Analysis of the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease_West China Medical Journal

Authors：

LIU Min , WANG Fang ,  DIAO Yongshu , MA Dengyan

Department of Nephrology, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

DIAO Yongshu, Email: dszhbf@163.com

Keywords：

Non-dialysis patients; Chronic kidney disease; Self-care behavior; Social support; Anxiety; Depression

DOI：

10.7507/1002-0179.201912178

Video：

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Objective To investigate the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease (CKD).Methods A total of 336 patients with CKD were investigated by a general data questionnaire, the CKD Self-care Behavior Scale, Social Support Scale, Generalized Anxiety Self-assessment Scale, and 9-item Patients Health Questionnaire through WeChat platform, and the influencing factors of self-care behavior were explored by binary logistic regression analysis.Results The median score of self-care behavior of CKD patients without dialysis was 60, and the patients with median and high level of self-care behavior accounted for 97.6%. The score of self-care behavior of CKD patients without dialysis was positively correlated with the total score of social support (r=0.210, P<0.001), objective support score (r=0.127, P=0.020), subjective support score (r=0.195, P<0.001), and social support utilization score (r=0.164, P=0.002), and negatively correlated with the anxiety score (r=–0.132, P=0.015), depression score (r=–0.230, P<0.001), body mass index (r=–0.181, P=0.001), and systolic blood pressure (r=–0.168, P<0.001). The results of binary logistic regression analysis showed that the influencing factors of non-dialysis CKD patients’ self-care behavior were gender [(odds ratio, OR)=2.179, 95% confidence interval, CI (1.134, 4.187), P=0.019], systolic blood pressure [OR=0.967, 95%CI (0.947, 0.987), P=0.002], and depression score [OR=0.844, 95%CI (0.765, 0.931), P=0.001].Conclusions The self-care behavior of CKD patients without dialysis is at the median and high level. Healthcare workers can improve the self-care behavior of CKD patients by reducing their negative emotions such as depression, and guiding patients to carry out blood pressure management, to delay the progress of the disease.

Citation： LIU Min, WANG Fang, DIAO Yongshu, MA Dengyan. Analysis of the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease. West China Medical Journal, 2020, 35(11): 1357-1363. doi: 10.7507/1002-0179.201912178 Copy

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2.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
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4.	Wong G, Hayen A, Chapman JR, et al. Association of CKD and cancer risk in older people. J Am Soc Nephrol, 2009, 20(6): 1341-1350.
5.	張路霞, 王海燕. 中國CKD的現狀及挑戰—來自中國CKD流行病學調查的啟示. 中華內科雜志, 2012, 51(7): 497-498.
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11.	曲姍, 勝利. 廣泛性焦慮量表在綜合醫院心理科門診篩查廣泛性焦慮障礙的診斷實驗. 中國衛生心理雜志, 2015, 29(12): 939-944.
12.	Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder - The GAD-7. Arch Intern Med, 2006, 166(10): 1092-1097.
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14.	中國醫學會心血管病學分會高血壓血組. 清晨血壓臨床管理中國專家指導建議. 中華心血管病雜志, 2014, 42(9): 721-725.
15.	周蓉, 魏黎, 胡俊峰, 等. 家庭醫生責任制管理的實施對社區高血壓患者的影響. 上海醫藥, 2017, 38(22): 35-38.
16.	王歷, 陸凱, 李建超, 等. 患者健康問卷在心血管門診抑郁障礙篩查中的價值. 中華心血管病雜志, 2015, 43(5): 428-431.
17.	張新安. 低蛋白飲食對糖尿病腎病患者影響的研究進展分析. 飲食保健, 2018, 5(15): 31-32.
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19.	王淑麗, 陳慈徽, 龔蘭芳, 等. 整體照護計劃對CKD病人自我照顧行為與腎功能的影響. 長庚護理, 2018, 29(1): 1-13.
20.	李莉, 李英華, 聶雪瓊, 等. 我國6省糖尿病患者自我管理行為調查. 中國健康教育, 2014, 30(1): 16-19, 38.
21.	何巧, 劉宇, 趙芳, 等. 新診斷2型糖尿病青年患者自我管理現狀及影響因素研究. 護理學雜志, 2018, 33(11): 26-30.
22.	Rodriguez KM. Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator. Clin Ther, 2013, 35(2): 170-178.
23.	劉靜, 王春梅. 2型糖尿病患者抑郁、焦慮與自我管理能力的相關性研究. 國際內分泌代謝雜志, 2013, 33(4): 283-286.
24.	沈玉蘭, 夏世萍, 鄒樹芳. 老年2型糖尿病患者焦慮、抑郁水平與自我管理水平的相關性. 中國醫藥導報, 2017, 14(35): 151-154.
25.	張彩虹, 陽曉麗, 郭洪花, 等. 自我管理項目對社區慢性阻塞性肺疾病患者焦慮抑郁及疲勞的影響. 中國老年學雜志, 2017, 37(2): 436-438.
26.	Wang J, Xiong X. Control strategy on hypertension in Chinese medicine. Evid Based Complement Alternat Med, 2012(1): 284847.
27.	毛曉清, 黃秋鵬, 謝席勝, 等. 臨床健康教育路徑在慢性腎臟病合并高血壓患者治療中的應用. 西部醫學, 2018, 30(2): 295-298.

1. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet, 2013, 382(9888): 260-272.
2. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med, 2004, 351(13): 1296-1305.
4. Wong G, Hayen A, Chapman JR, et al. Association of CKD and cancer risk in older people. J Am Soc Nephrol, 2009, 20(6): 1341-1350.
5. 張路霞, 王海燕. 中國CKD的現狀及挑戰—來自中國CKD流行病學調查的啟示. 中華內科雜志, 2012, 51(7): 497-498.
6. 徐紅, 劉偉竹. 認識并延緩慢性腎臟病進展. 中華全科醫師雜志, 2011(1): 71-72.
7. 幸露, 刁永書, 宋媛媛, 等. 慢性腎病早期病人自我管理行為與生活質量的關系研究. 護理研究, 2016, 30(35): 4377-4382.
8. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 2002, 39(2 Suppl 1): S1-266.
9. 王淑麗, 龔蘭芳, 陳慈徽, 等. CKD人自我照顧行為量表之發展與信效度檢驗. 護理雜志, 2016, 63(4): 90-99.
10. 肖水源. 社會支持評定量表. 心理衛生評定量表手冊(增訂版). 北京: 中國心理衛生雜志社, 1999: 267-275.
11. 曲姍, 勝利. 廣泛性焦慮量表在綜合醫院心理科門診篩查廣泛性焦慮障礙的診斷實驗. 中國衛生心理雜志, 2015, 29(12): 939-944.
12. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder - The GAD-7. Arch Intern Med, 2006, 166(10): 1092-1097.
13. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a serfreport version of PRIMEMD: the PHQ primary care study. JAMA, 1999, 282(18): 1737-1744.
14. 中國醫學會心血管病學分會高血壓血組. 清晨血壓臨床管理中國專家指導建議. 中華心血管病雜志, 2014, 42(9): 721-725.
15. 周蓉, 魏黎, 胡俊峰, 等. 家庭醫生責任制管理的實施對社區高血壓患者的影響. 上海醫藥, 2017, 38(22): 35-38.
16. 王歷, 陸凱, 李建超, 等. 患者健康問卷在心血管門診抑郁障礙篩查中的價值. 中華心血管病雜志, 2015, 43(5): 428-431.
17. 張新安. 低蛋白飲食對糖尿病腎病患者影響的研究進展分析. 飲食保健, 2018, 5(15): 31-32.
18. Pagels AA, S?derkvist BK, Medin C, et al. Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment. Health Qual Life Outcomes, 2012, 10(1): 71.
19. 王淑麗, 陳慈徽, 龔蘭芳, 等. 整體照護計劃對CKD病人自我照顧行為與腎功能的影響. 長庚護理, 2018, 29(1): 1-13.
20. 李莉, 李英華, 聶雪瓊, 等. 我國6省糖尿病患者自我管理行為調查. 中國健康教育, 2014, 30(1): 16-19, 38.
21. 何巧, 劉宇, 趙芳, 等. 新診斷2型糖尿病青年患者自我管理現狀及影響因素研究. 護理學雜志, 2018, 33(11): 26-30.
22. Rodriguez KM. Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator. Clin Ther, 2013, 35(2): 170-178.
23. 劉靜, 王春梅. 2型糖尿病患者抑郁、焦慮與自我管理能力的相關性研究. 國際內分泌代謝雜志, 2013, 33(4): 283-286.
24. 沈玉蘭, 夏世萍, 鄒樹芳. 老年2型糖尿病患者焦慮、抑郁水平與自我管理水平的相關性. 中國醫藥導報, 2017, 14(35): 151-154.
25. 張彩虹, 陽曉麗, 郭洪花, 等. 自我管理項目對社區慢性阻塞性肺疾病患者焦慮抑郁及疲勞的影響. 中國老年學雜志, 2017, 37(2): 436-438.
26. Wang J, Xiong X. Control strategy on hypertension in Chinese medicine. Evid Based Complement Alternat Med, 2012(1): 284847.
27. 毛曉清, 黃秋鵬, 謝席勝, 等. 臨床健康教育路徑在慢性腎臟病合并高血壓患者治療中的應用. 西部醫學, 2018, 30(2): 295-298.

West China Medical Journal

Analysis of the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease

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