Non-disease Specific Factors And The Effectiveness Of Intervention On Chronic Kidney Disease And Mineral Metabolic Bone Disorder

Objectives1 To develop a valid and reliable questionnaire that could be specific to patients with chronic kidney disease and mineral and bone disorder(CKD-MBD).2 To investigate and analyze the non-disease-specific factors of patients with CKD-MBD.3 To develop an advanced practice nurse-led continuity of care program for patients with CKD-MBD and to test the effectiveness of this program.Method1 Both of referring to relevant literatures, expert consultation and group discussion were combined to develop and estimate the CKD-MBD knowledge and behavior questionnaire(CKD-MBD-KB). 313 and 295 participants respectively accepted the questionnaire investigation. Correlation procedure, factor analysis and Alpha coefficient were employed to rescreen the items. Reliability testing and validity testing were conducted to analyze the psychometric properties of questionnaire.2 A multicentered, cross-sectional design study was adopted. A total of 397 maintained hemodialysis(MHD) patients were included. Univariate analysis was performed to test the relationship between serum phosphorus, corrected calcium and intact parathyroid hormone(i PTH) and four categories of relevant factors. Logistic regression was adopted to analyze the independent relevant factors of CKD-MBD.3 A randomized controlled trial was conducted. A total of 173 participants were randomly assigned into interventional group(n=87) and control group(n=86). The participants in the control group received conventional education in the hemodialysis center, and the participants in the interventional group received an advanced practice nurse-led continuity of care program on the bases of the conventional education. The following outcomes were employed to compare the effectiveness of two different interventions: serum phosphorus, corrected calcium, i PTH, alkaline phosphatase and albumin; the score of the general knowledge, compliance, attitude, physical component and a mental component; the achieved rate of the serum phosphorus,corrected calcium, i PTH; the rate of hospitalization relevant to heart disease, bone fracture and abdominal aortic calcification. Chi-square test, repeated measure ANOVA, one-way repeated measures ANOVA, simple effect analysis were used to analyze the data.Results1 The final version of the CKD-MBD-KB questionnaire covers 2 domains, 5 facets and 50 items. Six and 4 common factors were extracted from exploratory factor analysis that interpreted the cumulative variation of 62.06% and 60.48% in relevant knowledge and behavior domain respectively, and factor loadings of all items were greater than 0.4. The results of confirmatory factor analysis indicated that the model had a satisfactory goodness-of-fit. Meanwhile, a significant correlation was found between each item and its facet respectively. Reliability analysis showed that:Cronbach’s α coefficient of 5 facets were ranged from 0.58 to 0.85. Retest correlation coefficients of the five facets ranged from 0.83 to 0.94.2 Gender was an independent predictor of serum phosphorus and corrected calcium.Lower score of disease knowledge, dietary knowledge and compliance was independently associated with higher serum phosphorus while lower medication score was independently correlated to higher serum corrected calcium. Furthermore, dietary habit, long hemodialysis treatment duration and types of phosphate binder were significant relevant factor for higher serum phosphorus. Marital status was an independent related factor of i PTH.3 The participants in the interventional group had a better control of serum phosphorus(F=11.28,P=0.001), i PTH(F=7.71,P=0.006) and significant increased score of general knowledge(F=91.12,P<0.001), compliance(F=63.23,P<0.001),attitude(F=19.20, P < 0.001) and mental health(F=12.70, P < 0.001) than participants in the control group at month 16 post-intervention. The achieved rate of serum phosphorus was significantly higher in the interventional group than in the control group(c2=6.55, P=0.038). No statistical significance was found in the serum corrected calcium, i PTH, alkaline phosphatase, albumin and the physical component score between the groups(P>0.05). No significant difference were explored between the groups on the achieved rate of the serum corrected calcium, i PTH and the rate of hospitalization relevant to heart disease, bone fracture and abdominal aortic calcification(P>0.05).Conclusions1 The CKD-MBD-KB questionnaire has been confirmed with adequate reliability and validity.2 Interventions should be more targeted towards the male, young, longer hemodialysis durations, lower scores of disease, dietary, medicine knowledge and compliance, and those likely to eat foods high in protein as well as divorced or widowed patients.3 An advanced practice nurse-led continuity of care was an effective nursing program in the control of the increased serum phosphorus and i PTH, and could improve the CKD-MBD patients’ knowledge, and also the positive effect on patients’ behavior and mental health. However, the effects of this interventional program on the heart disease,bone fracture and the abdominal aortic calcification needed to be assessed in future study.