Clinical significance and correlation of compliance to thirst in maintenance hemodialysis patients

Abstract

BACKGROUND:

The main treatment method for end-stage renal disease (ESRD) is maintenance hemodialysis (MHD). With the continuous improvement of dialysis technology, the survival period of MHD patients has been effectively prolonged, but dialysis technology still cannot completely replace renal function.

OBJECTIVE:

To study the dietary compliance and its correlation with thirst in MHD patients and to provide guidance for clinical development of corresponding intervention countermeasures.

METHODS:

A total of 90 patients who received MHD treatment from March 2021 to March 2022 were selected as objects. The Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ) were used to analyze the dietary compliance and thirst status of patients. Pearson correlation analysis was used to analyze the correlation between diet compliance and thirst.

RESULTS:

Positive correlations were found between VAS and DTI, SXI and TDS ( $P<$ 0.05). Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and compliance in facing difficulties ( $P<$ 0.05), and negatively correlated with self-care compliance ( $r=-$ 0.35, $P<$ 0.05). Health attitude was positively correlated with VAS, DTI and SXI ( $P<$ 0.05). Acceptance attitude was positively correlated with DTI, SXI and TDS ( $P<$ 0.05). High RAAQ was associated with high VAS ( $b=$ 0.11, 95% CI: 0.05, 0.18), DTI ( $b=$ 0.28, 95% CI: 0.17, 0.38), SXI ( $b=$ 0.24, 95% CI: 0.14, 0.34) and TDS ( $b=$ 0.26, 95% CI: 0.13, 0.4).

CONCLUSION:

The overall performance of dietary compliance in patients with MHD is at a moderate level, and dietary compliance is negatively correlated with disease perception.

Keywords

End-stage renal disease maintenance hemodialysis thirst RAAQ RABQ

1. Introduction

End-stage renal disease (ESRD) is a stage of renal disease in which chronic kidney disease (CKD) develops to progressive renal failure after the end stage [1, 2]. The main treatment method is maintenance hemodialysis (MHD) [3]. With the continuous improvement of dialysis technology, the survival period of MHD patients has been effectively prolonged, but dialysis technology still cannot completely replace renal function.

Many previous studies have pointed out that the therapeutic effect of MHD, quality of life after dialysis and survival cycle are all affected by patient compliance, among which dietary compliance can have a profound impact on the treatment and prognosis of MHD patients [4, 5, 6, 7]. However, excessive fluid intake due to thirst, dry mouth and other factors is a barrier to MHD patients’ compliance with restricted diet. Compared with the normal population, dialysis patients are more likely to have degeneration of the salivary and lacrimal glands, manifested as decreased secretion of saliva and tears, leading to dry mouth [8, 9]. Thirst is caused by hypertonicity and hypovolemia. When extracellular fluid osmolarity increases, it stimulates osmotic receptors, excites the thirsty center, and causes thirst. When the body’s blood volume is reduced, the kidneys are stimulated to release renin, which activates the renin-angiotensin system, and angiotensin II stimulates the thirst sensory center, causing thirst [11, 12]. According to the World Health Organization (WHO), health systems need to develop methods for assessing adherence and its associated factors with the aim of improving treatment interventions. Thus, one of the instruments cited in the international literature to assess adherence to hemodialysis treatment, which has adequate psychometric quality, includes the Renal Adherence Attitude Questionnaire (RAAQ) and the Renal Adherence Behavior Questionnaire (RABQ).

We investigated the clinical significance and related factors between thirst and the dietary compliance. The potential effects of the dietary compliance and its correlation with thirst in maintenance hemodialysis patients and to provide guidance for clinical development of corresponding intervention countermeasures.

2. Materials and methods

2.1 Patients and study protocol

This study was approved by ethics committees of the First Affiliated Hospital of Nanjing Medical University, Nanjing, China, and adhered to the Declaration of Helsinki. Informed consent was also obtained from each participant. The inclusion criteria were as follows: $\geqslant$ 3 months, dialysis 2 $\sim$ 3 times a week, 4 h each time on hemodialysis (HD); $\geqslant$ 18 years of age; mentally and physically being able to participate and complete the study; with stable clinical conditions including stable dry weight and hematocrit. Patients who were possessing hemodynamic instability preventing sufficient ultrafiltration, hospitalization within the preceding 3-month, dementia, cancer, oral or terminal diseases and unwilling to participate in this study were excluded.

Finally, ninety MHD patients undergoing HD were included in our study and observed in the dialysis center of the First Affiliated Hospital of Nanjing Medical University. The clinical characteristics and dialytic data were recorded.

2.2 Assessment of thirst and xerostomia

Thirst was assessed by the dialysis thirst inventory (DTI), 100-mm self-rating visual analog scales (VAS), simplified oral dryness scale (SXI), thirst distress scale, (TDS).

DTI quantified the occurrence of thirst before, during and after dialysis, and perceived thirst during day and night [13]. Each item had a 5-point Likert-type scale (‘never’ $=$ 1 to ‘very often’ $=$ 5). The responses to the five items were summed, which results in a score ranging from 5 (never thirsty) to 25 (very often thirsty).

VAS was defined as the negative and the positive on the left and right, respectively ( $e . g .$ , 100 mm $=$ extremely thirst) [14].

TDS contains six measures. It measures thirst distress on a scale of 1–5. The assessment content of this scale includes the frequency, duration and pain of thirst, and can be used in combination with the visual analog scale to assess all dimensions of thirst.

SXI was used to assess oral dryness in patients with MHD, using a Likert 5-level score.

2.3 Renal disease dietary compliance scale

The RAAQ and RABQ were used. The RAAQ includes 4 dimensions of social restriction attitude, health attitude, self-care attitude and acceptance attitude, and 26 items. The scale is scored by Likert 5-point scoring method, and “completely disagree” and “completely agree” were calculated from 1 to 5 points. RABQ was developed by Rushe and McGee and includes 5 dimensions and 25 items, including compliance with fluid restriction, compliance with potassium intake, self-care compliance, salt intake compliance and compliance in the face of difficulties. The scale adopts the Likert 5 grading method, and the scores of “never” and “always” were 1 to 5 points, respectively. Higher scale scores indicate better dietary compliance.

2.4 Statistical analysis

Data were expressed as mean $\pm$ SD. Data were analyzed by ANOVA and spearman correlation coefficient was used to assess the correlations between continuous variables. Factors including multiple linear regressions with stepwise selection were identified and independently associated with the score of VAS thirst, DTI, VAS xerostomia, and XI. All statistical analyses were conducted using the statistical software package SPSS 13.0 at the two-tailed significance level of 0.05.

3. Results

3.1 Observational study

90 MHD patients (63 men and 27 women) were enrolled in the observational study. The median (IQR) age was 64.00 (51.00, 71.75) years. Years for the HD were $<$ 1 (10.0%), 1–5 (35.6%), 6–10 (27.8%) and $>$ 10 (26.7%). Causes for the chronic renal failure were polycystic kidney (31.1%), hypertension (33.3%), glomerulonephritis (13.3%) and diabetes (22.2%). Daily water intake was $<$ 100 ml (2.2%), 100–400 ml (30.0%), 401–800 ml (41.1%), 801–1000 ml (14.4%) and $>$ 1000 ml (12.2%). The clinical characteristics and dialytic data were presented in Table 1.

Table 1
The clinical characteristics and dialytic data

Variables	Total ( $n=$ 90)	Women ( $n=$ 27)	Men ( $n=$ 63)	$p$
Age, median (IQR)	64.00 (51.00, 71.75)	64.00 (50.00, 70.50)	64.00 (51.00, 72.00)	0.734
Standard of culture, $n$ (%)				0.414
Primary school and below	34 (37.8)	13 (48.1)	21 (33.3)
Junior high school/secondary school	20 (22.2)	5 (18.5)	15 (23.8)
High school and above	36 (40.0)	9 (33.3)	27 (42.9)
Per capita monthly household income, $n$ (%)				0.673
$<$ 3000	14 (15.6)	5 (18.5)	9 (14.3)
3001–5000	43 (47.8)	14 (51.9)	29 (46.0)
$>$ 5000	33 (36.7)	8 (29.6)	25 (39.7)
Smoking, $n$ (%)				0.003
No	66 (73.3)	26 (96.3)	40 (63.5)
Yes	24 (26.7)	1 (3.7)	23 (36.5)
Self-care ability, $n$ (%)				0.162
Fully independent	72 (80.9)	18 (69.2)	54 (85.7)
Partial self-care	15 (16.9)	7 (26.9)	8 (12.7)
Unable to care for themselves	2 (2.2)	1 (3.8)	1 (1.6)
Dialysis life, $n$ (%)				0.65
$<$ 1	9 (10.0)	2 (7.4)	7 (11.1)
1–5	32 (35.6)	8 (29.6)	24 (38.1)
6–10	25 (27.8)	10 (37.0)	15 (23.8)
$>$ 10	24 (26.7)	7 (25.9)	17 (27.0)
Causes for the chronic renal failure, $n$ (%)				0.336
Polycystic kidney	28 (31.1)	11 (40.7)	17 (27.0)
Hypertension	30 (33.3)	9 (33.3)	21 (33.3)
Glomerulonephritis	12 (13.3)	4 (14.8)	8 (12.7)
Diabetes	20 (22.2)	3 (11.1)	17 (27.0)
Height .cm., Median (IQR)	170.00 (163.00, 175.00)	160.00 (158.00, 164.50)	172.00 (170.00, 176.00)	$<$ 0.001
Dry dialysis weight.kg., Mean $\pm$ SD	64.47 $\pm$ 14.01	56.10 $\pm$ 14.74	68.06 $\pm$ 12.12	$<$ 0.001
Net surplus.kg., Median (IQR)	2.50 (2.00, 3.00)	2.20 (2.00, 2.75)	2.50 (2.00, 3.15)	0.13
Daily water intake, ml, $n$ (%)				0.885
$<$ 100	2 (2.2)	0 (0.0)	2 (3.2)
100–400	27 (30.0)	10 (37.0)	17 (27.0)
401–800	37 (41.1)	10 (37.0)	27 (42.9)
801–1000	13 (14.4)	4 (14.8)	9 (14.3)
$>$ 1000	11 (12.2)	3 (11.1)	8 (12.7)

3.2 Correlation matrix between RAAQ, RABQ and thirst

VAS was positively correlated with DTI, SXI and TDS in pairs ( $P<$ 0.05). RAAQ was positively correlated with VAS, DTI, SXI and TDS ( $P<$ 0.05), but not correlated with RABQ. There was no correlation between RABQ and the remaining variables (Table 2).

Table 2
The correlation matrix of RAAQ, RABQ and each thirst evaluation index

	VAS	DTI	SXI	TDS	RAAQ	RABQ
VAS	1.00	0.79^∗	0.77^∗	0.57^∗	0.46^∗	$-$ 0.10
DTI	0.79^∗	1.00	0.81^∗	0.68^∗	0.58^∗	$-$ 0.10
SXI	0.77^∗	0.81^∗	1.00	0.78^∗	0.57^∗	$-$ 0.02
TDS	0.57^∗	0.68^∗	0.78^∗	1.00	0.57^∗	$-$ 0.06
RAAQ	0.46^∗	0.58^∗	0.57^∗	0.57^∗	1.00	0.06
RABQ	$-$ 0.10	$-$ 0.10	$-$ 0.02	$-$ 0.06	0.06	1.00

Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and adherence to difficulties ( $P<$ 0.05), and negatively correlated with self-care compliance ( $r=-$ 0.35, $P<$ 0.05) (Table 3). Health attitude was positively correlated with VAS, DTI and SXI ( $P<$ 0.05), but not correlated with TDS. There was no correlation between self-care attitude and VAS, DTI, SXI and TDS. Acceptance attitude was not correlated with VAS, but positively correlated with DTI, SXI and TDS ( $P<$ 0.05). There was no correlation between the RABQ dimensions (fluid restriction, potassium intake, self-care, facing difficulties, and salt intake compliance) and VAS, DTI, SXI, and TDS.

High RAAQ was associated with high VAS ( $b=$ 0.11, 95% CI: 0.05, 0.18), but there was no linear relationship between RABQ and VAS. Other factors affecting VAS were age and self-care ability (Table 4).

Table 3

The correlation matrix between each dimension

	VAS		DTI		SXI		TDS		Social constraints		Health		Care for oneself		Acceptance		Fluid restriction		Potassium intake		Self care		Face the difficulties		Salt intake
VAS	1		0	.79^∗	0	.77^∗	0	.57^∗	0	.53^∗	0	.27	0	.04	0	.31	0	.1	$-$ 0	.22	$-$ 0	.23	0	.04	$-$ 0	.18
DTI	0	.79^∗	1		0	.81^∗	0	.68^∗	0	.62^∗	0	.31	0	.13	0	.42^∗	0	.1	$-$ 0	.23	$-$ 0	.33	0	.18	$-$ 0	.3
SXI	0	.77^∗	0	.81^∗	1		0	.78^∗	0	.61^∗	0	.31	0	.11	0	.47^∗	0	.18	$-$ 0	.26	$-$ 0	.22	0	.2	$-$ 0	.3
TDS	0	.57^∗	0	.68^∗	0	.78^∗	1		0	.59^∗	0	.37^∗	0	.23	0	.46^∗	0	.06	$-$ 0	.13	$-$ 0	.24	0	.14	$-$ 0	.2
Social constraints	0	.53^∗	0	.62^∗	0	.61^∗	0	.59^∗	1		0	.67^∗	0	.18	0	.66^∗	0	.19	$-$ 0	.26	$-$ 0	.35	0	.24	$-$ 0	.09
Health	0	.27^∗	0	.31^∗	0	.31^∗	0	.37^∗	0	.67^∗	1		0	.47^∗	0	.68^∗	0	.05	$-$ 0	.17	$-$ 0	.13	0	.07	0	.01
Care for oneself	0	.04	0	.13	0	.11	0	.23^∗	0	.18	0	.47^∗	1		0	.46^∗	0	.1	0	.01	$-$ 0	.07	0	.12	$-$ 0	.09
Acceptance	0	.31^∗	0	.42^∗	0	.47^∗	0	.46^∗	0	.66^∗	0	.68^∗	0	.46^∗	1		0	.28	$-$ 0	.18	$-$ 0	.15	0	.23	$-$ 0	.28
Fluid restriction	0	.1	0	.1	0	.18	0	.06	0	.19	0	.05	0	.1	0	.28^∗	1		0	.27	$-$ 0	.05	0	.67^∗	$-$ 0	.15
Potassium intake	$-$ 0	.22^∗	$-$ 0	.23^∗	$-$ 0	.26^∗	$-$ 0	.13	$-$ 0	.26^∗	$-$ 0	.17	0	.01	$-$ 0	.18	0	.27^∗	1		0	.09	0	.28	0	.37^∗
Self care	$-$ 0	.23^∗	$-$ 0	.33^∗	$-$ 0	.22^∗	$-$ 0	.24^∗	$-$ 0	.35^∗	$-$ 0	.13	$-$ 0	.07	$-$ 0	.15	$-$ 0	.05	0	.09	1		$-$ 0	.29	$-$ 0	.02
Face the difficulties	0	.04	0	.18	0	.2	0	.14	0	.24^∗	0	.07	0	.12	0	.23^∗	0	.67^∗	0	.28^∗	$-$ 0	.29^∗	1		$-$ 0	.02
Salt intake	$-$ 0	.18	$-$ 0	.30^∗	$-$ 0	.30^∗	$-$ 0	.2	$-$ 0	.09	0	.01	$-$ 0	.09	$-$ 0	.28^∗	$-$ 0	.15	0	.37^∗	$-$ 0	.02	$-$ 0	.02	1

Table 4

The linear regression results of RAAQ and RABQ with VAS

	b (95% CI)		SE	$P$	Wald
RAAQ	0.11	(0.05, 0.18)	0.03	0.00	12.81
RABQ	$-$ 0.07	( $-$ 0.17, 0.03)	0.05	0.16	1.98
Age	0.05	(0.01, 0.09)	0.02	0.03	5.19
Gender	$-$ 0.3	( $-$ 1.68, 1.07)	0.69	0.66	0.19
Degree of education	$-$ 0.17	( $-$ 0.82, 0.49)	0.33	0.62	0.26
Per capita monthly household income	$-$ 0.37	( $-$ 1.2, 0.45)	0.41	0.37	0.81
Smoking	0.72	( $-$ 0.43, 1.88)	0.58	0.22	1.56
Self care ability	1.13	(0.05, 2.21)	0.54	0.04	4.39
Duration of dialysis	0.23	( $-$ 0.26, 0.72)	0.25	0.35	0.88
diabetes	$-$ 0.83	( $-$ 2.18, 0.53)	0.68	0.23	1.47
Glomerulonephritis	$-$ 0.02	( $-$ 1.6, 1.57)	0.80	0.99	0.00
Polycystic kidney and others	$-$ 0.77	( $-$ 1.9, 0.36)	0.57	0.18	1.84
Height (m)’	$-$ 2.88	( $-$ 12.56, 6.81)	4.86	0.56	0.35
Dialysis dry weight (kg)’	0.01	( $-$ 0.05, 0.06)	0.03	0.80	0.07
Net output (kg)’	0.23	( $-$ 0.68, 1.15)	0.46	0.61	0.26
Water intake per day	0.34	( $-$ 0.21, 0.9)	0.28	0.22	1.53

High RAAQ was associated with high DTI ( $b=$ 0.28, 95% CI: 0.17, 0.38), but there was no linear relationship between RABQ and DTI. Other factors affecting DTI were age, daily water intake and self-care ability (Table 5).

Table 5

The linear regression results of RAAQ and RABQ with DTI

	$\beta$ (95% CI)		SE	$P$	Wald
RAAQ	0.28	(0.17, 0.38)	0.05	0	28.23
RABQ	$-$ 0.12	( $-$ 0.28, 0.05)	0.08	0.159	2.03
Age	0.08	(0.01, 0.15)	0.04	0.027	5.13
Gender	$-$ 0.15	( $-$ 2.43, 2.14)	1.15	0.898	0.02
Degree of education	$-$ 0.09	( $-$ 1.17, 0.99)	0.54	0.867	0.03
Per capita monthly household income	$-$ 1.52	( $-$ 2.89, $-$ 0.15)	0.69	0.031	4.87
Smoking	0.56	( $-$ 1.36, 2.48)	0.96	0.561	0.34
Self care ability	2.27	(0.48, 4.06)	0.9	0.014	6.39
Duration of dialysis	0.01	( $-$ 0.8, 0.83)	0.41	0.979	0
Diabetes	$-$ 1.44	( $-$ 3.7, 0.82)	1.13	0.207	1.62
Glomerulonephritis	$-$ 1.35	( $-$ 3.99, 1.29)	1.33	0.311	1.04
Polycystic kidney and others	$-$ 1.64	( $-$ 3.52, 0.24)	0.94	0.086	3.04
Height (m)’	$-$ 0.88	( $-$ 16.98, 15.22)	8.08	0.914	0.01
Dialysis dry weight (kg)’	0.02	( $-$ 0.07, 0.12)	0.05	0.615	0.26
Net output (kg)’	$-$ 0.06	( $-$ 1.58, 1.46)	0.76	0.937	0.01
Water intake per day	1.13	(0.21, 2.06)	0.46	0.017	5.97

High RAAQ was associated with high DTI ( $b=$ 0.24, 95% CI: 0.14, 0.34), and there was no linear relationship between RABQ and SXI. Other influencing factors of SXI were age, self-care ability, polycystic kidney disease and other causes and net expenditure (Table 6).

Table 6

The linear regression results of RAAQ and RABQ with SXI

	$\beta$ (95% CI)		SE	$P$	Wald
RAAQ	0.24	(0.14, 0.34)	0.05	0	21.68
RABQ	$-$ 0.1	( $-$ 0.26, 0.07)	0.08	0.243	1.39
Age	0.11	(0.04, 0.18)	0.03	0.003	9.38
Gender	$-$ 1.16	( $-$ 3.41, 1.1)	1.13	0.311	1.04
Degree of education	$-$ 0.03	( $-$ 1.1, 1.04)	0.54	0.953	0
Per capita monthly household income	$-$ 0.94	( $-$ 2.3, 0.41)	0.68	0.17	1.92
Smoking	0.65	( $-$ 1.25, 2.55)	0.95	0.498	0.46
Self care ability	2.62	(0.85, 4.39)	0.89	0.004	8.73
Duration of dialysis	0.06	( $-$ 0.74, 0.87)	0.4	0.88	0.02
Diabetes	$-$ 2.1	( $-$ 4.33, 0.14)	1.12	0.065	3.51
Glomerulonephritis	$-$ 0.68	( $-$ 3.28, 1.93)	1.31	0.607	0.27
Polycystic kidney and others	$-$ 1.89	( $-$ 3.74, $-$ 0.03)	0.93	0.046	4.12
Height (m)’	$-$ 6.87	( $-$ 22.77, 9.03)	7.98	0.392	0.74
Dialysis dry weight (kg)’	0.01	( $-$ 0.08, 0.11)	0.05	0.804	0.06
Net output (kg)’	1.7	(0.2, 3.19)	0.75	0.027	5.1
Water intake per day	0.44	( $-$ 0.48, 1.35)	0.46	0.343	0.91

High RAAQ was associated with high TDS ( $b=$ 0.26, 95% CI: 0.13, 0.4), but there was no linear relationship between RABQ and TDS. Other factors affecting TDS were self-care ability and net output (Table 7).

Table 7

The linear regression results of RAAQ and RABQ with TDS

	$\beta$ (95% CI)		SE	$P$	Wald
RAAQ	0.26	(0.13, 0.4)	0.07	0	15.57
RABQ	$-$ 0.12	( $-$ 0.33, 0.09)	0.11	0.245	1.37
Age	0.06	( $-$ 0.03, 0.15)	0.05	0.226	1.49
Gender	$-$ 0.75	( $-$ 3.67, 2.17)	1.47	0.612	0.26
Degree of education	0.45	( $-$ 0.93, 1.84)	0.69	0.518	0.42
Per capita monthly household income	$-$ 0.76	( $-$ 2.51, 1)	0.88	0.393	0.74
Smoking	$-$ 0.44	( $-$ 2.9, 2.01)	1.23	0.72	0.13
Self care ability	2.79	(0.51, 5.08)	1.15	0.017	5.93
Duration of dialysis	0.21	( $-$ 0.83, 1.25)	0.52	0.687	0.16
Diabetes	$-$ 2.81	( $-$ 5.7, 0.07)	1.45	0.056	3.78
Glomerulonephritis	$-$ 1.68	( $-$ 5.05, 1.7)	1.69	0.325	0.98
Polycystic kidney and others	$-$ 1.63	( $-$ 4.02, 0.77)	1.2	0.181	1.83
Height (m)’	$-$ 0.72	( $-$ 21.29, 19.86)	10.32	0.945	0
Dialysis dry weight (kg)’	$-$ 0.02	( $-$ 0.14, 0.1)	0.06	0.726	0.12
Net output (kg)’	2.46	(0.53, 4.4)	0.97	0.013	6.43
Water intake per day	$-$ 0.37	( $-$ 1.55, 0.81)	0.59	0.531	0.4

4. Discussion

MHD has become the most commonly used renal replacement therapy for patients with ESRD in China. Hemodialysis has prolonged the survival time of MHD patients. However, the existence of some complications, the limited economic ability of patients and the limitations of dialysis treatment lead to a variety of psychological and physiological symptoms in the process of dialysis treatment, among which thirst has become one of the main typical symptoms of MHD patients [15, 16, 17, 18]. This study investigated and analyzed the RAAQ and RABQ in maintenance hemodialysis patients, and explored the clinical significance of compliance and its correlation with thirst in maintenance hemodialysis patients. In this study a total of 90 patients (63 men and 27 women) who received maintenance hemodialysis from March 2021 to March 2022 were selected as the research objects.

In recent years, the incidence of CKD has been increasing year by year due to the influence of population aging and the increase of underlying diseases such as diabetes and hypertension, and with the development of CKD to the end stage, renal failure is gradually manifested [19]. The clinical characteristics showed the causes for the chronic renal failure were polycystic kidney (31.1%), hypertension (33.3%), glomerulonephritis (13.3%) and diabetes (22.2%). The median (IQR) age was 64.00 (51.00, 71.75) years, more than half of the new dialysis patients are elderly. The number of MHD patients in China has exceeded 1 000 000 and number of elderly patients is increasing. Due to the increasing incidence of diabetes, hypertension and other basic diseases, the proportion of maintenance hemodialysis patients in the elderly population has gradually increased. Elderly MHD patients have a longer dialysis age, a higher risk of complications, a relatively poor dialysis tolerance, a longer dialysis time, prominent psychological problems, malnutrition and other problems, and a relatively higher risk of death [20, 21, 22]. Therefore, it is necessary to strengthen the attention of elderly MHD patients.

Previous studies found that the incidence of thirst in the general population was 10%–46%, and that in MHD patients was 30.9%–95.0% [23]. In our study, the clinical dialytic data showed patients daily water intake were half had more than 400 ml (67.7%) and the dialysis dry weight was 64.47 $\pm$ 14.01. If thirst cannot be relieved in time, it often leads to unrestricted water intake and excessive interdialytic weight gain, resulting in volume overload and increasing the risk of cardiovascular and cerebrovascular complications and death.

Studies have shown that IDWG is positively correlated with VAS and DTI [24]. In Kara’s study, patients with higher IDWG tended to have higher levels of thirst distress [23]; High IDWG leads to weekly supplemental dialysis, which results in decreased quality of life and increased costs [25]. In addition, thirst can lead to psychological changes such as depression, anxiety and discomfort in MHD patients, and it has been shown that high scores on the VAS thirst scale are associated with significantly reduced quality of life [26, 27, 28]. In our study, positive correlations between VAS and DTI, SXI and TDS ( $P<$ 0.05). Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and compliance in facing difficulties ( $P<$ 0.05), and negatively correlated with self-care compliance ( $r=-$ 0.35, $P<$ 0.05). Health attitude was positively correlated with VAS, DTI and SXI ( $P<$ 0.05). Acceptance attitude was positively correlated with DTI, SXI and TDS ( $P<$ 0.05).

In addition, high RAAQ was associated with high VAS ( $b=$ 0.11, 95% CI: 0.05, 0.18), DTI ( $b=$ 0.28, 95% CI: 0.17, 0.38), SXI ( $b=$ 0.24, 95% CI: 0.14, 0.34) and TDS ( $b=$ 0.26, 95% CI: 0.13, 0.4). The overall performance of dietary compliance in patients with maintenance hemodialysis is at a moderate level, and dietary compliance is negatively correlated with disease perception. Reported dietary adherence was significantly correlated with VAS, DTI, SXI, and DTI, suggesting the validity of the reported adherence score. This study explored the dietary compliance and its correlation with thirst in maintenance hemodialysis patients, so as to provide guidance for clinical development of corresponding intervention strategies.

5. Conclusion

Dialysis machines are classified as a type of medical device with moderate and high risk therefore significant requirements are placed on their safety and performance every time they are used on patients [29, 30]. The condition of patients with CKD can be effectively controlled, and the maintenance hemodialysis patients can achieve regular dialysis is closely related to their own compliance [31, 32]. If the patient’s diet compliance is poor, cannot follow the dietary restrictions, water intake restrictions, etc., it will seriously affect the dialysis effect, increase the frequency of temporary dialysis and medical expenses, thus reducing the quality of life. Moreover, artificial intelligence (AI) has been drawing attention in the field of medical devices and a novel method for conformity assessment testing of dialysis machines for post-market surveillance purposes has been reported [33, 34].

Data availability

The data used to support the findings of this study are included within the article.

Author contribution

Guarantor of integrity of the entire study: Yanyan Pan; Study concepts: Yanyan Pan, Guozhen Sun; Study design: Yanyan Pan, Guozhen Sun; Definition of intellectual content: Yanyan Pan, Xiujuan Wu, Guozhen Sun; Literature research: Yanyan Pan; Clinical studies: Yanyan Pan, Xiujuan Wu, Xiaolin Lv; Experimental studies: Yanyan Pan, Yamei Zhu, Xiaolin Lv; Data acquisition: Yanyan Pan, Miao Zhu, Tingting Zhang, Lanlan Gao; Data analysis: Yanyan Pan, Xiujuan Wu, Xiaolin Lv; Statistical analysis: Yanyan Pan, Xiaolin Lv; Manuscript preparation: Yanyan Pan; Manuscript editing: Yanyan Pan, Xiaolin Lv; Manuscript review: Yanyan Pan, Guozhen Sun.

Ethics statement

This study was approved by the Ethics Committee of First Affiliated Hospital of Nanjing Medical University. Written informed consent was obtained from all patients.

Funding

No funding support was received for this study.

Footnotes

Acknowledgments

None to report.

Conflict of interest

The authors declare that there are no conflicts of interest in this work.

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Clinical significance and correlation of compliance to thirst in maintenance hemodialysis patients

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Materials and methods

2.1 Patients and study protocol

2.2 Assessment of thirst and xerostomia

2.3 Renal disease dietary compliance scale

2.4 Statistical analysis

3. Results

3.1 Observational study

Table 1 The clinical characteristics and dialytic data

Table 2 The correlation matrix of RAAQ, RABQ and each thirst evaluation index

5. Conclusion

Data availability

Author contribution

Ethics statement

Funding

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
The clinical characteristics and dialytic data

Table 2
The correlation matrix of RAAQ, RABQ and each thirst evaluation index