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

Abstract

Introduction: 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. Methods: 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. Findings: 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. Discussion: 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.