Tailoring Health-promoting Programs for Patients with Chronic Kidney Disease: Randomized Controlled Trial

Abstract

Research on dietary and lifestyle modifications to decrease cardiovascular risk and slow disease progression has been limited to patients in the later stages of chronic kidney disease (CKD). Studies on the effectiveness of stage-of-change-tailored interventions on lifestyle modifications for individuals with early stage CKD are limited. Using random assignment, 60 patients with early stage CKD who received up to six tailored intervention visits over 30 months were compared to 60 usual care patients on physical indicators, lifestyle behaviors, and quality of life. Tailored interventions were consistent with the trans-theoretical Model of Change. Waist circumference, nutrition, and stress management improved over time in the intervention group. There was no difference or change in quality of life. To promote a healthier lifestyle, findings suggest that clinicians working with patients with CKD should consider patients’ readiness to change their behaviors as well as implementation strategies tailored for different processes of change.

Keywords

chronic kidney disease health-promoting lifestyle trans-theoretical model

Get full access to this article

View all access options for this article.

References

Araújo-Soares

Hankonen

Presseau

Rodrigues

Sniehotta

F. F.

(2019). Developing behavior change interventions for self-management in chronic illness: An integrative overview. European Psychologist, 24(1), 7–25. https://doi.org/10.1027/1016-9040/a000330

Barzin

Hosseinpanah

Serahati

Salehpour

Nassiri

Azizi

(2014). Changes in waist circumference and incidence of chronic kidney disease. European Journal of Clinical Investigation, 44(5), 470–476. https://doi.org/10.1111/eci.12253

Chang

P. Y.

Chien

L. N.

Lin

Y. F.

M. S.

Chiu

W. T.

Chiou

H. Y.

(2016). Risk factors of gender for renal progression in patients with early chronic kidney disease. Medicine, 95(30), e4203. https://doi.org/10.1097/MD.0000000000004203

Chen

Y. C.

Lai

S. H.

Tsai

Y. W.

Chang

S. S.

(2018). Visceral adiposity index as a predictor of chronic kidney disease in a relatively healthy population in Taiwan. Journal of Renal Nutrition, 28(2), 91–100. https://doi.org/10.1053/j.jrn.2017.07.006

Chen

S. H.

Tsai

Y. F.

Sun

C. Y.

I. W.

Lee

C. C.

M. S.

(2011). The impact of self-management support on the progression of chronic kidney disease–A prospective randomized controlled trial. Nephrology, Dialysis, Transplantation, 26(11), 3560–3566. https://doi.org/10.1093/ndt/gfr047

Coresh

Turin

T. C.

Matsushita

Sang

Ballew

S. H.

Appel

L. J.

Arima

Chadban

S. J.

Cirillo

Djurdjev

Green

J. A.

Heine

G. H.

Inker

L. A.

Irie

Ishani

J. H.

Kovesdy

C. P.

Marks

Ohkubo

… Levey

A. S.

(2014). Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. JAMA, 311(24), 2518–2531. https://doi.org/10.1001/jama.2014.6634

Fischer

Lange

Klose

Greiner

Kraemer

(2016). Barriers and strategies in guideline implementation-A scoping review. Healthcare, 4(3), 36. https://doi.org/10.3390/healthcare4030036

Fung

Tamura

M. K.

(2016). Epidemiology and public health concerns of chronic kidney disease in older adults. Advances in Chronic Kidney Disease, 23(1), 8–11. https://doi.org/10.1053/j.ackd.2015.10.001

GBD Chronic Kidney Disease Collaboration. (2020). Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395, 709–733. https://doi.org/10.1016/S0140-6736(20)30045-3

10.

Hsu

C. C.

Hwang

S. J.

Wen

C. P.

Chang

H.Y.

Chen

Shiu

R. S.

Horng

S. S.

Chang

Y. K.

Yang

W. C.

(2006). High prevalence and low awareness of CKD in Taiwan: A study on the relationship between serum creatinine and awareness from a nationally representative survey. American Journal of Kidney Diseases, 48(5), 727–738. https://doi.org/10.1053/j.ajkd.2006.07.018

11.

Jha

Modi

G. K

. (2018). Getting to know the enemy better-the global burden of chronic kidney disease. Kidney international, 94(3), 462–464. https://doi.org/10.1016/j.kint.2018.05.009

12.

Kao

Y. H.

Huang

Y. C.

Chen

P. Y.

Wang

K. M.

(2012). The effects of exercise education intervention on the exercise behaviour, depression, and fatigue status of chronic kidney disease patients. Health Education, 112(6), 472–484. https://doi.org/10.1108/09654281211275827

13.

Lee

M. C.

S. F. V.

Hsieh

N. C.

Tsai

J. M.

(2016). Self-management programs on eGFR, depression and quality of life among patients with chronic kidney disease: A meta-analysis. Asian Nursing Research, 10(4), 255–262. https://doi.org/10.1016/j.anr.2016.04.002

14.

Liang

K. Y.

Zeger

S. L.

(1986). Longitudinal data analysis using generalized linear models. Biometrika,73(1), 13–22. https://doi.org/10.1093/biomet/73.1.13

15.

Lin

M. R.

(2000). Introduction to the development of the WHOQOL-Taiwan version. Chinese Journal of Public Health 19(4), 315–324. https://doi.org/10.6288/CJPH2000-19-04-10

16.

Lopez-Vargas

P. A.

Tong

Howell

Craig

J. C.

(2016). Educational interventions for patients with CKD: A systematic review. American Journal of Kidney Diseases, 68(3), 353–370. https://doi.org/10.1053/j.ajkd.2016.01.022

17.

Luyckx

V. A.

Tuttle

K. R.

Garcia-Garcia

Gharbi

M. B.

Heerspink

H. L.

Johnson

D. W.

Liu

Z. H.

Massy

Z. A.

Moe

Nelson

R. G.

Sola

Wheeler

D. C.

White

S. L.

(2017). Reducing major risk factor for chronic kidney disease. Kidney International Supplements, 7(2), 71–87. https://doi.org/10.1016/j.kisu.2017.07.003

18.

McCoy

C. E

. (2017). Understanding the intention-to-treat principle in randomized controlled trials. The Western Journal of Emergency Medicine, 18(6), 1075–1078. https://doi.org/10.5811/westjem.2017.8.35985

19.

Michishita

Matsuda

Kawakami

Tanaka

Kiyonaga

Tanaka

Morito

Higaki

(2018). The association between changes in lifestyle behaviors and the incidence of chronic kidney disease (CKD) in middle-aged and older men. Journal of Epidemiology, 27(8), 389–397. https://doi.org/10.1016/j.je.2016.08.013

20.

National Kidney Foundation (2002). K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. American journal of kidney diseases, 39(2 Suppl. 1), S1–S266. https://www.ncbi.nlm.nih.gov/pubmed/11904577

21.

Nguyen

N. T.

Douglas

Bonner

(2019). Effectiveness of self-management programme in people with chronic kidney disease: A pragmatic randomized controlled trial. Journal of Advanced Nursing, 75(3), 652–664. https://doi.org/10.1111/jan.13924

22.

Nojima

Meguro

Ohkawa

Furukoshi

Kawai

Itoh

(2017). One-year eGFR decline rate is a good predictor of prognosis of renal failure in patients with type 2 diabetes. Proceedings of the Japan Academy, Series B, 93(9), 746–754. https://doi.org/10.2183/pjab.93.046

23.

Pagels

A. A.

Söderkvist

B. K.

Medin

Hylander

Heiwe

(2012). Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment. Health and Quality of Life Outcomes, 10, 71. https://doi.org/10.1186/1477-7525-10-71

24.

Peng

Huang

Lun

Zeng

Zhang

Liu

(2019). Self-management interventions for chronic kidney disease: A systematic review and meta-analysis. BMC nephrology, 20(1), 142. https://doi.org/10.1186/s12882-019-1309-y

25.

Prochaska

J. O.

DiClemente

C. C.

(1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology 51(3), 390–395. https://doi.org/10.1037//0022-006x.51.3.390

26.

Prochaska

J. O.

Redding

C. A.

Evers

K. E.

(2008). The transtheoretical model and stages of change. In Glanz

Rimer

B. K.

Viswanath

(Eds.), Health behaviors and health education: Theory, research, and practice (4th ed., pp. 97–121). John Wiley & Sons.

27.

Prochaska

J. O.

Velicer

W. F.

Rossi

J. S.

Goldstein

M. G.

Marcus

B. H.

Rakowski

Fiore

Harlow

L. L.

Redding

C. A.

Rosenbloom

(1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13(1), 39–46. https://doi.org/10.1037//0278–6133.13.1.39

28.

Richards

K. C.

Enderlin

C. A.

Beck

McSweeney

J. C.

Roberson

P. K.

(2007). Tailored biobehavioral interventions: A literature review and synthesis. Research and Theory for Nursing Practice, 21(4), 271–285. https://doi.org/10.1891/088971807782428029

29.

Schulz

K. F.

Altman

D. G.

Moher

, & CONSORT Group (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Annals of Internal Medicine, 152(11), 726–732. https://doi.org/10.7326/0003-4819-152-11-201006010-00232

30.

Snijder

M. B.

Dekker

J. M.

Visser

Yudkin

J. S.

Stehouwer

C. D.

Bouter

L. M.

Heine

R. J.

Nijpels

Seidell

J. C.

(2003). Larger thigh and hip circumferences are associated with better glucose tolerance: The Hoorn study. Obesity Research, 11(1), 104–111. https://doi.org/10.1038/oby.2003.18

31.

Teng

H. L.

Yen

Fetzer

(2010). Health promotion lifestyle profile-II: Chinese version short form. Journal of Advanced Nursing, 66(8), 1864–1873. https://doi.org/10.1111/j.1365-2648.2010.05353.x

32.

Teng

H. L.

Yen

Fetzer

Sung

J. M.

Hung

S. Y.

(2013). Effects of targeted interventions on lifestyle modifications of chronic kidney disease patients randomized controlled trial. Western Journal of Nursing Research, 35(9), 1107–1127. https://doi.org/10.1177/0193945913486202

33.

Tsai

M. H.

Hsu

C. Y.

Lin

M.Y.

Yen

M.F.

Chen

H. H.

Chiu

Y. H.

Hwang

S. J.

(2018). Incidence, prevalence, and duration of chronic kidney disease in Taiwan: Results from a community-based screening program of 106,094 individuals. Nephron, 140(3), 175–184. https://doi.org/10.1159/000491708

34.

Walker

S. N.

Sechrist

K. R.

Pender

N. J.

(1987). The Health-Promoting Lifestyle Profile: Development and psychometric characteristics. Nursing Research, 36(2), 76–81. https://doi.org/10.1097/00006199-198703000-00002

35.

Wen

S. L.

Wang

A. N.

M. M.

H. Y.

Y. F.

Zhang

J. P.

(2018). Effects of transtheoretical model-based intervention on the self-management of patients with an ostomy: A randomized controlled trial. Journal of Clinical Nursing, 28(9-10), 1936–1951. https://doi.org/10.1111/jocn.14731

36.

Yang

Chen

Zhao

Chen

Wang

Tian

Liu

Shen

. (2019). Comparison of the correlates between body mass index, waist circumference, waist-to-height ratio, and chronic kidney disease in a rural Chinese adult population. Journal of Renal Nutrition, 29(4), 302–309.e1. https://doi.org/10.1053/j.jrn.2018.10.008

37.

Yen

Huang

J. J.

Teng

H. L.

(2008). Education for patients with chronic kidney disease in Taiwan: A prospective repeated measures study. Journal of Clinical Nursing, 17(21), 2927–2934. https://doi.org/10.1111/j.1365-2702.2008.02348.x

38.

Zhu

L. X.

S. C.

Sit

J. W. H.

H. G.

(2014). The effects of a transtheoretical model-based exercise stage-matched intervention on exercise behavior in patients with coronary heart disease: A randomized controlled trial. Patient Education and Counseling, 95(3), 384–392. https://doi.org/10.1016/j.pec.2014.03.013