The effects of supported shared-care and hemodialysis self-care on patient psychological well-being, interdialytic weight gain, and blood pressure control.

Abstract

Traditionally hemodialysis (HD) treatments are undertaken by dialysis staff. Self-care has been reported to improve psychological well-being and treatment compliance for patients with chronic diseases. We evaluated our shared-care HD program to determine whether shared-care benefits patients. We reviewed the electronic health care and HD sessional records and psychological distress thermometer (DT) scores of patients in our HD centers. HD shared care was classified as grade 0-none, grade 1 patients weighing themselves and measuring blood pressure (BP), grade 2 performs HD, and grade 3 additionally troubleshoots problems. We reviewed 675 HD patients; mean age 64.1 ± 16.3 years, 62.3% male, 45.9% diabetic, Stoke-Davies co-morbidity grade 1 (1-1), frailty score 4 (3-5), DT 3 (0-5). 60.3% performed no shared care, 19% grade 1, 14.8% grade 2, and 6% grade 3. Patients performing more shared care were younger, less frail, less co-morbid, and physically stronger. We then propensity matched 113 patients with grade ≥ 2 shared care for age and frailty with 113 no shared-care patients. Fewer shared-care patients were prescribed antihypertensives (50.7 vs. 70.7%, P < 0.01), and had lower serum N terminal probrain natriuretic peptide 3033 (1083-8502) vs. 4814(1514-135821) pg/mL), phosphate (1.62 ± 0.49 vs. 1.78 ± 0.62 mmol/L), and higher albumin (40.7 ± 4.3 vs. 38.0 ± 4.3 g/L), all P < 0.05 but no differences in psychological DT scores. Although there was no significant benefit in psychological well-being, as measured by the self-reported DT, patients performing more shared care demonstrated other benefits in terms of blood pressure and volume control.