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KNOWLEDGE AND ADHERENCE OF PATIENTS WITH END STAGE RENAL DISEASE REGARDING HEMODIALYSIS IN FEDERAL TEACHING HOSPITAL, IDO-EKITI

CHAPTER ONE

 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

According to Kidney Disease Improving Global Outcomes (KDIGO, 2012), kidney disease is an abnormality in the function or structure of the kidney and how it affects the health of an individual, it can occur suddenly and either resolve or progress to chronic kidney disease which when detected early, the associated complications and the progression to kidney failure can be delayed or prevented. Chronic kidney disease (CKD) is a condition in which a person has damaged kidneys or reduced kidney function for more than 3 months and during this time, the kidneys cannot properly filter waste out of the blood and if not detected or treated early it can lead to kidney failure and early death (Centers for Disease Control and Prevention (CDC), 2015).

 

Chronic kidney disease is a progressive irreversible structural damage of kidney function and there are 5 stages in which stage 5 that is, end stage renal disease (ESRD) is the last and most serious stage (KDIGO, 2012).  According to the National Kidney Foundation (2017), chronic kidney disease affects 30 million Americans and is a significant problem to public health in the United States; its progression is slow and often asymptomatic until it reaches kidney failure. Chronic kidney disease has become a worldwide public health concern due to its increased prevalence and incidence, high cost of treatment and poor outcomes, individuals experience a steady deterioration of kidney function over months to years and eventually develop ESRD (Taslim, 2014).

According to the American Kidney Fund (2015), some racial and ethnic groups are at greater risk for kidney failure, it is almost 4 times higher for African Americans, 1.5 times higher in Native Americans and 1.5 times higher in Asians as compared to whites and Hispanics are almost 1.5 times more likely to be diagnosed of kidney failure than non-Hispanics.  Hemodialysis is the most common form of treatment for patients with kidney failure and it involves the use of a dialysis machine to clean waste, salt and fluid from a person’s blood when the kidney are not healthy enough to do it on their own (CDC, 2015).

 

Renal replacement therapy (RRT) is used in patients with ESRD as an alternative measure to take over fully or in part the functions of the kidneys, the options of renal RRT are dialysis and kidney transplant (Nigerian Association of Nephrology, 2015).

Hemodialysis is readily available and accessible in developed countries to patients because of efficient social security systems and also health insurance schemes unlike in developing countries (Makusidi, Liman, Yakubu, Abdullahi & Chijioke, 2014). Africa has the lowest dialysis uptake rates in the world despite chronic kidney disease being three to four times more common in Africa than it is in the developed world. Low rate of dialysis can be attributed to inadequacy of dialysis infrastructure, lack of government subsidies for dialysis and severe shortage of trained personnel (Taslim, 2014).

 

End stage renal disease has assumed epidemic proportions as the global incidence and prevalence of chronic kidney disease and consequently ESRD has steadily increased in the last two decades with the number of patients being treated for ESRD globally estimated to be 3,010,000 at the end of 2012 (Nigerian Association of Nephrology (NAN), 2015).  The growth rate is approximately 7% and continues to increase significantly, 78.3% of these patients are on hemodialysis while 21.7% are living with kidney transplant (NAN, 2015). According to medical experts, the high rate of kidney disease which mostly leads to organ failure can be linked to the increased incidence of high blood pressure across age groups (Nuruddeen & Judd, 2015).

In the United States, the two leading causes of kidney failure are diabetes and high blood pressure but when these diseases are controlled by treatment, kidney disease can often be prevented or slowed down (National Kidney Foundation, 2015). The third leading cause of kidney failure is glomerulonephritis, a disease that damages the kidney filtering unit known as the glomeruli, in many cases it may be inherited or triggered by an infection (National Kidney Foundation, 2015).  Diabetes is the leading cause of kidney failure and the American Kidney Fund, (2015) emphasizes that diabetes causes 44% of all new cases of kidney failure and in 2012, it was the primary cause for 239,837 cases of kidney failure and it was estimated that 29.1 million people have diabetes and 8.1 million of them do not know they have it.

African Americans with diabetes are 3.5 times more likely to have kidney disease than whites (American Kidney Fund, 2015). Routine testing of high risk group such as people with diabetes, hypertension, cardiovascular disease, structural renal tract disease, family history of kidney disease, those receiving nephrotoxic drugs or those found to have hematuria or proteinuria can serve as an early indication of kidney damage which can lead to the introduction of available interventions at an early stage (KDIGO, 2012).

To identify the progression of CKD, the glomerular filtration residue and presence of albuminuria should be assessed annually in people with CKD or in individuals with higher risk of progression or in situations where measurements would impact therapeutic decisions (KDIGO, 2012). Sedentary lifestyle and lack of physical activity are prevalent among civil servants in Nigeria thus, predisposing them to complications such as Obesity, hypertension and also chronic kidney disease (Egbi et al., 2014).

These statistics show that renal failure is a global issue that needs to be addressed. Hence, the studynvestigated the knowledge and adherence of patients with end-stage renal disease regarding hemodialysis at the Federal Teaching Hospital, Ido-Ekiti (FETHI).

 

1.2 STATEMENT OF PROBLEM

In Nigeria, as in the case of most parts of sub-Saharan Africa, the focus of health care policy over the years has been on the control of communicable disease and maternal and child health (Federal Ministry of Finance, 2013). This has led to the situation where the annual budget allocation and international aid are towards the control of communicable disease and the cost of this focus on communicable diseases and maternal and child health challenges has led to the reduced focus of growing burden in which CKD is a major contributor (Taslim, 2014). Chronic kidney disease is an enormous public health issue, in the 2015 Global Burden of Disease Study, kidney disease was the 12th most common cause of death, accounting for 1.1 million deaths worldwide and the overall CKD mortality has increased by 31.7% over the last 10 years making it one of the fastest rising major causes of death (Neuen, Chadban, Demaio. Johnson & Perkovic, 2017).

If discovered early, CKD can be treated as people can make lifestyle changes to slow down the progress of the disease and prevent or delay kidney failure, the only treatment for kidney failure are dialysis or kidney transplant (CDC, 2015). The limited availability of organ donors made hemodialysis procedure the most efficient and practical method for the management of patients with ESRD (Karam et al., 2017). Africa has the lowest hemodialysis uptake rate despite CKD being three to four times more common in Africa than in the developed world (Taslim, 2014). Failure of adherence in hemodialysis patients can lead to increase morbidity, mortality, cost and burden on health care system.

Hence, the research studied the knowledge and adherence of patients with end-stage kidney disease regarding hemodialysis at FETHI.

 

1.3 OBJECTIVES OF THE STUDY

The aim of this study is to assess the knowledge and adherence of patients with end-stage renal disease regarding hemodialysis at FETHI.

The specific objectives therefore include:

1. To assess the knowledge level of patients regarding end stage renal disease at FETHI.
2. To evaluate the rate of adherence of patients with end stage renal disease to hemodialysis in FETHI.
3. To identify barriers to hemodialysis adherence among patents with end stage renal disease in FETHI.

 

1.4 RESEARCH QUESTIONS

The research questions for this study are:

1. What is the knowledge level of patients regarding ESRD and hemodialysis in FETHI?
2. What is the rate of adherence among participants with end stage renal disease to hemodialysis in FETHI?
3. What are the barriers encounters by patients regarding adherence to hemodialysis in FETHI?

 

1.5 SIGNIFICANCE OF THE STUDY

The incidence and mortality rate related to end stage renal disease in Africa is relatively high and this can be due to reduced or lack of knowledge and poor perception regarding haemodialysis as one of the treatments for end stage renal disease. Kidney disease can progress from the first stage to the last stage (end stage kidney disease) without detection and this can be due to inadequate understanding of the symptoms of kidney disease. This study is essential to assess the knowledge of patients regarding end stage renal disease and the importance of hemodialysis in treating the condition. It is envisaged that the findings from this study can provide relevant information with regards to the various barriers encountered by patients on hemodialysis and alert the appropriate authorities on measures that can be taken to overcome the identified barriers so as to save the lives of patients with ESRD. Lastly, it is belief that the findings may add to the already existing body of knowledge about hemodialysis and ESRD.

1.6 SCOPE OF STUDY

This study covered information about the knowledge and adherence to hemodialysis among patients with end stage renal disease in Federal Teaching Hospital Ido-Ekiti. It aims to identify the level of knowledge and rate of adherence of patients with kidney failure to hemodialysis. It covers recent information on chronic kidney disease, its growing pandemic and prevalence in Nigeria, while meeting its specified objectives. The total population involves 84 hemodialysis patients.

1.7 OPERATIONAL DEFINITION OF TERMS

An operational definition is a strategy through which a set of characteristics essential to the connotative meaning of a concept is identified (Burns & Grove, 2001)

The terms used are as applied to this study:

Knowledge– Wilson (2002) defined knowledge as a mental process of comprehension, understanding and learning that go on in the mind. For the purpose of this study, Individuals with end stage renal disease who are aware of its symptoms, progression, methods of treatment used are considered knowledgeable.

 

Adherence– this is the process in which a person follows rules, guidelines, or standards especially as a patient follows a prescription and recommendations for a regiment of care (Mosby’s Medical Dictionary, 2009). For the purpose of this study individuals with end stage renal disease who follow treatment regiments and recommendations are considered adherent.

 

Barriers- Barriers are the factors that prevent an individual from gaining access to health, social care and services (Morris, 2012).For the purpose of this study factors that affect the adherence to hemodialysis are considered barriers.

 

Chronic kidney disease (CKD)– Chronic kidney disease is a condition in which a person has damaged kidneys or reduced kidney function for more than 3 months (CDC, 2015). In this study individuals with reduced kidney function that lasts more than 3 months are said to have chronic kidney disease.

 

Renal replacement therapy (RRT)– Renal replacement therapy is the use of alternative measures to take over fully or in part the functions of kidneys in patients that have ESRD (Nigerian Association of Nephrology, 2015). For the purpose of this study individuals who use dialysis or kidney transplant as an alternative measure to take over fully or in part the functions of the kidneys, are said to use renal replacement therapy.