Abstract
BackgroundAutosomal dominant polycystic kidney disease (PKD) is the most common genetic renal disease and the fourth leading cause of end-stage renal disease in the United States. Although there is no cure for PKD, several treatments are considered to be beneficial, including blood pressure control, exercise, low-salt diet, and high volume water intake. However, levels of understanding of the importance of these treatments and adherence to these recommendations vary among patients. This study explores illness perception models of patients with PKD to reveal barriers in adherence to prescribed therapies; satisfaction with medical care; and sources of medical information.MethodsWe designed a phenomenological interview study to evaluate illness perception models of individuals with PKD. Patients were identified from the national PKD Foundation e-mail distribution list (N = 190) and responded voluntarily to an introductory survey (N = 50). Seventeen PKD patients in the Bay Area were scheduled for one-on-one in-depth interviews with one trained interviewer (W-CT). Open-ended questions administered with an interview guide were used to evaluate patients’ beliefs.ResultsMean age was 56.6 +/− 12 years (range 29–78); 65% were female. Many of the PKD patients in this study were highly motivated and willing to incorporate blood pressure, exercise, low-salt diet, and high volume water intake into their daily routines. Barriers to adherence to these therapies include personal beliefs and confusion due to unclear recommendations.ConclusionsThese findings suggest there is variability between what patients understand about their disease and treatments and what they believe their doctors have told them. Not all physicians focus on lifestyle-based treatments, but the majority of PKD patients in our study are motivated and willing to incorporate blood pressure control, exercise, low-salt diet, and high volume water intake into their daily routines and would like specific recommendations on how to implement these. These findings support a role for further exploring patient beliefs about the disease and its necessary treatments in order to design strategies to improve communication and meet the needs of these patients.
Highlights
Autosomal dominant polycystic kidney disease (PKD) is the most common genetic renal disease and the fourth leading cause of end-stage renal disease in the United States
This study explores illness perception models, focusing most centrally on patients perceptions of treatments needed among patients with PKD to reveal barriers to adherence to prescribed therapies; satisfaction with medical care; and sources of medical information
We found that PKD patients are motivated and willing to incorporate blood pressure control, exercise, low-salt diet, and high volume water intake into their daily routines
Summary
Autosomal dominant polycystic kidney disease (PKD) is the most common genetic renal disease and the fourth leading cause of end-stage renal disease in the United States. There is no cure for PKD, several treatments are considered to be beneficial, including blood pressure control, exercise, low-salt diet, and high volume water intake. Despite the absence of a cure, several recommended treatments may attenuate progression of kidney disease and / or reduce risk of cardiovascular events. These include 1) blood pressure control [4]; 2) exercise [5]; 3) low-salt diet [6]; and 4) high volume water intake [7]. A suppression of the antidiuretic hormone (ADH) with high volume water intake is a known method to attenuate progression of kidney cyst growth [10, 11], and the medication tolvaptan (an ADH antagonist) is currently an approved therapy for PKD in Japan, Canada, and Europe. Many individuals are told to “drink a lot of water” to achieve this effect [7], adherence with this prescription is uncertain
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