A qualitative analysis of eating behaviour change for patients with diabetes and non‐dialysis dependent chronic kidney disease stages 4–5

Abstract

SUMMARY Background Dietary changes recommended for chronic kidney disease (CKD) stages 4–5 and concurrent diabetes are difficult to follow given the multitude of food and fluid restrictions aimed at reducing the rate of CKD progression. Reduced adherence is commonplace and there is limited literature on patients’ experiences with dietary changes and potential strategies to overcome this. Objectives Examine patients’ experiences when adopting dietary changes recommended for CKD Stages 4–5 (pre‐dialysis) and diabetes, and their perceptions of dietetic services and how they can be improved to assist them with dietary change. Methods An exploratory qualitative study was undertaken using a purposive sampling method from a dietetic pre‐dialysis clinic. Participants were interviewed using a semi‐structured interview style. Data were analysed using an inductive thematic analysis from a constructivist perspective. Results Three themes were identified: (1) Negative motivation to change eating behaviour to avoid dialysis; (2) sustaining motivation for change is challenging due to a sense of loss and confusion to incorporate the dietary changes recommended and (3) support is needed for eating behaviour change. Conclusion These findings have implications for dietitians to enhance their understanding of the patient experience and improve their skills in motivational counselling. Development of dietitian‐specific communication and nutrition counselling programmes are recommended to equip dietitians with skills to better support patients. CKD Stage 3 nutrition education programmes could be beneficial to promote earlier access to dietetic services and dietary recommendations.

The association between dietetic consultation and time to dialysis for patients attending a pre‐dialysis clinic: A retrospective cohort study

“…Median eGFR at baseline for all patients was 16 mL/min/1.73 m 2 (interquartile range (IQR) = 13-20) and there was a significant difference between the DC and no-DC groups (DC group median 17 (IQR = 14-22) versus no-DC group median 15 [12][13][14][15][16][17][18][19] ; P = 0.005). Patients received DC at a median time of 39 days (IQR 0-99 days) post-initial education with the pre-dialysis nurse.…”

“…Thus, interventions focused on delaying disease progression have been recommended . Delaying dialysis has been reported by patients as a significant motivator for dietary change . This idea has been mostly explored in patients on dialysis, which may have previously underestimated the role of DC in delaying CKD progression .…”

“…12 Delaying dialysis has been reported by patients as a significant motivator for dietary change. 13 This idea has been mostly explored in patients on dialysis, which may have previously underestimated the role of DC in delaying CKD progression. 14 Whilst pre-dialysis presents an opportune intervention period for CKD, evidence on the impact of DC on delaying dialysis is limited.…”

“…Results: A cohort of 246 patients was identified. Median estimated glomerular filtration rate was 16mL/min per 1.73 m 2 (interquartile range = [13][14][15][16][17][18][19][20] at initial pre-dialysis clinic visit and 63% commenced dialysis during the study period. Only 41% of patients received dietetic consultation.…”

Systematic Review and Meta-analyses: Dietary Behavior Interventions in Non-dialysis Chronic Kidney Disease

“…When CKD is diagnosed, dietary behavior changes, such as decreasing the intake of protein and salt, contribute to delaying the deterioration of renal function and postponing the onset of dialysis (Berns, 2018;Rhee et al, 2018). Patients with early stages of CKD have inconspicuous somatic symptoms, so patients do not have a strong desire to make dietary changes (Notaras & Conti, 2018;Reid et al, 2012). Consequently, the key point of dietary education in the early stages of CKD is to increase patients' awareness of the significance of a healthy diet.…”