Factors Associated With Nutrition Therapy Related Challenges and Support Needs for Patients With End Stage Kidney Disease Undergoing Hemodialysis at Kenyatta National Hospital

Abstract

Background: Nutritional challenges in end-stage kidney disease (ESKD) is a common occurrence experienced by patients on hemodialysis. Protein-energy wasting is the depletion of protein/energy stores seen in an advanced stage of Chronic Kidney Disease (CKD), and it is linked to poor clinical results, high morbidity and mortality rates, and higher healthcare expenses. Nutritional guidance for those with CKD/ESKD can be complex, and successful dietary management involves careful planning, periodic nutritional assessments, and dietary compliance and monitoring. The majority of patients with ESKD on dialysis at KNH have been reported to be nutritionally challenged and subsequently referred for nutritional counselling and follow up. Aim of the study: To establish nutrition and therapy related challenges and support needs for patients with end-stage kidney disease undergoing hemodialysis at Kenyatta National Hospital. Materials and Methods: This was a descriptive study. Simple random sampling was used to recruit patients into the study. The study was conducted in the Renal Unit of Kenyatta National Hospital where review of patients’ medical files, anthropometric examination and interviewing was used to screen ESKD patients undergoing HD at KNH. The collected quantitative data was entered into Epidata and then exported into SPSS version 24 for analysis. The data was analysed both descriptively using frequencies, percentages and using logistic regression. Results: The findings established that 59.1% of the patients were male. The average age was 45.39 (SD±16.03) years, 43.9% had secondary level of education. Patient’s awareness on commonly recommended diet showed that majority of patients were taking carbohydrates and vegetables 86.4%, low fluid diet 77.3%, low potassium diet 66.7% and low salt intake diet 63.6%. The findings established that 51.5% of the patients were having difficulties in following the recommended diet. Common challenges limiting patients from following the recommended diet include financial challenges 51.5%, food unavailability 47%, personal food preferences 37.9% and feeding complications 27.3%. On investigating therapy related challenges, 31.8% of the patients affirmed to having missed their medication with 66.7% citing high cost of medication. Assessment of bio-clinical nutritional related factors established that 42.4% of the patients had malnutrition. The results also showed that 87.9% of the patients were anaemic. In investigating the body mass index, 83.3% of the patients had normal weight. The findings also established that being a male patient (OR =3.33, 95% CI: 1.15 – 9.68, p =0.042), having formal employment (OR =0.26, 95% CI: 0.07 – 0.97, p=0.045) and being single (OR =3.51, 95%CI: 1.56 – 5.88, p<0.001) were associated with malnutrition. Conclusion and recommendations: Poor adherence to recommended diet and high cost of medication were major factors contributing to nutritional challenges. Therefore, there is need for healthcare providers to conduct regular nutrition counselling to patients and their caregivers and the government should also consider expanding NHIF coverage to incorporate medication as well as consultation