Kidney Week

Abstract: TH-PO301

Self-Management Barriers in Patients on Dialysis: A Potential Target for Improving Clinical and Patient-Reported Outcomes

Session Information

• Hemodialysis and Frequent Dialysis - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Driehuis, Esmee, Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands

Esmee Driehuis, MS, MSc

• Meuleman, Yvette, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands

Yvette Meuleman, PhD

• Bonenkamp, Anna A., Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands

Anna A. Bonenkamp, MD

• Dekker, Friedo W., Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands

Friedo W. Dekker, PhD

• Abrahams, Alferso C., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands

Alferso C. Abrahams, MD, PhD

• van Jaarsveld, Brigit C., Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands

Brigit C. van Jaarsveld, MD, PhD

Group or Team Name

• DOMESTICO Study Group.

Background

Self-management skills are important to dialysis patients, as they may lead to better health outcomes. However, knowledge is lacking on self-management barriers in these patients, hereby impeding identification of patients in whom self-management may be improved and how these barriers impact health. Thus, we aimed to 1) identify self-management barriers in dialysis patients, 2) assess their relation to patient characteristics and 3) assess their effect on clinical and patient-reported outcomes.

Methods

Patients from the DOMESTICO study, a cohort study in adult incident dialysis, who filled in the Self-Management Screening questionnaire were included. Descriptives of self-management barriers were reported. We determined the barriers’ associations with sex, age, educational level, cohabitation, modality (hemodialysis [HD] vs. peritoneal dialysis [PD]) and multimorbidity using point bi-serial correlations. Effects of self-management barriers on health outcomes at 6 and 12 months were investigated using linear and quasi-binomial regression with adjustment for confounding.

Results

In 1518 patients, the presence of self-management barriers varied widely. For instance, most felt confident in their own abilities (self-efficacy; 84.3%), while only 43.6% reported good problem-solving coping skills. Many patient characteristics were related to self-management barriers. For example, age was associated with almost all barriers, PD patients were more willing to perform self-care (r 0.23, 95%CI 0.18;0.28), and patients with more comorbidities were less willing (-0.09, -0.14;-0.04). At 6 months, in patients with more barriers, diastolic blood pressure (DBP) was lower (β -0.51, 95%CI -0.81;-0.20), interdialytic weight gain (IDWG) was higher (0.03, 0.01;0.05), symptom burden was higher (1.99, 1.45;2.55), physical health-related quality of life (HRQoL) was lower (-0.81, -1.04;-0.57) and mental HRQoL was lower (-1.14, -1.38;-0.90). Except for IDWG, these effects persisted at 12 months.

Conclusion

We identified important self-management barriers in incident dialysis patients and their relation to patient characteristics. These barriers impact patients’ DBP, IDWG, symptom burden and HRQoL, hence they may be a potential target to improve clinical and patient-reported outcomes.

Funding

• Commercial Support – Fresenius Medical Care Deutschland GmbH, Baxter, Dirinco, AstraZeneca, Cablon Medical, Eurocept Homecare, Novartis, CSL Vifor, Bayer, Alnylam