Intervention Compliance of Diet and Fluids to Interdialytic Weight Gain in Patients with Chronic Kidney Disease Undergoing Hemodialysis: A Systematic Review

Abstract


INTRODUCTION
Chronic kidney disease is a disease with a relatively high prevalence in the world. There are ten people in the global population and one person who has chronic kidney disease at some stage. The results of WHO global prevalence data are 13.4% and are the 12th cause of death in the world. According to sources from the World Health Organization (WHO), Chronic Kidney Disease (CKD) is a problem with an increasing incidence every year. The incidence of chronic kidney disease in Indonesia currently amounts to 713,783 sufferers [1]. The morbidity and mortality rate of patients with end-stage renal disease is approximately 22% [1]. Management of chronic kidney disease includes hemodialysis by 78%, Continuous Ambulatory Peritoneal Dialysis (CAPD) by 3%, and kidney transplantation by 16%. Chronic kidney disease patients undergoing hemodialysis increased from 77,892 [2]. The Central Java region reported 7,906 new patients [2].
Chronic kidney disease is a progressive and irreversible kidney disorder in which the body is unable to maintain metabolism, is unable to maintain fluid and electrolyte balance and increases urea [3]. Patient compliance is defined as patient behavior in accordance with the provisions given by health workers [4]. Factors that affect adherence to hemodialysis patients, namely education, involvement of health workers, family support, patient self-concept, patient knowledge, gender, self-management, and duration of hemodialysis [5]. Excessive fluid intake in people with chronic kidney disease can be seen through increased body weight or interdialytic weight gain status, namely weight gain between two hemodialysis sessions. The value of interdialytic weight gain in hemodialysis patients is recommended not to be more than 3.5% [6]. Poor adherence to fluid intake management is detrimental to long-term survival in patients undergoing hemodialysis.
Hemodialysis patients are often advised to reduce water intake, but this suggestion is not always followed during the process of undergoing a hemodialysis program [7].
Patients with chronic kidney disease undergoing hemodialysis programs must make dietary adjustments, routine care, and limit fluids [6]. Sodium build-up results in a decrease in kidney function that is not optimal to maintain homeostasis and ultimately causes an increase in extracellular fluid volume during the interval between hemodialysis [8].

Literature Search Strategy
The   reaches at least 50% and meets the critical appraisal criteria, the article will be selected for data synthesis. All articles (n = 12) in the last screening achieved a score between 77% and 88%, which means that the score reached > 50% higher so that data synthesis could be carried out. Articles will be selected for data synthesis.

Data Extraction
For this research article, data extraction was designed to guide information from notes to fit the research objectives. The data extracted in each research article includes the author, year, population and setting, study design, fluid intake, thirst, social support, selfefficacy, and stress. However, if it is accompanied by disease, the patient may not be able to adapt to these changes [12].
There is an effect of dietary compliance on the IDWG value which is manifested by dry weight gain. In this study, 49% of respondents were in the non-adherence category and experienced an increase in interdialytic weight gain which was included in the moderate addition category and 4% were included in the high category due to noncompliance with dietary and fluid restrictions [13]. The IDWG value is based on the percentage of the patient's weight gain, where the IDWG value is said to be mild if the weight gain is not more than or equal to 3% of body weight during 2 hemodialysis sessions, during the first post-hemodialysis and the second pre-hemodialysis, moderate category if it is severe body weight increased by 4% -6%. If the weight gain is more than 6% then it is categorized as heavy [11]. IDWG can be avoided by controlling fluid intake, managing thirst, and increasing patient self-efficacy.
Dietary compliance is important in controlling the stability of interdialytic weight gain values [14]. In this systematic review, it is expected to be able to answer questions about the effectiveness of diet and fluid adherence to interdialytic weight gain in chronic kidney disease patients undergoing hemodialysis programs.      In the control group, fluid adherence scores in CRF patients differed significantly (p=0.000). In the treatment group, fluid adherence scores in CKD patients differed significantly (p=0.000). There was a difference in post-education compliance scores between the control and experimental groups (p=0.040). Education using audio-visual is very effective to increase one's knowledge, so it is recommended for subsequent researchers to conduct health research using audio-visual methods in more than one meeting.  In the intervention group, decreases were observed in pre-and post-dialysis interdialytic weight gain, ultrafiltration volume (UF), and blood pressure values of patients after training. There was a statistically significant reduction in mean scores for the frequency and degree of nonadherence to dietary restriction, and for the frequency and degree of nonadherence to fluid restriction in participants in the intervention group compared to participants in the control group (P < 0.05). There was a statistically significant increase in mean scores obtained from the FCHPS and its subscales by participants in the intervention group compared to participants in the control group (P < 0.05). Conclusion: The training provided to hemodialysis patients positively contributed to their adherence to diet and fluid restriction. Patient adherence to diet and fluid restriction increased.

11
Tarek Self-efficacy scores and medication adherence were significantly higher in the experimental group. The ratio of interdialytic weight gain to dry weight decreased significantly in the experimental group, and serum potassium and phosphorus levels were not significantly lower between the experimental group and the control group.

DISCUSSION
All research articles reviewed, the authors differentiated the interventions provided in this study. Education-based interventions to improve dietary adherence, namely peer education research on interdialytic weight gain [20], family support-based health education [21], health education in improving dietary compliance and interdialytic weight gain [22], psychoeducation in reducing anxiety and increasing dietary adherence in CKD patients [11], the use of audiovisual media and leaflets in increasing adherence to the diet of CKD patients with hemodialysis programs [23], education about fluid control and diet [16], and diet management education programs and fluid restriction [17]. In  [27]. But social support can affect adherence to diet and fluid restriction [28].
This social support is obtained from the association of fellow CKD patients, and the CKD patient community which can support optimizing the lives of CKD patients with hemodialysis programs. This is positive support considering that CKD patients will undergo hemodialysis therapy for the rest of their lives including good self-efficacy will make it easier for CKD patients to accept their condition and increase their enthusiasm for living rest of their lives with hemodialysis.
Good motivation should be given by the people around him.
Interventions include using cell phones in managing diet and fluid adherence, as well as IDWG stability, namely preparation for discharge planning using applications as a reminder for fluid management and education management for CKD patients [29], the use of calendars and fluid management reminders using cell phones (SMS) in maintaining interdialytic weight gain in CKD patients [30] and the use of the IDWG calculator for the stability of interdialytic weight gain values in CKD patients on hemodialysis programs [14].

CONFLICT OF INTEREST
Authors disclose no conflicts of interest related to the work in this manuscript.