FACTORS INFLUENCING ADHERENCE TO DIET AMONG PATIENTS ATTENDING RENAL UNIT IN TWO SELECTED HOSPITALS IN ENUGU
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Renal diet is a set of diet guide lines for people with kidney disease, designed to help patients, eat the best balanced diet for their body (Jordan 2011; Willis, 2007). A renal diet is a specific type of restriction/elimination diet, intended to modify eating behavior to relieve the kidneys from accumulating excess waste products like urea. It allows the kidneys to devote their energy to effect repair, where possible or delay failure, thereby preserve maximal kidney function. The diet is designed to control the amount of sodium, potassium, phosphorous and macronutrients which affects the kidney more than others; and removing those elements from the diet is the goal in the renal diet (Jordan, 2011).
Renal disease has taken a dangerous dimension such that, chronic kidney failure (crf) accounts for about 10% of medical admissions in Nigeria hospitals. (Ijoma, 2011). This means about 200-300 patients per million is suffering from renal disease. Chronic kidney disease (CKD) has assumed epidemic proportion globally. In the 2009 CKD surveillance report, the U.S. centers for disease control, found that an estimated twenty six million (11.6%) Americans have CKD (Verneda , Bosky 2012).Worldwide 300 million people suffer from CKD, while 3.4 million people died from it in 2012 (Nipro,2012).
In Sub Saharan Africa, the percentage of renal disease is about (13.9%) (Stranifier, 2014).Gunbers, (2014) stated that about 20% Nigerians are potential renal patients who may require dialysis or kidney transplant; he identified the period of developing renal disease to be during the middle age. While Bamboye (2014) estimated that one in every seven Nigerians is at one stage or another of kidney failure (renal disease) and 15,000 patients developing kidney disease every year with about 50,000 patients requiring dialysis. Unfortunately majority of affected patients present late and die early, from uremia and cardiovascular disease. (Arongundade et al, 2011).
End stage renal disease (ESRD) is a life threatening, potentially disabling disease, with a growing adjusted prevalence rate that reached 1.500 per million Americans in 2007 (USA renal data system 2009). ESRD has reached epidemic proportion and they are more than 400,000 affected individuals in USA and well over one million worldwide. CKD is at least 30 fold higher than that of ESRD. At the current rate of growth, it is expected that the incidence rate of ESRD cases in the U.S. will be over 400,000 per year in 2030 (Collin et al, 2003) Kidney disease is the 9th leading cause of death in United States. More than 20 million adults from 20 years plus in U.S have kidney disease unawares. Diabetes and hypertension are the two leading causes of kidney disease (DaVita, 2013).
According to Jordan (2013) when the diagnosis of kidney disease is made, the doctor places the patient on a renal diet to help preserve maximal kidney function. When placed on renal diet, with proper planning and the right mindset, adherence to renal diet will be easy. If followed in detail, a renal diet is the best approach at retaining control over one’s life (Jordan 2013).Adopting intervention at early stage of ckd can save a family and the entire nation from the burden of the disease (Huda et al 2012).
In Nigeria problem of chronic kidney disease is enormous and the prevalence of kidney failure is rising. Currently, ckd is emerging as a worldwide public health problem. According to the world health report 2002, the global burden of diseases from CKD causes approximately 850, 000 deaths every year and gave rise to 15, 010,167 disability adjusted life of years. Globally, ckd represent the 12th cause of death and 17th cause of disability. This might be an underscore to the true picture of CKD’s contribution to global burden of disease. (Ulasi & Ijoma, 2010). Kidney damage is a major determinant for the development of progression of accelerated atherosclerosis, ischemic vascular disease, and cardiovascular death.
Cardiovascular disease is a risk factor for premature death before reaching end stage. The Cost of provision of health care services for these patients is huge: cost of dialysis, transplant services, indirect cost like human resources lost at the workplace. CKD is under- recognized, under diagnosed in developing countries, patients present late or not at all to health facilities for several reasons ranging from prohibitive cost of health care services to use of alternative treatment like spiritual healing and tradition/native healers(Ulasi & Ijoma, 2010).
In developing countries the available renal replacement therapies [RRT] is usually unaffordable by most patients. In Nigeria there is no social security system or health insurance scheme in place to assist the patient and the burden is borne solely by the patient and relations. (Ulasi & Ijoma, 2010). In developed countries over 2 million (12%) of world population is sustained on RRT. That is 20% in about 100 developing countries, 50% world population has ESRD which is associated with very low quality life and an average patient might be sustained on RRT for 10 years only. CKD is treated with good glycemic and blood pressure control, plus other established modifiable risk factors (Couser, Remuzzi, Mendis, Tonelli, 2011).
The incidence of chronic kidney Disease (CKD) in Nigeria has been shown by various studies to range between 1.6 and 12.4 %. The burden of renal disease in Nigeria is probably significantly higher than any previous study on end-stage renal disease (ESRD) because most studies are hospital based and did not include the patients who have no access to hospital care. ESRD among blacks in the United States and South Africa compared with other races also suggests that ESRD may be more prevalent in Africa than in the United State and other developed nations. Common causes of CKD in Nigeria, in adults are glomerulonephritis and hypertension, while common causes in children are glomerulonephritis and posterior urethral valve
In United States, diabetes and hypertension are the commonest causes of CKD. Access to renal replacement therapy (RRT) in Nigeria is limited, and mortality rates are very high, ranging between 40 and 50% there is need for development of prevention programs and increased funding to ensure increased availability of RRT. Health policies concerning CKD must be formulated, and lack of renal registry makes it difficult for this to be done. There is need for the development of a functional organizational structure for the reporting of CKD in Nigeria, in the Nigerian Renal registry (Odubanjo, Oluwasola, Kadiri, 2011).
Careful adherence to a kidney diet can lessen the symptoms of kidney failure and prolong the usefulness of the kidneys (Davidson 2007). Renal disease, both in its acute or chronic stages need to be controlled. All patients with renal disease are required to adhere to diet, fluid and medications regimen.
Although technology today is increasingly efficient, the dialysis treatment does not perfectly reproduce normal kidney functions .Renal patients need to adhere to diet to avoid adverse effects of high potassium for instance ; itching, weight loss, fluid overload and bone disease (Higgins 2006). The researcher wants to know the level of adherence, to renal diet by patients at UNTH. ItukuOzalla/ NEO dialysis center especially, on low protein, salt, and potassium restricted diets.
Factors Influencing Adherence to Diet Among Patients Attending Renal Unit in Hospitals
1.2 Statement of the Problem
The population of patients suffering from kidney diseases leading to failure is about 10% of Nigerians (Ijoma, 2011). Bamigboye (2013) lamented that the burden of kidney disease is estimated at 15,000 and new cases are diagnosed every year in the country. It is also estimated that 36.8 million Nigerians suffer from kidney disease (Obinna, 2013). In Nigeria the available resources for caring for this group of patients is very minimal .The cost of care for these patients, is quite expensive with resultant economic and social burden on the patients ,their families, the community and the nation .(Unuigbe 2013; Nalado et al 2012).
According to Davidson ( 2007) kidney diet research carried out by professionals in many different settings (laboratories, clinics, hospitals) researchers came up; with a set of guidelines to allow patients with kidney failure, to eat and drink in a way that helps to manage their disease most effectively. Patients who follow this diet usually feel better, and can prolong the use of their kidneys. Diet guide line is a set of diet for people with kidney disease i.e. restricted protein, phosphorus, potassium, salt and fluid to suit individual health need. (Jordan, 2011).
The researcher observed that at UNTH ItukuOzalla; dialysis patients come in with worsening kidney symptom with severe edema, extreme weakness, , grossly anemic with major complaint of anorexia ,nausea and vomiting indicating dysfunctional kidney. (Smelter and Bare,2010). Therefore, the researcher who has nursed these patients for a long time with poor outcome, wants to find out; these patients adherence behavior to their dietary prescriptions, extent and factors influencing it.
Factors Influencing Adherence to Diet Among Patients Attending Renal Unit in Hospitals
1.3 Purpose of the Study
The purpose of this study is to identify factors that influence adherence to diet among patients , attending renal units in two hospitals in Enugu ; UNTH ItukuOzalla and NEO hospital and dialysis center Enugu.
Objectives of the study are to:
- Determine the proportion of patients who attend the renal units that adhere to the
- Determine demographic factors that influence adherence to the renal diet
- Identify socio-economic factors that influence their adherence to renal diet
1.4 Research Questions
- What proportion of patients who attend the renal unit and dialysis center adhere to the renal diet?
- What demographic factors influence patients’ adherence to the renal diet?
- Does socio economic factor influence adherence to renal diet?
Factors Influencing Adherence to Diet Among Patients Attending Renal Unit in Hospitals
1.5 Significance of the Study
This study will be helpful to health professionals for better planning and organizing of dietary education/counselling activities for patients and their families; to aid quality family support thereby enhancing nutritional management and their adherence behaviour. Results from the study will help further determine the understanding of the renal patients in planning of age specific nursing care and health education programs for patients with renal failure.
The study will contribute to the wealth of Literature on renal diet such that students, nurses and others who wish to study adherence of renal patients to dietary and other therapies can make use of. The findings will help the renal patients to realize their limitations and deal with them accordingly to improve adherence to the regimen so as to prolong their life span. The findings will be made available to the two selected hospital for the study and used to educate the patients at the dialysis centres and beyond.
1.6 Scope of the Study
This study is delimited to the adherence of renal diet regimen by patients attending renal unit UNTH and NEO hospital and dialysis center for dialysis.
1.7 Operational Definition of Terms
Adherence- is strictly keeping to specific dietary instruction given to a patient with renal disease, to eat only the recommended renal diet in the recommended proportion and regularity.
Renal diet- Restricted diet low in potassium, phosphorous, protein of high biological value (no plant protein) low salt and restricted fluid intake(in this study concentration is on restricted salt and protein).
Patient with renal disease –Is somebody who receives medical treatment as a renal patient i.e. has kidney disease and is challenged with not passing out adequate volume of urine or not at all in any day therefore is placed on renal substitution therapy like dialysis or conservative management using drug.
Factors-There are conditions or situation within the patient, his environment and in the regimen that will influence renal patients’ adherence to prescribed diet. In this study the factors of interest include demographic, socio-economic, family support and educational background.
Renal disease- kidney disease/renal disease describes a variety of disease and disorders that affect the kidneys. Most disease of the kidney attacks the filtering units of the kidney-the nephron and damages their ability to eliminate wastes and excess fluid.
Dialysis- is a mechanical way the kidney is relieved of excess fluid and wastes from the body.
Adherence to diet:- keeping strictly to the amount of sodium, potassium, phosphorus, protein and fluid as prescribed for the individual patient by the renal dietician to lessen the symptoms of kidney failure and prolong the usefulness of the kidneys.
Lawson Peter – Chief Editor in Projectvilla Nigeria. A writer and academic researcher.