Perceived Barriers to Adherence to Hemodialysis Dietary Recommendations

Abstract

Barriers to following dietary recommendations have been described; however, they remain poorly understood. The purpose of this qualitative study was to explore perceived barriers to adherence to dietary recommendations in a diverse hemodialysis patient population. Participants were eligible to participate in a semi-structured qualitative telephone interview prior to randomization for an ongoing clinical trial to evaluate the efficacy of an intervention designed to reduce dietary sodium intake. Interviews were digitally recorded, transcribed verbatim and coded using an iterative qualitative process. In total, 30 (37% females, 53% Caucasians) participants, 63.2 ± 13.3 years, were interviewed. Time, convenience, and financial constraints hindered dietary adherence. Dietary counseling efforts were rated positively but require individualization. Ability to follow recommended guidelines was challenging. Suggestions for addressing barriers include technology-based interventions that allow patients to improve food choices and real-time decision-making, and permit tailoring to individual barriers and preferences.

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

“…DOPPS Phases 1–3 found that HD patients with poor social support were more likely to experience serum albumin <3.5 g/dL (OR = 1.18, 95% CI: 1.02–1.37) [ 201 ]. In contrast, HD patients with social support achieved better social interactions and coping mechanisms toward kidney disease [ 202 ], as well as fewer depression symptoms [ 208 ]. Ultimately, presence of social support enables patient self-efficacy to reach better health status.…”

Pilot study to reduce interdialytic weight gain by provision of low‐sodium, home‐delivered meals in hemodialysis patients

“…Cultural differences in adherence likely contributed to the lower adherence and more modest results compared to the Izmir group, as high‐sodium foods are present in both countries 43 . Furthermore, there are numerous barriers to low‐sodium dietary adherence in the United States that have previously been reported 14–17 . The home‐delivered meal approach used in the current study may be a more efficacious approach for reducing sodium intake, especially in patients with higher IDWG's, because it bypasses many of the barriers upon following a low‐sodium diet or other renal diet restrictions.…”

“…43 Furthermore, there are numerous barriers to low-sodium dietary adherence in the United States that have previously been reported. [14][15][16][17] The home-delivered meal approach used in the current study may be a more efficacious approach for reducing sodium intake, especially in patients with higher IDWG's, because it bypasses many of the barriers upon following a low-sodium diet or other renal diet restrictions. However, cost considerations should be taken into account for provision of these meals ($6.99 per renal meal; $587 per patient in this study).…”

“…13 These findings may be attributed to a high-sodium food environment and a variety of barriers to dietary and behavioral changes. [14][15][16][17] A multitude of other HD dietary restrictions (e.g., phosphorus and potassium) further complicates dietary adherence. 18,19 Recent studies have shown that sodium can be stored in soft tissues, such as skin and muscle, and that elevated tissue sodium is associated with hypertension and left ventricular hypertrophy.…”

“…Unfortunately, most HD patients still consume excessive dietary sodium and nutritional education, and counseling to reduce sodium intake is largely ineffective 13 . These findings may be attributed to a high‐sodium food environment and a variety of barriers to dietary and behavioral changes 14–17 . A multitude of other HD dietary restrictions (e.g., phosphorus and potassium) further complicates dietary adherence 18,19 …”