Association between health-related hope and distress from restrictions in chronic kidney disease and dialysis

Abstract

Background: In chronic kidney disease (CKD), the durability of patient adherence to fluid and dietary restrictions may depend on the degree to which they have hope that they will enjoy life. Previous cross-sectional studies have shown that higher hope was associated with lower distress from fluid and dietary restrictions and better adherence in the short term. In this study, we aimed to examine the long-term relationship of hope with distress from fluid and dietary restrictions.

Methods: This prospective observational cohort study included 444 patients with CKD undergoing dialysis in one of five Japanese nephrology centers. Hope as a predictor was measured using an 18-item health-related hope scale. Outcomes were two-item measures of distress from fluid and dietary intake restrictions using the Japanese version of the Kidney Disease Quality of Life Short Form, Version 1.3 (higher scores indicate lower levels of distress). Multivariate linear mixed models were used to estimate the association of baseline health-related hope with distress from fluid and dietary restrictions at baseline and follow-up.

Results: The mean age of the participants was 67 years, and 31.1% of them were females. In total, 124, 98, and 222 had non-dialysis CKD, peritoneal dialysis, and hemodialysis, respectively. Higher levels of baseline health-related hope were associated with lower levels of distress from fluid restriction after one year (per 10-point increase, 2.6 points (95% confidence interval, 1.0 to 4.1)); whereas the baseline score was not associated with the distress from fluid restriction at 2 years. Similarly, higher levels of baseline health-related hope were associated with lower levels of distress from dietary restriction after one year (per 10-point increase, 2.0 points (95% confidence interval, 0.3 to 3.6)); whereas the baseline score was not associated with the distress from dietary restriction at 2 years.

Conclusions: Health-related hope, regardless of depression, can potentially mitigate long-term distress from fluid and dietary restrictions in patients with a wide range of CKD severities.

Trial registration: UMIN000054710.

Keywords: Chronic kidney disease; Depression scale; Diet restriction; Fluid restriction; Health-related hope.

Fig. 1

Distribution of the HR-Hope score in a histogram. HR-Hope: Health-Related Hope Top left: Overall population; Top right: Subgroup of non-dialysis chronic kidney disease; Bottom left: Subgroup of peritoneal dialysis; Bottom right: Subgroup of hemodialysis

Fig. 2

The distribution and combination of fluid and dietary restriction-related distress scores at baseline. A Sankey diagram was used to depict the combination (flow) of the fluid and dietary restriction-related distress scores measured by the items from the Kidney Disease Quality of Life Short Form, Version 1.3. The height of individual boxes (nodes) on the vertical axis indicates relative proportions. The thickness of the links connecting the boxes for the effects of fluid and dietary restrictions indicates the relative proportions of the combination. Light blue indicates ‘not at all bothered’ (100 points), light khaki indicates ‘somewhat bothered’ (75 points), rose indicates ‘moderately bothered’ (50 points), sienna indicates ‘very much bothered’ (25 points), and maroon indicates ‘extremely bothered’ (0 points). For example, 31.3% of the patients responded with ‘not at all bothered’ for both fluid restriction and dietary restriction. On the other hand, 5.2% and 1.4% of those were ‘not at all bothered’ by fluid restriction but ‘moderately bothered’ or ‘very much bothered’ by dietary restriction, respectively

Fig. 3

Evolution of predicted mean fluid and diet restriction-related distress scores by selected baseline HR-Hope scores. Predicted mean fluid (A) and dietary (B) restriction-related distress scores at selected HR-Hope scores at baseline were derived from the linear mixed effect models presented in Tables 2 and 3, respectively. Red squares, blue circles, and green triangles indicate point estimates of the effects scores for patients, with baseline HR-Hope scores of 20, 60, and 100 points, respectively. Error bars indicate 95% confidence intervals HR-Hope: Health-Related Hope