Knowledge, Practice, Barriers and Enablers of Pre-dialysis Care Among Health Service Providers at the Kenyatta National Hospital Kenya

Abstract

Introduction- Pre-dialysis care is offered during the period of transition of chronic kidney disease (CKD) to end stage kidney disease (ESKD). Lower mortality has been reported on patients who receive pre-dialysis care as opposed to those who do not. Globally, pre-dialysis care is wanting with developed countries like USA still reporting challenges on pre-dialysis care. In Kenya, Kenyatta National Hospital (KNH), more than 50% of patients are started on kidney replacement therapy (KRT) without any counseling done inferring that pre-dialysis care practice is not well adhered to by the health service provider (Kabinga et al., 2019) Broad objectives: This study was mainly to determine the level of knowledge, practice, barriers and enablers of pre-dialysis care among health service providers (HSP) at KNH. Methodology: A cross section study design was used. Data collection was by a pretested questionnaire. Knowledge score was generated and Bloom's modified cut-off points was used to rank the knowledge. Factors associated with knowledge of pre-dialysis care were assessed using binary logistic regression and presented using odds ratios and p-values. Factors that had p values less than 0.25 in the bivariable analysis were selected for the multivariable analysis. Significance of the tests was interpreted at 5% significance level using p values and odds ratios. Quantitative data was analyzed using R version 4.1.2. One focused group discussion (FGD) session was conducted to support quantitative data. Focused group discussion session was audio recorded and later transcribed and analyzed using NVivo 14. Coding for the themes and subthemes was done and findings presented in narrative form together with the reports from the respondent in quotation marks. Results: The response rate was at 100 % (n=97) with the most of the respondents being nurses at 69% (n=67). Most of the participants were aged between 29 to 38 and in terms of sex female were the majority with 50.5% (n=49). Good knowledge of pre-dialysis was at 37.1 % (n=36) while 52.6% (n=51) of HSP had a fair knowledge. Only 10.3% (n=10) had poor knowledge among the respondents. In practice, more than 70 % (n=60) of end stage kidney disease patients are started on dialysis as an urgent intervention to save their live. Only 14.5% (n=12) of dialysis sessions were planned before initiation. Some of the barriers to pre-dialysis reported were shortages of HSP and lack of pre-dialysis care guideline. Supportive environment was identified as the enabler of pre-dialysis care. The response rate for FGD was 100 % (n=5). After analysis, four themes were developed; Care given before initiation of dialysis, inadequate knowledge of pre-dialysis among nurses and nutritionists, Shortage of resources and Supportive environment. Conclusions: Pre-dialysis care knowledge at KNH is average with less than forty percent of HSP having good knowledge. Most patients are started on dialysis as urgent measures to save their life. Shortage of HSP, lack of guideline and inadequate knowledge are the main barriers of pre-dialysis care while the main enabler is the supportive environment. Recommendations: Development of a pre-dialysis clinical practice guideline, continuous medical education on pre-dialysis care, formulation of a committee that will ensure patients are enrolled in pre-dialysis care and finally KNH to continue identifying and mitigating pre-dialysis care barrier