。参与者年龄为18岁或以上，警觉和导向，会说英语，独立居住在社区，并接受门诊血液透析作为终末期肾病的永久性治疗方式。将与每个参与者进行面对面的访谈，以收集有关液体顺应性、认知功能、知觉、口渴和自我护理策略的数据。化验值和透析前和透析后体重将从临床记录中获得。有关合并症的数据将从主治医师或护士处获得。建议的研究为期24个月。天平的改进将先于所有其他数据分析。将使用非参数和单变量统计方法来分析数据。以前没有研究在血液透析患者的液体顺应性阶段中同时调查所有这些重要变量。研究结果将大大提高对血液透析患者液体顺应性的了解，这是开发有效干预措施所必需的。

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.