Knowledge, Attitudes, Practices Of Low Protein Dietary And Its Influential Factors In CKD Patients

Background:CKD is currently one of the major public health issues worldwide. The prevalence of chronic kidney disease (CKD) has increased in the U.S. population from 20 million to 26 million people during 1999-2004, Therapy for end-stage renal disease imposes a heavy financial burden to patients, proper evidence-based nutritional therapy and nutrition monitoring may effectively improve the patients’nutrition status and delay the progression of chronic kidney disease.Low protein diet is the most efficient medical nutritional therapy in individuals with CKD stages 1-4.Objective:To test the reliability and validity for the questionnaire of individual’s diet with CKD stages 1-4. to investigate their socio-demographic characteristics, clinical traits, nutrition status etc. To investigate the status of knowledge, attitude and practice (KAP) on low protein diet and related influencing factors. using the non-conditional logistic regression analysis to explore knowledge. attitudes, practice and its influential factors. developing health education strategies in future for the patients with CKD. Maintain nutritional health, and delay progression of CKD.Subject and Methods:1. A questionnaire was designed by reviewing the recently published literatures and combining professional knowledge on LPD,CKD and KAP. Questionnaire’s validity and reliability are proved.2. We did a cross-sectional survey in department of nephrology in Zhongshan hospital.The clinical data of 159 hospitalized patients with CKD stage 1-4 was randomly chosen from Nov.2011 to July.2012.Survey included demographic status, income, anthropometric measurements including height, weight, and blood pressure. Blood biochemical parameters including total protein, albumin, prealbumin, urea nitrogen, serum creatinine, uric acid, glucose, were measured in these patients. investigated the current status of the knowledge, attitudes and practice about low protein diet and analysed the related risk factors. The statistical inference includes t test, chi-square test,logistic regression by spss 17.0.RESULTquestionnaire was found to have good validity and reliability among this study sample, 63% of the 159 CKD inpatients were 1gA in Pathologic diagnosis. The largest portion is in stage 3 of CKD Biochemical examination including systolic pressure, prealbumin, hemoglobin,24-hour urinary creatinine excretion was worse. The higher the stage, the worse the physical status,the result of the trend test analysis has statistical significance..P=0.001,.P=0.007, P=0.001, P=0.009). (P<0.01) There was no significant difference between the score of knowledge,attitude,practice in stage 1 to 4. The situation of knowledge for low protein diet is disappointed,The average score is below 60.The lowest isO.For question "Do you know low protein diet?",60% patients choose the correct answer, about 21.3% know the stage of themselves,. About 18.2% know the knowledge about starch. The score of knowledge was related to education level, medicine care, course of disease and the times to hospital with single factor analysis variance The score of knowledge was related to education level,medicine care, course of disease and the times to hospital with logistic regression analysis. The scores achieved by individuals who are hospitalized more than 3 times was 16 higher than those only one time. The scores achieved by individuals with more than 10 years disease course is 10 high than those only in one year. The lowest scores in attitude survey is "do you want replace rice with wheat starch". The highest score achieved in "do you want information from dietitian" There were no significant difference in all the factors on attitude. The situation of practice on individuals With CKD Stages 1-4 is also disappointed. The average score is below 60 The lowest is 0. For question "Do you know get information about your CKD and diet",61.3% patients choose the correct answer,but only 5 individuals (3.1%)replaced rice with wheat starch in their diets. The score of practice was related to education level, medicine care, course of disease and the times to hospital with. Single factor analysis variance, the higher the education level,the higher score the patient achieved. (P<0.05), the higher the scores of knowledge,the higher score the patient achieved. (P<0.01)。 The score of practice was related to education level, medicine care, course of disease and the times to hospital with logistic regression14. The sums score of KAP was relate education level, residence,course of disease and the times to hospital with single factor analysis variance.15. The sum scores of KAP was relate education level, residence, course of disease and the times to hospital with, with logistic regression16. The higher the education level,the higher scores the patient achieved. (P<0.05),17. The scores achieved by individuals with more than 3 times to hospital was higher than those only one time. The scores achieved by individuals who was graduated from college was higher than those who only from primary school(P<0.001) The scores achieved by individuals who was living Shanghai was higher than those from other provinces. (P<0.05)18. There are no one got 3 by using NRS2002 to screen the nutritional risk for the individuals.Conclusion1. The higher the stage, the worse the physical status, include systolic pressure, prealbumin, hemoglobin,24-hour urinary creatinine excretion.2. There are no one got 3 by using NRS2002 to screen the nutritional risk for the individuals NRS2002 is perhaps not propitious to patients with CKD1-4.3. The factor of knowledge for low protein diet was education level, course of disease and the times to hospital.4. The factor of practice for low protein diet was education level, course of disease, knowledge, attitude and the times to hospital.5. The factor of KAP for low protein diet was education level, course of disease, domicile, and the times to hospital.6. focus on individuals’ education level in mean for developing health education strategies in future for the patients with CKD.7. Strengthen education cause on low protein diet for patients when there are in hospital is the key to improve the patients’ nutrition status.8. Maintain an optimum nutritional status along the continue of CKD stages 1 to medical nutrition therapy by dietitian services for patients.9. Dietitians can provide necessary guidance and support to individuals with CKD. Dietitians are the nutrition information resource for patients with stages 1 to 4.