Compliance, illiteracy and low-protein diet: multiple challenges in CKD and a case of self-empowerment

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Abstract

Background

Low-protein diets (LPD) are an important means of delaying the need for dialysis and attaining a stable metabolic balance in chronic kidney disease (CKD). Many authors consider a low educational level and illiteracy to be adverse features for a good dietary compliance.

Case presentation

We report the case of a 77-year old woman, illiterate, affected by advanced CKD (stage 4 according to KDIGO guidelines). She was initially ashamed of her problem and did not declare it, leading to an overzealous reduction in protein intake. However, with her daughter’s help, who translated the dietary prescription into images, she overcame the barrier represented by illiteracy and was able to correctly follow the prescriptions, attaining good kidney function stability and preserving an adequate nutritional status.

Conclusions

The case underlines the importance of a personalized approach to dietary prescriptions and suggests that it is possible to achieve a good compliance to the dietary treatment of CKD also in patients with relevant cultural barriers.

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Most cited references 26

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Patient perception of treatment burden is high in celiac disease compared with other common conditions.

Sveta Shah, Mona Akbari, Rohini Vanga … (2014)

The only treatment for celiac disease (CD) is life-long adherence to a gluten-free diet (GFD). Noncompliance is associated with signs and symptoms of CD, yet long-term adherence rates are poor. It is not known how the burden of the GFD compares with other medical treatments, and there are limited data on the socioeconomic factors influencing treatment adherence. In this study, we compared treatment burden and health state in CD compared with other chronic illnesses and evaluated the relationship between treatment burden and adherence.

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Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia

Ataur Khan, Zaki Al-Abdul Lateef, Mohammad A. Al Aithan … (2012)

Purpose: The purpose of the study was to measure the rate of non-compliance and the factors contributing to non-compliance among the diabetic patients in the Al Hasa region of Saudi Arabia. Materials and Methods: A cross-sectional survey was conducted in the Al Hasa region during the period of June 2010 to June 2011. Random sampling was carried out for the selection of 535 diabetic patients from three chronic disease centers in different parts of Al Hasa. The data were collected by means of interviewing questionnaires and file records. Any patient who had been prescribed optimum treatment and was properly advised on diet and exercise for his / her diabetes, but did not follow the medical advice, with Hb1AC of more than 7% at the time of interview, was considered as non-compliant. Results: The overall prevalence of therapeutic non-compliance of the participants was 67.9% (n = 318, 95% CI 63.59 – 72.02%). The non-compliance of males (69.34%) was higher than females (65.45%, P = .003). The non-compliance among the urban participants was significantly higher than (71.04 vs. 60.15%, P = .023) in the rural participants. There was a statistically significant difference in the prevalence rate of non-compliance among the participants with different levels of education. Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender (OR = 1.90, CI =1.32-4.57),level of education (Illiteracy) (OR = 5.27, CI = 4.63 – 7.19), urban population (OR =5.22, CI= 3.65 – 8.22), irregularity of the follow-up (OR = 8.41, CI = 4.90 – 11.92), non-adherence to drug prescription (OR = 4.55 , CI = 3.54 – 5.56), non-adherence to exercise regimen (OR = 5.55, CI = 4.2 6 – 6.), insulin (OR = 1.29, CI = .71 – 1.87), and insulin with oral Metformin (OR = 1.20, CI = .65 – 1.75). Conclusion: The findings indicate that there is a high rate of non-compliance among the diabetes patients in the Al Hasa region of Saudi Arabia and there is a definite need for improvement in the healthcare system, health education, and training of diabetic patients.

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A method for estimating nitrogen intake of patients with chronic renal failure.

Russell T Steinman, Bradley J Maroni, W Mitch (1984)

A method for monitoring dietary compliance would be useful in treating patients with chronic renal failure (CRF). Nineteen nitrogen balances were measured while patients were eating unrestricted diets containing 6.4 to 15.1 g of nitrogen per day and 14 while patients consumed a 20 to 25 g mixed-quality protein ketoacid-supplemented diet containing 5.2 to 6.6 g of nitrogen per day. Urea nitrogen appearance (U) calculated as the sum of urinary urea nitrogen plus the variation in the body urea pool (using changes in serum urea nitrogen and either the 14C urea space or 60% body weight) was correlated with nitrogen intake (r = 0.84). Both methods gave indistinguishable values for U. Total non-urea nitrogen excretion (NUN) and its components did not correlate with dietary nitrogen. NUN averaged 31.3 +/- 2.1 mg N/kg/day and was not different between the two groups or in patients in neutral compared to those in mildly negative or positive nitrogen balance. Nitrogen balance calculated using estimated U and 31 mg N/kg/day was indistinguishable statistically from measured nitrogen balance. Thus, U varies directly with dietary protein intake and can be estimated using urinary urea nitrogen, SUN, and body weight. Total nitrogen excretion can be estimated accurately as U + 31 mg N/kg/day. From the estimated total nitrogen excretion, dietary compliance of CRF patients in approximately neutral nitrogen balance could be assessed. Furthermore, if nitrogen intake were known, nitrogen balance could be estimated.

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Author and article information

Contributors

Stefania Maxia: stefania.maxia@yahoo.it

Valentina Loi: valentina.loi@aol.com

Irene Capizzi: irene.capizzi@gmail.com

Giorgina Barbara Piccoli: gbpiccoli@yahoo.it

Gianfranca Cabiddu: gianfranca.cabiddu@tin.it

Antonello Pani: antonellopani@aob.it

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 29 September 2016

Publication date PMC-release: 29 September 2016

Publication date Collection: 2016

Volume: 17

Electronic Location Identifier: 138

Affiliations

[1 ]SC Nephrology and Dialysis, Brotzu Hospital, Piazzale Alessandro Ricchi 1, 09134 Cagliari, Italy

[2 ]SS Nephrology, SCDU Urologia, Department of Clinical and Biological Sciences, University of Torino, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043 Orbassano, Italy

[3 ]Nephrologie, Centre Hospitalier Le Mans, 194 av. Rubillard, 72037 Le Mans, France

Article

Publisher ID: 353

DOI: 10.1186/s12882-016-0353-0

PMC ID: 5041291

PubMed ID: 27683011

SO-VID: d967b4eb-a7b4-4a52-8896-58f23a7e72a6

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 8 April 2016

Date accepted : 22 September 2016

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: case report,illiteracy,low protein diet,chronic kidney disease,compliance

Data availability:

ScienceOpen disciplines: Nephrology

Keywords: case report, illiteracy, low protein diet, chronic kidney disease, compliance

Compliance, illiteracy and low-protein diet: multiple challenges in CKD and a case of self-empowerment

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Abstract

Background

Case presentation

Conclusions

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Most cited references 26

Patient perception of treatment burden is high in celiac disease compared with other common conditions.

Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia

A method for estimating nitrogen intake of patients with chronic renal failure.

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