THE EFFECTS OF NON-COMPLIANCE

OF DIETARY RESTRICTIONS ON
HEMODIALYSIS PATIENTS
HEALTH OUTCOMES

BY

Christiana Ikome, FNPs

Problem Identification
and significance
Problem: The effects of non-compliance of dietary
restrictions on HD patients heath outcome.
The significance: To create further awareness of
the problem, highlight the prevalence, causes
and health effects of dietary non-compliance on
HD patients.

Background information

Over 20 Million Americans have some degree of

renal insufficiency.1 in 8 people.

20 million others are at risk

Hypertension & Diabetes are the leading causes

of kidney failure
23% of all Americans have hypertension
16 million Americans have diabetes

Both are independent risk factors for

cardiovascular disease

Blacks are 3x >likely to experience kidney disease

compared to general population

Incidence by Race

2008

African Americans Develop ESRD

at a Younger Age

Literature review

Causes of Dietary non-compliance in HD

patients:
* Wells, 2012
* Mok Wen, Q., Hui Ang, J., & Christensen, M.
,2011
* Kammerer 2013

Literature review

Effects of Dietary non-compliance:

*USRDS, 2013, National Kidney
Foundation, 2014
*Denhaerynch, 2009
* Eskridge, 2010
*Mok Wen, Q., Hui Ang, J., &
Christensen, M. (2011).

Stage 3 Medical Focus

CKD MBD Metabolic bone disease
Acidosis - Bicarbonate
Anemia Erythropoietin

Class reinforces
bone and
heart healthy diet.

Vascular Calcification

Kidney damage causes decreased

phosphorus excretion. This stimulates
phosphotonins to increase phosphorus
excretion.
Phosphotonins and kidney damage
decrease the activation of vitamin D
This weakens muscles, decreasing bone
strength.
This decreases the calcium depositing in
bone, and along with phosphorus leads to
changes in blood vessel cells
Calcium deposits in blood vessels
Inflammation and Hyperlipidemia
(metabolic syndrome) make this worse
High fructose corn syrup makes metabolic
syndrome works

DIET IS IMPORTANT!!!

Purpose of the clinical project

1.

2.

3.

To explore and gain more information and

understanding about factors which affect
dialysis patients non-adherence to dietary
and fluid restrictions
Create an opportunity to disseminate
relevant health care information to patients,
care providers, and family members of
patients with CKD, ESRD, and on HD.
Ascertain current knowledge, identify gaps
and determine future needs.

Projection for ESRD

Population

USRDS ADR 2008

Objectives
Create awareness
1. be informed about
factors contributing to
dietary and fluid nonadherence.
2.
State at least
three effects of
dietary noncompliance on CKD,
ESRD, HD patient

Create awareness

3. use laboratory
parameters to assess
electrolytes (K+, Na+,
Ca+, Phos.) and assess
anemia, albumin
4. Use and interpret
laboratory parameters
to assess CKD bone
disorders

Incidence and Prevalence of End-Stage

Renal Disease in the US

Stages in Progression of Chronic

Kidney Disease and Therapeutic
Strategies
Complications
Complications

Normal
Normal

Screening
for CKD
risk factors

Increased
Increased
risk
risk
CKD risk
reduction;
Screening for
CKD

Damage
Damage

GFR
GFR

Kidney
Kidney
failure
failure

Diagnosis
Estimate
Replacement
& treatment; progression;
by dialysis
Treat
Treat
& transplant
comorbid complications;
conditions;
Prepare for
Slow
replacement
progression

CKD
CKD
death
death

Objectives
Create awareness
Kidney anatomy

Few functioning nephrons

mean
1. Inadequate
erythropoietin,
Accumulation of
potassium, hydrogen
2. Inadequate activation of
vitamin D (bone disease
3. Accumulation of waste
products urea, creatinine

Create awareness CKD,

ESRD, HD statistics

Cardiovascular Mortality in the General

Population and in ESRD Treated by
Dialysis
Annual mortality (%)
100

Dialysis

10

General population

1
0.1

Male
Female

0.01

Black
White
2534 3544 4554 5564 6574 7584
Age (years)

85

Implementation process
Site: Future Care Irvington, Baltimore MD
Contact Person: Ms. J. Mitchell,
Participants: Care providers of patients with CKD,
ESRD, HD in a long term care facility
Length of presentation: 30 minutes
The participants shall receive a hand out of the
power point presentation.
Evaluation of effectiveness: Question/answer
session

Description of Topic
Causes of dietary non-adherence:
1. Lack of self-care management skills
2. Lack of self-motivation
3. Co-morbidities
4. Financial, economic and social constraints
5. Lack of self-care ability
6. Educational Level and age
7. Other factors: a)knowledge deficit
b)hectic lifestyle
c)lack of decision making

Description of the Topic

Effects of dietary non-compliance on heath
outcome:
1. Electrolyte accumulation
2. Worsening hypertension
3. Cardiovascular effects
4. Impaired glomeruli filtration/elevated urea
and creatinine
5. Mental status change

What can health care providers

or patients do?

1.
2.
3.
4.
5.
6.

Patient education (nutrition and effects)

Assess self-care management
Behavioral modification
Self monitoring
Organizational changes
Appropriate Nutritional planning religious
and cultural consideration

Why Topic Was Selected

Share significant findings

of the article with peers.

Significance to Nursing Practice

1.

2.

3.

4.

Raise awareness among people at risk for

CKD
Educate people with CKD, ESRD, HD about
how to manage their condition
Provide information, training and tools to
help health care providers detect and treat
CKD, ESRD, HD patients
Support health system change to facilitate
effective CKD, detection and management

Authors Approach and Findings of the study

Study Title
Use of pedometer to
monitor physical
Activity in older
Adults.

Study Abstract

The abstract included

the study objective,
the design, sample,
measurement, result,
conclusion and key
words.

Research Problem

Research Purpose
To determine the
reliability of
pedometer use.

The problem was

clearly identified in
the abstract and in
the first paragraph of
the article.

To determine if there
was a significant
difference between
steps measured by
observational count
and pedometer count.

Review of Literature
Brief due to existence of only few
studies on the research problem.
Relevant previous studies
identified in the references
section.
Twenty-seven articles were cited
by the authors.
Eleven sources were current
(less than 5 years).
Some of the articles reviewed
dated as far back as 48 years
old.

Study Framework
Presented with clarity and
fit logically with study.
Linked to the research
purpose.
Coxs interaction model of
client behavior.
Four constructs:
* Personal
* Interpersonal
* Environmental factors
* Physical activity

Research Objectives, Questions

or Hypotheses
Research Objectives

Clearly and concisely

expressed.
Logically linked to the
research purpose.
Linked to concepts and
relationships from the
framework.

Research Hypotheses
There is no significant
difference in steps
measured by observational
count and pedometer
count.
Pedometer counts were
significantly correlated
with self reported walking
distance and amount of
leisure physical activity,
but not with walking
energy expenditure.

Research Variables
Independent Variables

Physical activity
Questionnaire
Walking
Pedometer
Elderly
Environment/setting

Dependent Variables

Pedometer readings

Physical steps

Attributes or Demographic
Variables

These variables could be

manipulated by either the
subjects or the researcher
to change the outcome of
the study.

Gender
Ethnicity
Age
Educational status
Blood pressure
BMI.

Research Design
Design was identified as a descriptive cross-sectional
study.
Involves observation of all of a population, or a
representative subset, at a defined time.
Used to describe some feature of a population,, or it
may support inferences of cause and effect.
Four different logs used including a 7-day PA log, a 7day step count, a self reported observational log,
and a log to record the pedometer readings.