Your browser doesn't support javascript.
loading
Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis.
Griva, Konstadina; Nandakumar, Mooppil; Ng, Jo-An H; Lam, Kevin F Y; McBain, Hayley; Newman, Stanton P.
Afiliação
  • Griva K; Department of Psychology, National University of Singapore, Singapore; School of Health Sciences, City, University of London, London, United Kingdom. Electronic address: konstadina.griva@ntu.edu.sg.
  • Nandakumar M; National Kidney Foundation, Singapore.
  • Ng JH; Department of Psychology, National University of Singapore, Singapore.
  • Lam KFY; Department of Psychology, National University of Singapore, Singapore.
  • McBain H; School of Health Sciences, City, University of London, London, United Kingdom; Community Health Newham, East London NHS Foundation Trust, London, United Kingdom.
  • Newman SP; School of Health Sciences, City, University of London, London, United Kingdom.
Am J Kidney Dis ; 71(3): 371-381, 2018 03.
Article em En | MEDLINE | ID: mdl-29198641
BACKGROUND: Poor adherence to treatment is common in hemodialysis patients. However, effective interventions for adherence in this population are lacking. Small studies of behavioral interventions have yielded improvements, but clinical effectiveness and long-term effects are unclear. STUDY DESIGN: Multicenter parallel (1:1) design, blinded cluster-randomized controlled trial. SETTING & PARTICIPANTS: Patients undergoing maintenance hemodialysis enrolled in 14 dialysis centers. INTERVENTION: Dialysis shifts of eligible patients were randomly assigned to either an interactive and targeted self-management training program (HED-SMART; intervention; n=134) or usual care (control; n=101). HED-SMART, developed using the principles of problem solving and social learning theory, was delivered in a group format by health care professionals over 4 sessions. OUTCOMES & MEASUREMENTS: Serum potassium and phosphate concentrations, interdialytic weight gains (IDWGs), self-reported adherence, and self-management skills at 1 week, 3 months, and 9 months postintervention. RESULTS: 235 participants were enrolled in the study (response rate, 44.2%), and 82.1% completed the protocol. IDWG was significantly lowered across all 3 assessments relative to baseline (P<0.001) among patients randomly assigned to HED-SMART. In contrast, IDWG in controls showed no change except at 3 months, when it worsened significantly. Improvements in mineral markers were noted in the HED-SMART arm at 3 months (P<0.001) and in potassium concentrations (P<0.001) at 9 months. Phosphate concentrations improved in HED-SMART at 3 months (P=0.03), but these effects were not maintained at 9 months postintervention. Significant differences between the arms were found for the secondary outcomes of self-reported adherence, self-management skills, and self-efficacy at all time points. LIMITATIONS: Low proportion of patients with diabetes. CONCLUSIONS: HED-SMART provides an effective and practical model for improving health in hemodialysis patients. The observed improvements in clinical markers and self-report adherence, if maintained at the longer follow-up, could significantly reduce end-stage renal disease-related complications. Given the feasibility of this kind of program, it has strong potential for supplementing usual care. TRIAL REGISTRATION: Registered at ISRCTN with study number ISRCTN31434033.
Assuntos
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Diálise Renal / Cooperação do Paciente / Cooperação e Adesão ao Tratamento / Autogestão / Falência Renal Crônica Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País como assunto: Asia Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Diálise Renal / Cooperação do Paciente / Cooperação e Adesão ao Tratamento / Autogestão / Falência Renal Crônica Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País como assunto: Asia Idioma: En Ano de publicação: 2018 Tipo de documento: Article