Associations between Blood Pressure and the Adherence to Fluid, Diet, and Medication among Children Undergoing Hemodialysis in the Gaza Strip

Afaf Abdul Latif Abu Nimer
عفاف عبد اللطبف أبو نمر
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Al-Quds University
Chronic kidney disease is a progressive and irreversible kidney damage associated with decreased glomerular filtration rate. This purpose of the study was to identify the relationship between adherence to diet, fluid, medication, and blood pressure in pediatric patients with CKD undergoing hemodialysis in governmental hospitals in Gaza Strip. The study utilized a descriptive, cross-sectional design. The population of the study consisted of 49 children, and the sample of the study consisted of 43 children with CKD and undergoing hemodialysis (census) with response rate 87.7%. The researcher developed a questionnaire for data collection. The questionnaire consisted of sociodemographic characteristics, adherence to diet, adherence to fluid restriction, measurement of Blood Pressure, role of the nurse in monitoring adherence, and Morisky Medication Adherence Scale (MMAS). The questionnaire distributed to a panel of experts for content validity, and a pilot study carried out on 20 children to check reliability of the questionnaire, and Cronbache alpha for the role of the nurses in monitoring the adherence was 0.79 and for MMAS was 0.92. The researcher used SPSS version 22 for data analysis. Statistical analysis included frequencies, percentage, means, standard deviation, independent (t) test, One way ANOVA, and Pearson correlation test. The results showed that 69.8% of study participants were male children and 30.2% were female children, with mean age 11.78±4.52 years, 44.2% had primary school education and 30.2% were preschoolers. In addition, 88.4% of study participants had hypertension, and on dialysis for 6 months to 8 years with mean 3.73±2.26 year. Furthermore, The results indicated poor adherence to diet as pre-dialysis serum K+ ranged from 4.27 to 7.27 mg/dl (m= 5.49±0.77 mg/dl), pre-dialysis serum PO4 ranged from 2.67 to 11.83 mg/dl (m= 6.52±1.98 mg/dl), pre-dialysis serum BUN ranged from 55.33 to 292.0 mg/dl (m= 161.04±52.42 mg/dl). Interdialytic weight gain ranged from 0.10 g to 3.83 kg (m= 1.73±0.86 kg). The results also indicated low adherence to antihypertensive medication among CKD patients with mean score 4.5 on Morisky scale with 84.2% of children lad low adherence to medication.The nurses showed high level (95.65%) of monitoring the adherence of their patients concerning diet, fluid intake, and medication. In general, the results showed that 7% of study participants were fully adhered to diet, 88.4% were fully adhered to fluids intake, and 36.8% were fully adhered to anti-hypertensive medication. Mean systolic BP at pre-dialysis phase was 129.66±19.50 mmHg and mean diastolic BP was 78.58±13.52 mmHg. There was statistically significant correlation between diastolic BP and fluid intake (P= 0.03), diet and medication (P= 0.04), and between BP and number of hours per session of dialysis. There were statistically no significant differences in SBP and DBP related to gender, age, place of residency, family income, parents’ level of education, and years on dialysis, while secondary school children had significant higher DBP, and children from Al Rantesy hospital had significantly lower SBP and DBP. In addition, 12 years old and more and secondary schoolchildrenshowed higher adherence to fluid intake. Moreover, children on dialysis for less than five years had higher level of BUN and lower adherence to fluid intake. The study concluded that interventions should focus on both patient factors and system problems that compromise the patient's ability to adhere to treatment program. However, nurses’ role is important in identifying barriers to adherence, and offer strategies to help patients improve adherence to treatment program.