Download brief resume of the intended work

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 NAME OF THE CANDIDATE AND Ms.ANIT JOHN
Ist Year MSC Nursing, Koshys College of
ADDRESS
Nursing,
No.31/1,
Hennur
Bagalur
Road,
Kadusonnappanahalli, Kannnur Post, Bangalore
– 562149.
Koshys College of Nursing
2 NAME OF THE INSTITUTION
Bangalore
Ist year MSC Nursing
3 COURSE OF THE STUDY AND
SUBJECT
Medical Surgical Nursing
09-06-10
4 DATE OF ADMISSION TO THE
COURSE
A study to assess the knowledge and attitude
5 TITLE OF THE TOPIC
regarding dietary regulations among chronic
renal failure clients undergoing hemodialysis in
selected hemodialysis units of Bengaluru with a
view to develop a self instructional module.
1
BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
“He who takes medicine and neglects to diet wastes the skill of his
doctors”.
- Chinese Proverb.
Chronic renal failure is a growing problem with an increasing number of patients
suffering from loss of kidney function. The morbidity and mortality of these patients is
much higher than that of the general population. The patient with chronic kidney disease,
even with only a moderate level of renal failure, falls in the highest risk category for
cardiovascular disease. A proper evaluation and management of these patients is necessary
to prevent further loss of kidney function, to prevent cardiovascular diseases and to
manage the co-morbid conditions like peripheral arterial diseases, stroke, hypertension etc
associated with renal failure and the complications due to renal failure.1
Chronic kidney disease (CKD) represents the gradual, substantial and
irreversible reduction in the excretory and homeostatic functions of the kidneys. It is
characterized by progressive destruction of renal tissue over a period of at least months to
many years, depending on the underlying etiology. Glomerular filtration rate progressively
decreases to less than 60 mL/min/1.73 m2 with loss of functioning of nephrons.2
The definition of chronic kidney disease has been simplified over the last 5 years.
It is now defined as the presence of kidney damage for a period greater than 3 months. An
estimated or measured glomerular filtration rate of less than 60 mL/min/1.73 m2 is
*Note: CKD: Chronic Kidney Disease
2
considered abnormal for all adults. A rate of more than 60 mL/min/1.73 m2 is considered
abnormal if it is accompanied by abnormalities of urine sediment or abnormal results of
imaging tests, or if the patient has had a kidney biopsy with documented abnormalities.3
As the reporting of estimated glomerular filtration rates has become more
common, the relatively high prevalence of impaired kidney function (i.e., estimated
glomerular filtration rate < 60 mL/min/1.73 m2) has become evident.4
Kidney failure occurs when kidneys could no longer clean the blood or rid
the body of extra fluid. When the kidneys stopped working completely or when they did
not work well enough to keep a person healthy then artificial assistance is required.
Patients feel well until just a few weeks or months before being diagnosed. When drugs
and diet no longer worked to slow the progression of kidney failure, dialysis is needed to
do the job that the kidneys used to do.5
Diabetes and hypertension are the most common causes and account for
approximately two third of cases of chronic renal failure. Other major causes include
glomerulitis, polycystic kidney diseases, kidney stone, infection etc.6
Kidney diseases is often referred to as silent disease as some people may
not even feel sick or they may not notice their symptom while others only become aware
of their condition when their kidneys are no longer removing waste. As the kidney
function slows the symptoms of uremia are experienced like feeling tired or weak,
swelling of hands and feet, shortness of breath, loss of appetite ,nausea, vomiting,
difficulty in sleeping etc.6
3
Clients with chronic renal failure develop less kidney functioning at less
than 10-15% of capacity. By then the kidneys are not able to keep up with waste and fluid
clearance on their own and dialysis becomes the only option to support life.6
Dialysis was an artificial process used to purify the blood. Dialysis will not
cure kidney disease but it removes the waste products and excess water from the body and
stabilizes the blood chemistries. Hemodialysis removes waste products and excess fluid
directly from the blood by pumping it through a filter called a dialyzer, or artificial kidney.
A small amount of blood is continually removed from the body, pumped through the
dialyzer filter and returned to the body. Only a small amount of blood was taken outside of
the body at any time because it is a continuous process. The blood is returned to the body
as fast it is removed.7
Chronic kidney disease clients need to make changes in their diet,
including limiting fluids, eating a low-protein diet as recommended, restricting salt,
potassium, phosphorous, and other electrolytes. The purpose of this diet is to maintain a
balance of electrolytes, minerals, and fluid in patients who are on dialysis. The special diet
is important because dialysis alone does not effectively remove all waste products. These
waste products can build up in the body between dialysis treatments. Most dialysis
patients urinate very little or not at all. Therefore, fluid restriction between treatments is
very important. Without urination, fluid will build up in the body and lead to excess fluid
in the heart, lungs, and ankles.8
6.1 NEED FOR THE STUDY:
CKD is a worldwide threat to public health, but the dimension of the
problem is probably not fully appreciated. There are 1.8 million people in the world who
are alive with one form or another of renal replacement therapy.9
4
Data on the prevalence of predialysis CKD in low- and middle-income
countries are sparse. There are at least comparable numbers of patients with CKD in poor
countries as in developed nations. Examples indicate that the overall prevalence of CKD is
21%, 10.6% and 11% in urban areas, respectively, of Moldova, Nepal and China. Data
from India suggested that in a developing country the prevalence rate of CKD could
varied almost 5-fold between rural and city populations. These observations implied that
CKD would affect not only very many people in the developing world, but preferentially
the poor within these countries who usually have no information about disease and risk
factors and cannot have access to health care.10
A population screening study showed the prevalence of CRF in India was
0.8%. The screening in New Delhi had involved 48 hospitals and 4712 subjects
participated in a blood biochemistry test. Mean age was 42.38±12.54 years, 56.16% were
male. Thirty-seven were found to have chronic renal failure with a prevalence rate of
0.78%. If these data are applied to India's billion populations there are 7.85 million
Chronic Renal Failure (CRF) patients in India.11
The Kidney Help Trust of Chennai, India has embarked on a screening
programme among 25000 people. Trained social and health workers have recorded blood
pressure, checked for abnormal glucose levels and for the presence of protein in the urine.
This survey showed hypertension in 5.2%, diabetes in 3.6%, kidney disease without renal
dysfunction in 0.68% and chronic renal failure in 0.16% of the screened population .12
The dietary approach in the different phases of chronic renal insufficiency
(CRI) is one of the most important, and yet controversial, topics in the whole history of
**Note: CRF: Chronic renal failure,
CRI: Chronic Renal Insufficiency
5
nephrology, since 35 years ago when dialysis facilities were not yet easily available and a
low protein diet was the only means to delay the occurrence of uremic symptoms. In the
subsequent decades of the dialysis era, low protein diets
varying from 0.3 to
0.85 g/kg/day with supplementation of essential amino acids and keto‐analogues were
given emphasis, in order to slow the progression rate of CRI.13
A study was conducted to determine what factors contributed to medication
noncompliance in the hemodialysis patient population. Age, race, gender, and educational
level were used to examine medication noncompliance, knowledge and attitudes in
hemodialysis patients. Results showed that higher educated patients 72% had more
knowledge about medication compliance than lower educated patients 40%.14
A study was conducted to investigate whether knowledge of the diet and
medical consequences of noncompliance influences dietary compliance among seventyone of the eligible 82 patients on hemodialysis. The result was that more than one third of
patients were noncompliant with at least one dietary restriction. Phosphorus dietary
restrictions were the most commonly abused and potassium the least. Patients’ knowledge
of the medical consequences of noncompliance was poorer than knowledge of renal
dietary restrictions (mean scores 29.4%; 74.7%). There was no association between
compliance with potassium or sodium/fluid restrictions and knowledge of these dietary
restrictions. Patients with better knowledge about the medical complications of
noncompliance were less likely to be compliant for phosphorus (P=.002) and sodium/fluid
(P=.008) restrictions.15
A prospective study was conducted to assess knowledge, attitude and
practices regarding CKD and referral to Nephrologists on the basis of estimated
Glomerular Filtration Rate (eGFR) reporting with Modification of Diet in Renal Disease
6
(MDRD). A paper based questionnaire was used to survey 114 subjects. Majority of the
study subjects (78.07%) were aware that eGFR is better than raised serum creatinine
alone, in assessing severity of kidney disease. 48.28% of the subjects were not aware on
reference, based on eGFR. 84.21% of the respondents knew implications of late referral
(morbidity and mortality) but 55.26% were still not referred to nephrologists even with
symptoms. Residents were more likely to refer to a Nephrologist early as compared to
consultants.16
A dietary survey was done in Indian hemodialysis patients. The nutritional
intake of 106 maintenance hemodialysis patients was studied. After two months of dialysis
the mean calorie intake was 29+ 6.6 k.cal/ kg ideal body weight and the mean protein
intake was 0.93+. 0.39 g/kg ideal body weight. Dietary deficiency of both protein and
calorie was present in 64.9% of patients. In summary this study showed suboptimal energy
and protein intake in maintenance hemodialysis population in India.17
A study was conducted in United States to explore the knowledge and
beliefs of CKD patients about the role of diet in their disease presentation and
management. Researchers concluded that eighty percent respondents said they would like
to receive dietary advice as soon as they know they have renal damage. Renal dietitians
were identified as the most reliable and trustworthy source of dietary information,
followed by renal specialist doctors.
18
The number of CRF clients alive with hemodialysis is increasing day by day
in the World. In developing countries like India, dietary considerations are among the
most important modifiable behaviors that can adjust for dialysis clients. Following dietary
 Note: eGFR: estimated Glomerular Filtration Rate
MDRD: Modification of Diet in Renal Disease
7
regulations can help the clients to keep healthy along with the dialysis. Malnutrition is
common in dialysis clients and is linked with lack of knowledge and poor nutritional
intake that can leads to a higher risk of infection, hospitalization and even death.
Therefore, assessment of nutritional status and knowledge about nutritional management
of dialysis clients play a central role in everyday nephrological practice. Dietary selfefficacy, a concept less studied in dialysis, has been linked to positive compliance
outcomes in the chronic illness literature. Therefore, the aim of the present research is to
determine the knowledge and attitude of dialysis clients about dietary regulations and
provide awareness to the clients with the help of an instructional module.
6.2 REVIEW OF LITERATURE:
Review of literature is an integral component of research process. It
enhances the depth of knowledge and inspires a clear insight into crux of problem. It help
the researcher to know what data are available to narrow the problem itself as well as the
technique that might be used.
Review of literature for this study is divided under following headings:
 Studies and Literature related to diet for hemodialysis clients.
 Studies and Literature related to knowledge of CRF clients on dietary
regulation.
 Studies and Literature related to attitude of CRF clients on dietary
regulation.
8
 Studies and Literature related to diet for hemodialysis clients
According to the Initiative Guideline given by National Kidney Foundation
and Kidney Disease Outcome Quality Initiative center, both non dialyzed and
hemodialysed patients were to calculate energy intake of 35kcal/kg/day for patients
younger than 60 years of age. 1.2g restriction in protein helps the kidneys work less thus
delaying the progress of CKD by controlling uremia. 2g potassium restriction in dietary
potassium is necessary because the kidneys were unable to remove potassium. 1g
phosphorous restrictions inhosphorous levels were related to the diminished function of
the kidney to remove excess phosphorous from the body leading to hyperphosphatemia.19
A Literature states that the diet is important for patients on hemodialysis.
Goals of nutritional therapy are to minimize uremic symptoms and fluid and electrolyte
imbalances, to maintain good nutritional status through adequate protein, calorie, vitamin
and mineral intake, and to enable the patient to eat a palatable and enjoyable diet.
Ignorance of dietary restrictions will lead to life threatening complications such as
hyperkalemia and pulmonary edema.20
An article on factors influencing compliance with dietary restriction in dialysis
patients says that dietary restrictions for dialysis patients were very demanding and
compliance has been shown to be poor in many patients. A number of psychosocial
variables were investigated in a sample of 41 dialysis patients for possible effects on
dietary compliance. Clinical criteria of dietary abuse indicated problems in 58% of the
sample. The longer patients had been on dialysis, the less likely they were to report
dietary compliance. Acceptance of the limitations imposed by illness was significantly
associated with clinical dietary abuse scores. 16
9
 Literature related to knowledge of CRF clients on dietary regulation
An experimental study was conducted on effect of information booklet
provided to care givers of patients undergoing hemodialysis on knowledge regarding
home care management including dietary management and fluid management in Vijaya
dialysis unit Chennai with a sample size of 30.After pre test the information booklet
containing information on home care management was provided to the care givers and
post test was conducted. The major findings of the study showed that the overall
knowledge score obtained by the care givers in the pretest was 50.35 and 86.25 in the post
test.21
A descriptive study was conducted to assess dietary and fluid compliance
behaviors in hemodialysis patients in China. The sample of the study was 62 chronic
hemodialysis patients. Information was obtained about their knowledge of dietary and
fluid restrictions related to dialysis, health beliefs, personal and medical characteristics,
and self-reported compliance. In addition, serum levels of potassium (K) and phosphate
(PO4) and interdialytic daily weight gain were retrieved from the medical records. Dietary
and fluid compliance was observed in only 35.5% and 40.3% of the patients, respectively.
No direct relationship was observed between dietary knowledge and any compliance
measures. 22
 Note: K: Potassium,
PO4: Phosphate
10
A descriptive study was conducted to assess the nutritional status of 50
patients on maintenance hemodialysis in Yamen.. The anthropometric mean ,pre and post
dialytic weight , clinical signs and malnutrition score was calculated from Body Mass
Index. The mean total knowledge score about avoidable food was 25% and only 14% have
a satisfactory knowledge score. Malnutrition was 16% moderately malnourished and 20%
severely malnourished. The result of the study was poor nutritional status was detected
among a significant patients with poor dietary knowledge and practice.23
A descriptive study was conducted on the awareness of kidney disease,
among Africans and Americans. The results showed that African Americans awareness of
kidney disease was high that is about 70% but knowledge of the magnitude of the
disease, its symptoms, its predisposing risk factors, and strategies for prevention and
treatment were low that is only
38%. These results served to justify the need for
continued patient education to all individuals.24
A cross sectional cohort study was conducted to determine the effectiveness
of patient knowledge in improving calcium-phosphate (Ca x P) balance among
hemodialysis patients at 2 centers in Singapore with serum phosphate levels ≥ 4.5 mg/dL
and a Ca × P product > 55 mg2/dl2. The patients were interviewed to determine their
knowledge of phosphate binders, compliance and dietary restrictions. 31 patients were
enrolled in the study and 30 patients were kept as controls. In the control group, no formal
counseling was done. Formal counseling was provided to study group to ensure that the
patients were aware of the importance of taking their phosphate binders and maintaining
dietary regulations. After counseling 39% of patients in the study group were having
significant decrease in the serum phosphate level (8.6 ± 0.4 vs 7.4 ± 0.6 mg/dl, p < 0.05)
11
and Ca × P product (83.6 ± 4.9 vs 68.9 ± 5.6 mg2/dl2, p < 0.01), which showed an increase
in the knowledge level regarding phosphate binders and dietary restrictions.25
A descriptive study was conducted to explore detailed knowledge on
dietary management of 39 haemodialysis patients attending a single haemodialysis centre,
North Wales, London concerning food sources, clinical sequel of fluid gain, biochemical
control alongside measurement of dietary compliance and psychological factors. Patients
completed a detailed 26 item renal dietary knowledge questionnaire measuring knowledge
of clinical consequences of dietary behavior as well as content of food sources. The result
showed that 59% patients reported full understanding their dietary advice while 41%
requested further advice over potassium and phosphate.26
 Literature and Studies related to attitude of CRF clients on dietary regulation
A descriptive study was conducted in India among 25 patients with Chronic
Kidney Disease. Advices were given about dietary protein restriction. Among 25 patients,
22followed up the advised diet regularly, only 4 out of 22
patients felt that they would follow the diet plan on a long term basis. 9 patients felt that
they could manage with the advised diet with great difficulty, 4 patients felt that they
could manage with the diet plan only for a short period while 5 felt that it was impossible
to follow the prescribed diet.27
A descriptive studywas conducted among 62 historically disadvantaged
patients undergoing haemodialysis completed a battery of psychometric instruments
measuring attitudes, subjective norms, perceived behavioral control regarding dietary and
fluid adherence, health literacy, perceived social support, and self-reported dietary and
 Note: Ca x P: Calcium-Phosphate
12
fluid adherence in Western Cape. Interdialytic weight gain (IDWG), predialytic serum
potassium levels, and predialytic serum phosphate levels served as biochemical indicators
of dietary and fluid adherence. Regression analyses indicated that the linear combination
of attitudes and perceived behavioral control significantly accounted for 15.5% of the
variance in self-reported adherence (a medium-effect size) and 11.4% of the variance in
IDWG (a modest-effect size). 28
A descriptive study was conducted to describe non – adherence with diet and
fluid restriction and level of perceived social support in Turkey among 160 hemodialysis
patient. Data was collected using Dialysis Diet and Fluid Non-adherence Questionnaire
and Multidimensional Scale of Perceived Social Support. Result showed that most patients
in the study adapted some degree of non-adherence to fluid restriction (68%) and diet
(58%). Participant’s perceived social * *Note:
IDWG:
Inter Dialytic Weight Gain
support was low. Non-adherence was maximum with younger patient and those with low
levels of perceived social support.29
A cross-sectional study using a descriptive-comparative design was
conducted in Spain to identify the factors that influence dietary adherence in Hispanic
patients receiving maintenance hemodialysis and to determine the differences in dietary
adherence between Hispanic and non-Hispanic patients. A total of 17 Hispanic and 17
comparison patients were included. Information was obtained by a questionnaire about
knowledge of the diet, preferred language for education, consumption of potassium- (K+)
and phosphate (PO4) containing foods, and adherence attitudes and behaviors. Both groups
were adherent to the diet because their mean levels of Serum Albumin(SAlb),
Potassium(K+), and Phosphate(PO4) were within acceptable limits. Dietary adherence was
13
observed in 76% of the Hispanic patients for SAlb, 88% for K+, and 65% for PO4, whereas
the rate of adherence was 59%, 88%, and 76%, respectively, for the comparison group30
A comparative study was conducted to examine and compare the food
preferences of patients undergoing maintenance hemodialysis (HD) and continuous
ambulatory peritoneal dialysis (CAPD) in Sydney, Australia with those among thirty-three
patients on HD, 17 patients on CAPD, and 30 control subjects with normal renal function.
two questionnaires, one assessing preferences for 88 food items (according to a nine-point
hedonic scale) and the other assessing factors influencing dietary habits. Researcher
concluded that Sweet foods (P = .002), vegetables (P = .003), red meats (P = .010), and
fish and poultry (P = .015) were less pleasant for patients on HD than for control subjects.
Red meats (P = .019), fish and poultry (P = .032), and eggs (P = .005) were less pleasant
for patients on HD than for patients on CAPD. Red meat was the most unpopular food
group for all dialysis patients. The most common factor affecting dietary intake was a loss
of interest in food and/or cooking.31
A qualitative interview was conducted on attitudes towards advance care
planning, co-morbidity and symptom burden and expectations for the future in 21dialysis
patients in London. Data collected were demographic information, co-morbidity data
using the Charlson Index, functional capacity using the Karnofsky Index, and devised
tools for symptom assessment, quality of life, support network and advance planning
readiness. Older patients who start Renal Replacement Therapy (RRT) often had a poor
understanding and unrealistic expectations of RRT. They tend toover estimate their
functional status and often under report symptoms because they feel that they should be
Note: HD: Hemo Dialysis
CAPD: Continuous Ambulatory Peritoneal Dialysis
RRT: Renal Replacement Therapy
14
stoical. The majority 65% of patients seem prepared to go along with whatever plan is
suggested to them by the doctor.26
6.3 STATEMENT OF THE PROBLEM :
A study to assess the knowledge and attitude regarding dietary regulations
among chronic renal failure clients undergoing hemodialysis in selected hemodialysis
units of Bengaluru with a view to develop a self instructional module.
6.4 OBJECTIVES OF THE STUDY:
1. To assess the knowledge of chronic renal failure client undergoing hemodialysis
regarding dietary regulation.
2. To assess the attitude of chronic renal failure client undergoing hemodialysis
regarding dietary regulation
3. To determine the association between knowledge and selected demographic
variable like age, sex, educational status, dietary pattern, religion, family income
and duration of illness.
4. To prepare a self instructional module regarding dietary regulations for renal
failure clients undergoing hemodialysis.
6.5 HYPOTHESIS
H0: There is no significant relationship between knowledge with selected
demographic variables.
H1: There is a significant relationship between knowledge with selected
demographic variables.
15
6.6 OPERATIONAL DEFINITIONS:
1. Assess:
refers to the process used to identify and analyze the level of
knowledge and attitude regarding dietary regulations in CRF clients undergoing
hemodialysis in selected hemodialysis unit.
2. Knowledge: refers to the awareness of chronic renal failure client undergoing
hemodialysis regarding dietary regulation as assessed by the responses to the items
of the knowledge questionnaire.
3. Attitude:
refers to the opinion of chronic renal failure client undergoing
hemodialysis regarding dietary regulation as assessed by Likerts scale.
4. Hemodialysis:
refers to an act of ridding the body of wastes by filtering blood
through an external device called dialyzer.
5. Chronic renal failure (CRF): refers to the gradual, substantial, and irreversible
reduction in the excretory and homeostatic functions of the kidneys.
6. Client : refers to a person who has been diagnosed to have Chronic Renal Failure
and between the age group of 25-60 years.
7. Self Instructional Module: refers to the systematic and scientific information and
specific instructions related to dietary regulations in hemodialysis clients prepared
by the investigator and validated by experts in the field of Nursing and Medicine.
6.7 ASSUMPTIONS:
1. It is assumed that chronic renal failure client undergoing hemodialysis may have
moderate knowledge regarding dietary regulation.
16
2. It is assumed that chronic renal failure client undergoing hemodialysis may have
favorable attitude towards dietary regulation.
3. It is assumed that knowledge of chronic renal failure client undergoing
hemodialysis regarding dietary regulation may be influenced by age, sex,
educational status, dietary pattern, religion, family income, duration of illness,
duration of dialysis treatment, occupation etc.
6.8 DELIMITATION:
1. The study was restricted to selected hemodialysis units of Bengaluru..
2. The study was limited to Chronic Renal Failure clients with hemodialysis only.
3. The study was limited to the age group of 25-60years.
7.MATERIALS AND METHODS
7.1 SOURCE OF DATA
The source of data will be collected from Chronic Renal Failure clients with
hemodialysis from selected hemodialysis units of Bengaluru.
7.2 METHODS OF DATA COLLECTION
Research methodology
: Non experimental Descriptive method.
Sampling technique
: Convenient Sampling.
Sample size
: 60 clients between 25-60 years of age.
Population
: Chronic Renal Failure clients with
Hemodialysis in Selected hemodialysis unit of
Bengaluru.
Setting
: Selected Hemodialysis Units of Bengaluru.
17
7.2.1 CRITERIA FOR SELECTION OF SAMPLE:INCLUSION CRITERIA:This study includes clients,
 Who are present at the time of data collection.
 Who are willing to participate.
 Who are able to read English or Kannada.
 Male & female clients of age between 25-60 years.
EXCLUSION CRITERIA:This study excludes clients,
 Who are not present at the time of data collection.
 Who are not willing to participate Client who are not available at the time
of data collection.
 Who are not able to read English or Kannada.
 Whose age is below 25 and above 60 years.
7.2.2 DATA COLLECTION TOOLS:A Structured knowledge Questionnaire will be prepared to Assess the
Knowledge and Likerts scale to assess the attitude of Chronic Renal Failure clients
undergoing hemodialysis in selected Hemodialysis unit of Bengaluru. A Self
Instructional Module will be prepared on knowledge regarding Dietary regulations in
Hemodialysis clients.
Part-1: It consists of demographic variables of clients.
Part-2: It consists of two sections. Section A & B.
18
Section A: Consists of closed ended questions assessing knowledge of CRF clients
undergoing Hemodialysis regarding dietary regulations.
Section B:
Consist of \modified attitude scale assessing the attitude of CRF clients
undergoing Hemodialysis regarding dietary regulations.
7.2.3 DATA ANALYSIS METHOD:Data analysis will be done in terms considering objectives of the study
using descriptive and inferential statistics Frequency & Percentage Distribution will be
done to analyze Demographic Variables. Mean and Standard Deviation will be done to
assess the knowledge and attitude regarding dietary regulations. The Chi-square test(x)
will be done to find out the association between the Mean Knowledge score with selected
Demographic Variables. The finding will be presented in the form of Table, Diagram and
Graphs.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER
HUMAN’S OR ANIMALS? IF SO DESCRIBE.
YES: Only a structured Self Instructional Module and a Structured
Knowledge and attitude Questionnaire were prepared & validate to make it standardized
no physical or mental harm to the samples will be made.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED
YES:-A written Permission from the concerned Authority will be obtained prior to
the study.
-Consent will be taken from the Sample before conducting the study.
-Confidentiality and Anonymity of the Subject will be maintained.
19
8.LIST OF REFERENCE
1. Adeera Levin, Brenda Hemmelgarns, Bruce Culleton, Sheldon Tobe, Philip Mc
farlane, Marcel Ruzicka et al. Guidelines for management of chronic kidney disease.
CMAJ 2008 Nov 18; 179(11):1154-78.
2. Joyce M, Esteher Matassarin. Medical Surgical Nursing. 5th ed. Singapore: Saunders
publishers; 1998.
3. Beck G J, Klohr S, Levey A S. K/DOQL Clinical practice guidelines for CKD:
Evaluation Classification and Stratification. AMJ Kidney Dis 2002; 39(1):51-266.
4. Coresh J. Prevalence of CKD and decrease kidney function in adult US population:
third National Health & Nutrition Survey. AMJ Kidney Dis 2003; 41:1-12.
5. Centre for Medicare and medical services .You can live your guide to live with
kidney failure .DHHS publication no.CMS-02119.
6. Harilall Bharita. Experience of patient on hemodialysisand continuous ambulatory
peritoneal dialysis in ESRD. 2006. Inkosi Albert Luthuli Central Hospital. Durban.
7. Kline Bolton, Bruce Culleton.: Overview of dialysis .Gambro Healthcare 2004;2230.
8. Cynda Ann, T Alp Ikizler .Dialysis diet. Health Guide 2010 Nov 3;5:16-25.
9. Remuzzi G,Weening U. Albuminuria as early test for vascular disease. Lancet 2005;
365:556-7.
10. Norbetto Perico .Screening for chronic kidney disease in emerging countries:
feasibilityand hurdles. Oxford journals. Nephrology dialysis transplantation 2004;
24(5):1555-58.
20
11. Agrawal SK . Prevalence of chronic renal failure in adults in Delhi, India. Nephrol
Dial Transplant 2005;20:1638-42.
12. Mani M K. experience with progrmme for prevalence of CRF in India. Kidney int
suppl 2005; 575-78.
13. Francesco Loatellieti, Denis Fongne, Olof Heimburger, Timan B Drueke, Walter H
Horl, Eberhard Ritz Nutritional status in dialysis patients: a European consensus.
Oxford journal.Nephrology dialysis transplantation 2010;17(4):563-72.
14. Clarie Louse, Michelle Holdsworth. Knowledge of dietary restriction and and
medical consequences of non compliance of patient on hemodialysis are not
predictive of dietary compliance. Journal of American diabetic association 2003 Dec
30; 104(1):35-41.
15. Mikklos Zyrini, Maria Juhaz, Jozsef Bulla, Eva Katona, Thomas Ben. Dietary self
efficacy determinant of compliance behavior and biochemical outcome in
hemodialysis patient. Oxford journal 2003;18(9):1869-73.
16. Shahista Tamizuddin, Wasim Ahmed. Knowledge, attitude, practice regarding CKD
and estimated GFR in a tertiary care hospital in Pakistan. JMPA 2010; 60(12):342 –
58.
17. Sharma M, Rao M, Jacob C K. A dietary survey in Indian hemodialysis patients.
Nursing journal of India 2004;76:82-94
18. Rachel Hokingdale, Debbie Suttan, kathyrin. Facilitating dietary changes in renal
disease investigating patients perspective .Journal of renal care 2008 ; 34(3):136-42.
19. Ashlee
Schoch,
Lusi
Martin.Kidney
disease
case
study:Doccument
Transcript.American Journal of Kidney Disease 2009 Oct 6; 56:1046-64.
21
20. Sharon Mantik Lewis, Margaret McLean Heitkemper, Shannon Ruff dirkren.
Medical Surgical Nursing.6th ed.Missouri:Mosby Publishers;2004.
21. Fathima L. A study to evaluate the effect of information booklet on home care
management of hemodialysis clients. Nursing journal of India.2004 April; 23:12345.
22. Shuk-hang lee, Alexander Molassiotis. Dietary and fluid compliance in Chinese
Hemodialysis patients. International journal of nursing studies 2002; 39(7):695-709.
23. William F Martin, Lawrence E Armtreng.The nutritional status of end stage renal
disease patients on maintenance hemodialysis.Soudi journal of kidney disease
andtransplantation2002;65:122-45.
24. Norrie K ,Agodosa L. Unraveling renal diaparities associated with kidney disease.
Kidney International 2003; 68:914-24.
25. K Y Fung, C L Low, W L Lyc. Patient education and its effect on calcium phosphate
balance in hemodialysis patient. Hemodialysis International 2004; 17(1):73-104.
26. H Kierdorf, H G Sieberth. Epidemiology and outcome [Serial online] 2001 Mar
[Cited
2004
Jan];
2(2):1353-58.
Available
from:
URL:htt://www.ndt.oxfordjournals.org. NDT plus.
27. Nephrol J.Guidlines for the management of nutrition.Indian journal of nephrology
India 2005;5(1):542-46.
28. Rafee A, Mossa M. Dietary and fluid adherence among hemodialysis patient. SAfr J
Clini.Nutri. 2008; 2(12):78-90.
22
29. Belguzar K, Kaysee C. Non adherence with diet and fluid restriction and perceived
social support in patients receiving hemodialysis. Journal of nursing scholarship
2007; 39 (3): 243-8
30. Claudia
Morales
Lopez,
Jerrilynn
D,
Burrowes,
Frances
Gizis,Deborah
Brommage.Dietary adherence in Hispanic patients receiving hemodialysis.Journal of
Renal Nutrition 2007 March; 17:138-147.
31. Dobell E, Chan M, Williams P, Allman M. Food preferences and food habits of
patient with CRF undergoing dialysis. JAM Diet Assoc.1993 Oct ;93(10):1129-35.
23
9
10
SIGNATURE OF THE
CANDIDATE
Anit John
REMARKS OF THE GUIDE
A client on dialysis should know the lifestyle
adaptation, which make them to live an optimal
living. This study focuses on the dietary
regulation which is an important aspect of them.
11
NAME AND DESIGNATION
Mrs.Sheeba A
HOD, Medical Surgical Nursing Koshys college
of nursing, Bangalore.
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
Mrs.Sheeba A
HOD, Medical Surgical Nursing,
koshys college of nursing, Bangalore.
11.5 HEAD OF THE
DEPARTMENT
11.6 SIGNATURE
12
12. 1 REMARKS OF THE
Diet plays an important part in being healthy.
PRINCIPAL
This study helps the person undergoing
hemodialysis to plan and have a proper diet
which will be helpful for them to live positively.
12.2 SIGNATURE
24