Hemodialysis Patients' Experiences of Diet and Fluid Restriction: A Qualitative Study

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Özlem Bulantekin Duzalan https://orcid.org/0000-0002-9521-2510
Arife Albayrak Cosar https://orcid.org/0000-0003-3049-5895
Sibel Sarikaya https://orcid.org/0000-0001-6313-977X


Hemodialysis, Diet and fluid restriction, Adherence, Qualitative research


Study Objective: Adherence to diet and fluid restriction is one of the most important elements of hemodialysis (HD) treatment. The aim of this study was to explore the methods used by HD patients in adhering to diet and fluid restrictions, and the sources of motivation and experiences affecting adherence. Methods: A qualitative design underpinned by a phenomenological hermeneutical approach was applied. The study was conducted with 14 patients undergoing HD, using the face-to-face interview method. Sound recordings were transcribed to written form, and content analysis. Results: Four themes were determined as a result of the content analysis. These were self-management, sources of motivation, existential struggle and future expectations. In the study, an analysis was made of the difficulties in the socio-cultural field which the HD patients had in adhering to diet and fluid restrictions, and their adherence to diet and fluid restrictions in order to meet their expectations for the future, to live well in the present and to remain alive, and to meet the expectations of their friends and families. Conclusion: It is important in this sense for nurses to evaluate their patients in all dimensions and contribute to their care.


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1. United States Renal Data System. 2020 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2020.
2. Registry Of The Nephrology, Dialysis And Transplantation In Turkey, Turkish Society of Nephrology, http://www.nefroloji.org.tr/folders/file/registry_kitabi_2014.pdf (Erişim Tarihi: 20.04.2019.
3. Tong A, Sainsbury P, Chadban S, Walker RG, Harris DC, Carter SM, Hall B, Hawley C, Craig JC. (2009). Patients’ experiences and perspectives of living with CKD. Am J Kidney Dis. 2009;53(4):689–700.
4. Reid C, Seymour J, Jones CA. Thematic synthesis of the experiences of adults living with hemodialysis. Clin J Am Soc Nephrol.,2016;11(7):1206–18.
5. Griva K, Ng HJ, Loei J, Mooppil N, McBain H & Newman SP. Managing treatment for end-stage renal disease – a qualitative study exploring cultural perspectives on facilitators and barriers to treatment adherence. Psychology & Health, 2013; 28: 13–9.
6. Hong L, Wang W, Chan EY, Mohammed F & Chen HC. Dietary and fluid restriction perceptions of patients undergoing haemodialysis: an exploratory study. Journal of Clinical Nursing, 2017; 26: 3664–76.
7. Kara B. Validity and Reliability Study of the Dialysis Diet and Fluid Restriction Compliance Scale. Anatolian Journal of Nursing and Health Science.2009; 12:3.20-7.
8. Sarkar SR, Kotanko P & Levin NW. Interdialytic weight gain: implications in hemodialysis patients. Seminar in Dialysis, 2006;19:429–33.
9. Sagawa M, Oka M, Chaboyer W, Satoh W, & Yamaguchi M. Cognitive behavioral therapy for fluid control in hemodialysis patients. Nephrology Nursing Journal,2001; 28(1):37-9.
10. Cimilli C. The Psychıatrıc Aspects Of Hemodıalysıs. Official Journal of the Turkish Nephivlogy As.2003;12 (1): 88-2.
11. Creswell JW. Qualitative inquiry and research design: Choosing among five approaches. (3th ed). (M Bütün & SB Demir, Trans). Ankara, Siyasal Kitabevi. 2020, (Original work published 2016).
12. Merriam SB. Qualitative research: A guide to design and implementation. (3nd end) (S Turan, Trans). Ankara, 2018; Nobel Akademik Yayıncılık. (Original work published 2009).
13. Cicolini G, Palma E, Simonetta C, & Di Nicola M. (2012). Influence of family carers on haemodialyzed patients’ adherence to dietary and fluid restrictions: an observational study. Journal of Advanced Nursing, 2012; 68:2410–17.
14. Yokoyama Y, Suzukamo Y, Hotta O, Yamazaki S, Kawaguchi T, Hasegawa T, Fukuhara S. Dialysis staff encouragement and fluid control adherence in patients on hemodialysis. Nephrology Nursing Journal, 2009; 36;289-98.
15. Tekindal M, Uğuz A. A review of the scope and process of the phenomenological approach as a qualitative research method. Journal of Turkey Federation of the Blind Person, 2020;20 (1): 153-82.
16. Lorig KR, & Holman HR. Self-management: History, definition, outcomes, and mechanisms. Ann Behav Med, 2003;26(1), 1-7.
17. Clark NM, & Gong M. Management of chronic disease by practioners and patients: Are we teaching the wrong things? BMJ,2000; 320: 572-75.
18. Alemdar H, Çınar-Pakyüz, S. Evaluation of the effect of self-care power on quality of life in hemodialysis patients. Nephrology Nursing Journal, 2015;2: 19-30.
19. Kalender N& Tosun N. Determination of the relationship between adequacy of dialysis and quality of life and self-care. Journal of Clinical Nursing, 2013; 23:820-28.
20. Kurbun H, & Metin Akten İ. Evaluating the Self-Care Ability and Quality of Life in Hemodialysis Patients. Turkish Nephrology, Dialysis and Transplantation Journal, 2018;27(3): 277-87.
21. Moattari M, Ebrahimi M, Sharifi N, Rouzbeh J. (2012). The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: A randomized controlled tria. Health and Quality of Life Outcomes, 2012; 10:1-10.
22. Onbe H, Oka M, Shimada M, Motegi E, Motoi Y, Okabe A. Defining the culture and attitude towards dietarymanagement actions in people undergoing haemodialysis. Journal of Renal Care, 2013;39:90–5.
23. Tijerina MS. Psychosocial factors influencing mexican-american women's adherence with hemodialysis. Treatment Social Work in Health Care, 2006;43:57–4.
24. Chilcot J, Wellsted D & Farrington K. Illness representations are associated with fluid nonadherence among hemodialysis patients. Journal of Psychosomatic Research, 2010;68:203–12.
25. Clark Cutaia MN, Ren D, Hoffman LA, Burke LE, & Sevick MA. Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers. Journal of Renal Nutrition, 2014;24:92-9.
26. Rambod M, Peyravi H, Shokrpour N, & Sareban MT. Dietary and fluid adherence in Iranian hemodialysis patients. Health Care Manager,2010; 29: 359–64.
27. Kugler C, Vlaminck H, Haverich A & Maes B. Nonadherence with diet and fluid restrictions among adults having hemodialysis. Journal of Nursing Scholarship, 2005;37:25–9.
28. Al-Nazly E, Ahmad M, Musil C, & Nabolsi M. Hemodialysis stressors and coping strategies among Jordanian patients on hemodialysis: A qualitative study. Nephrol Nurse J (2013): 40(4), 321-27.
29. Stavropoulou A, Rovithis Grammatikopoulou MG, Kyriakidi K, Pylarinou A, and Markaki, AG. Exploring Patients’ Experiences After Chronic Kidney Disease Diagnosis: A Qualitative Study. Nephrology Nursing Journal,2020; 47(1):67-5.
30. Krespi MR, Bone M, Ahmad R, Worthington B, & Salmon P. Hemodialysis Patients' Evaluation of Their Lives. Turkish Journal of Psychiatry,2008; 19(4):365-72.
31. Lazarus RS, & Folkman S. Stress, Appraisal, and Coping.1984; New York: Springer.
32. Khareme Taheri Z, Zamanian H, Foroozanfar S, and Afsahi S. Religious Wellbeing as a Predictor for Quality of Life in Iranian Hemodialysis Patients. Glob J Health Sci,2014; 6(4):261-69.
33. Al -Zaben F, Khalifa DA, Sehlo MG, Al Shohaib S, Awad Binzaqr S, Magdi Badreg A, Koenig HG (2015). Religious involvement and health in dialysis patients in saudi arabia. J Relig Health, 2015:54, 713–30.
34. Guerra Guerrerro V, del-Pilar Camargo Plazas M, Cameron BL, Santos Salas AV, & Cofre Gonz alez. CG. Understanding the life experience of people on hemodialysis: adherence to treatment and quality of life. Nephrology Nursing Journal, 2014; 41:289–98.
35. Lai AY, Loh AP, Mooppil N, Krishnan DS & Griva K. Starting on haemodialysis: a qualitative study to explore the experience and needs of incident patients. Psychology Health Medicine, 2012;17: 674–84.
36. Yılmaz M. Transcultural Nursing Approach in the Care of Dialysis Patients and Their Families. Journal of Nephrology Nursing, 2015; 10(1):32-39.

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