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Background: Chronic kidney disease (CKD) is an emerging global public health problem. Control of risk factors and prevention of complications can delay the progression to end-stage renal disease. Self-efficacy and self-management behavior in patients with predialysis CKD has not been investigated in Nepal.
Objectives: To describe knowledge of CKD, self-efficacy, and self-management behavior in patients with predialysis CKD and to determine the relationships between knowledge in CKD and self-efficacy with self-management behavior.
Methods: Ninety-seven predialysis CKD patients visiting nephrology clinic of a tertiary care hospital in Kathmandu, Nepal were recruited from November 2016 to December 2016. Questionnaires comprised of sociodemographic data, CKD knowledge, self-efficacy, and self-management behavior questionnaires were used. Data were analyzed, using descriptive statistics and Pearson product moment correlation coefficient.
Results: The mean age of 97 participants was 45.67 years. There were 3 stages of CKD among participants: stage G4 (54.64%), stage G3 (42.27%), and stage G2 (3.09%), respectively. Hypertension was the most common comorbidity (81.44%) followed by diabetes mellitus (30.92%). Predialysis CKD patients had a moderate level of knowledge on CKD and self-efficacy and high level of self-management behavior. There were positive relationships between knowledge in CKD and self-management behavior (r = 0.52; P < .05), and between self-efficacy and self-management behavior (r = 0.39; P < .05).
Conclusions: This study suggested that education, counseling, workshop to increase the knowledge, self-efficacy, and self-management behavior might be helpful for the predialysis CKD patients. Healthcare providers can educate, motivate, and train the patients to practice self-management behavior to delay the progression of CKD.
2. International Society of Nephrology. KDIGO 2012 clinical practice guideline for the evaluation and management
of chronic kidney disease--chapter 2: definition, identification, and prediction of CKD progression. Kidney Int Suppl. 2012;3(1):63-72. doi:10.1038/kisup.2012.6.
3. Murali R, Sathyanarayana D, Muthusethupathy MA. Assessment of quality of life in chronic kidney disease patients using the kidney disease quality of life-short form questionnaire in Indian population: a community based study. Asian J Pharm Clin Res. 2015;8(1):271-274.
4. Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765. doi:10.1371/journal.pone.0158765.
5. World Health Organization. Nepal top 50 causes of death, 2014. http://www.worldlifeexpectancy.com/country-health-profile/nepal. Accessed April 5, 2019.
6. Hasan M, Sutradhar I, Gupta RD, Sarker M. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrol. 2018;19(1):291. doi:10.1186/s12882-018-1072-5.
7. Abraham G, Varughese S, Thandavan T, et al. Chronic kidney disease hotspots in developing countries in South Asia. Clin Kidney J. 2016;9(1):135-141. doi:10.1093/ckj/sfv109.
8. Murphree DD, Thelen SM. Chronic kidney disease in primary care. J Am Board Fam Med. 2010;23(4):542-550. doi:10.3122/jabfm.2010.04.090129.
9. National Center for Chronic Disease Prevention and Health Promotion. National Chronic Kidney Disease Fact Sheet, 2017. https://www.cdc.gov/kidneydisease/pdf/kidney_factsheet.pdf. Accessed April 5, 2019.
10. The World Bank. GDP (current US$), 2016. https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=NP. Accessed April 5, 2019.
11. Agrawal HK, Jain D, Pawar S, Yadav RK. Health-related quality of life in different stages of chronic kidney disease. QJM. 2016;109(11):711-716. doi:10.1093/qjmed/hcw1054.
12. Welch JL, Johnson M, Zimmerman L, Russell CL, Perkins SM, Decker BS. Self-management interventions in stages 1-4 chronic kidney disease: an integrative review. West J Nurs Res. 2015;37(5):652-678. doi:10.1177/0193945914551007.
13. Havas K, Douglas C, Bonner A. Person-centred care in chronic kidney disease: a cross-sectional study of patients’ desires for self-management support. BMC Nephrol. 2017;18(1):17. doi:10.1186/s12882-016-0416-2.
14. Zungu LI, Djumbe FR. Knowledge and lifestyle practices of hypertensive patients attending a primary health care clinic in Botswana. http://hdl.handle.net/10500/8684. Accessed April 5, 2019.
15. Larsan PD. Lubkin's Chronic Illness: Impact and Intervention (Lubkin, Chronic Illness). 9th ed. Burlington, MA: Jones & Bartlett Learning; 2016.
16. Cohen J. A power primer. Psychol Bull. 1992;112(1):155-159. doi:10.1037/0033-2909.112.1.155.
17. Grove S, Burns N, Gray J. The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. St. Louise, Missouri: Elsevier Saunders; 2013.
18. Curtin RB, Walters BA, Schatell D, Pennell P, Wise M, Klicko K. Self-efficacy and self-management behaviors in patients with chronic kidney disease. Adv Chronic Kidney Dis. 2008;15(2):191-205. doi:10.1053/j.ackd.2008.01.006.
19. Behling O, Law KS. Translating Questionnaires and Other Research Instruments. Thousand Oaks, CA: Sage Publications; 2000. doi:10.4135/9781412986373.
20. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. doi:10.1159/000180580.
21. McIntyre NJ, Fluck R, McIntyre C, Taal M. Treatment needs and diagnosis awareness in primary care patients with chronic kidney disease. Br J Gen Pract. 2012;62(597):e227-e232. doi:10.3399/bjgp12X636047.
22. Welch JL, Bartlett Ellis RJ, Perkins SM, et al. Knowledge and awareness among patients with chronic kidney disease stage 3. Nephrol Nurs J. 2016;43(6):513-519.
23. Mishra D, Koirala P. Status of chronic kidney disease patients registered in National Kidney Center, Banasthali, Kathmandu. JMMIHS. 2015;1(4):19-23. doi:10.3126/jmmihs.v1i4.11997.
24. Paudel YP, Dahal S, Acharya T, et al. Biochemical profile of chronic kidney disease (CKD) paitents in various age and gender group subjects visiting Kist Medical College & Teaching Hospital, Kathmandu. J Chitwan Med Coll. 2013;3(2):36-39. doi:10.3126/jcmc.v3i2.8441.
25. Devraj R, Borrego M, Vilay AM, Gordon EJ, Pailden J, Horowitz B. Relationship between health literacy and kidney function nephrology. Nephrology (Carlton). 2015;20(5):360-367. doi:10.1111/nep.12425.
26. Wright JA, Wallston KA, Elasy TA, Ikizler TA, Cavanaugh KL. Development and results of a kidney disease knowledge survey given to patients with CKD. Am J Kidney Dis. 2011;57(3):387-395. doi:10.1053/j.ajkd.2010.09.018.
27. Whaley-Connell A, Shlipak MG, Inker LA, et al. Awareness of kidney disease and relationship to end-stage renal disease and mortality. Am J Med. 2012;125(7):661-669. doi:10.1016/j.amjmed.2011.11.026.
28. Daker-White G, Rogers A, Kennedy A, Blakeman T, Blickem C, Chew-Graham C. Non-disclosure of chronic kidney disease in primary care and the limits to instrumental rationality in chronic illness self-management. Soc Sci Med. 2015;131:31-39. doi:10.1016/j.socscimed.2015.02.035.
29. Phua SH, Taha NA, Pau KB, Kong WY. Evaluation of self management behavior of chronic kidney disease patients. J Pharm Pharmacol. 2017;5:179-188. doi:10.17265/2328-2150/2017.04.002.
30. Bhandari P, Kim M. Self-care behaviors of Nepalese adults with type 2 diabetes: a mixed methods analysis. Nurs Res. 2016;65(3):202-214. doi:10.1097/NNR.0000000000000153.
31. National Kidney Disease Education Program (NKDEP). Chronic Kidney Disease (CDK) and Diet: Assessment, Management, and Treatment. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/ckd-diet-assess-manage-treat-508.pdf. Revised April 2015. Accessed April 5, 2019.
32. Nutrition Services. Chronic Kidney Disease and Nutrition, 2011. https:// www.health.govt.nz/system/files/documents/topic_sheets/ckd-and-nutrition.pdf. Accessed January 24, 2019.
33. Burnier M, Pruijm M, Wuerzner G, Santschi V. Drug adherence in chronic kidney diseases and dialysis. Nephrol Dial Transplant. 2015;30(1):39-44. doi:10.1093/ndt/gfu015.
34. Sontakke S, Budania R, Bajait C, Jaiswal K, Pimpalkhute S. Evaluation of adherence to therapy in patients of chronic kidney disease. Indian J Pharmacol. 2015;47(6):668-671. doi:10.4103/0253-7613.169597.
35. Pagels AA, Hylander B, Alyarsson M. A multi-dimensional support programme for patients with diabetic kidney disease. J Ren Care. 2015;41(3):187-194. doi:10.1111/jorc.12114.
36. Qobadi M, Besharat MA, Rostami R, Rahiminezhad A. Health literacy and medical adherence in hemodialysis patients: the mediating role of disease-specific knowledge. Thrita. 2015;4(1):e26195. doi:10.25812/thrita.26195.
37. Shailendranath B, Ushadevi C, Kedlaya PG. Impact of knowledge, attitude and behavior among maintenance hemodialysis patients for adherence to dietary regimen - a single centre experience. Int J Humanit Soc Sci. 2014;4(12):257-262.
38. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215.
39. Lorig K, Ritter PL, Villa FJ, Armas J. Community-based peer-led diabetes self-management: a randomized trial. Diabetes Educ. 2009;35(4):641-651. doi:10.1177/0145721709335006.