Psycho-Dietary Adaptation Among End Stage Renal Disease Clients On Hemodialysis At Kenyatta National Hospital

Abstract

Background: Hemodialysis care requires events of adjustment in dietary options that must be adhered to. The diagnosis of end stage renal disease (ESRD) or renal failure disease and initiation of hemodialysis care influences the psychological status of clients. The level of adaptation will influence the success in haemodialysis care. Poor adaptation results in non-adherence and poor outcome in haemodialysis care or renal disease care or management. Therefore there is a need to investigate how clients with kidney Failure disease adapt psychologically, nutritionally and to determine their anthropometric measurements to hemodialysis treatment. Objectives: To assess psychological and dietary adaptation, and to determine anthro among clients with End stage renal disease on haemodialysis at Kenyatta national hospital renal unit. Methods: Descriptive prospective study was used for this study. Purposive sampling was adopted for this study and a sample size of 83 was obtained. Data was collected by use of structured questionnaires with in-depth interview .Hospital anxiety depression scale (HADS-A) standard tool was used to assess psychological adaptation .The anthropometric measurements were taken that is height and weight for body mass index (BMI) for first contact and second BMI repeated after three weeks. The chemical biomarkers total protein and haemoglobin data was obtained from participants file. Eighty three participants were sampled in renal unit. The quantitative results were analyzed by SPSS software and for qualitative data the results were analyzed by NVIVO software. Continuous data was analysed using t-test; categorical data was analysed using chi-square. Results: Using cut offs of the summative scores for Hospital anxiety Depression subscale (HADS-D) items, the prevalence of anxiety among respondents was 89 % (n=74) .The prevalence of depression was 84% (n=74). There was significant association between depression and Religion (p= 0. 046). There was a significant association between protein level and age (p = 0.006). There was a significant association between BMI and duration since dialysis was initiated (p = 0.039). There was a significant reduction in BMI during second assessment conducted after three weeks with mean BMI at 21.9 (SD 4.1), (t = 4.64, DF = 78, p < 0.001).There was a significant correlation between protein and haemoglobin levels. There was a positive correlation between haemoglobin and protein (Pearson‟s‟ correlation coefficient, rho = 0.312). The haemoglobin levels increased by 0.3 units for each unit increase in protein level (p = 0.005). xvi Conclusion: The study has indicated that respondents with end stage renal disease undergoing hemodialysis experience high prevalence of depression and anxiety; they are not adapted nutritionally as indicated by chemical biomarkers and history from respondents, and have significant derangements in anthropometric indices. Recommendation:  There is need to enhance counselling process for clients with ESRD on Psychological care, that is counselling before and during hemodialysis.  Continuous monitoring of hemodialysis clients of their mental state using hospital anxiety depression scale assessment (HADS-A) or the hospital can develop their own tool should be enhanced.  The nutrionist should be in cooperated in the management of clients undergoing hemodialysis to give individual advice on nutritional requirements.  The anthropometric measurements monitoring should be done regularly with the feedback of this information given to the patients alongside implementation of corrective actions in cases where changes are noted