Effect of a Behavioral Self-Regulation Intervention on Patient Adherence to Fluid-Intake Restrictions in Hemodialysis: a Randomized Controlled Trial

• Published in: Annals of behavioral medicine 2016-04, Vol.50 (2), p.167-176
• Main Authors: Howren, M. Bryant, Kellerman, Quinn D., Hillis, Stephen L., Cvengros, Jamie, Lawton, William, Christensen, Alan J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Behavior; Behavior Therapy - methods; Chronic illnesses; Drinking - physiology; Family Medicine; Female; General Practice; Health Psychology; Hemodialysis; Humans; Intervention; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Compliance - psychology; Renal Dialysis - psychology; Renal Insufficiency, Chronic - psychology; Renal Insufficiency, Chronic - therapy; Self-Control - psychology; Studies; Treatment Outcome
• ISSN: 0883-6612; 1532-4796
• DOI: 10.1007/s12160-015-9741-0

Objective The purpose of this study is to evaluate the efficacy of a behavioral self-regulation intervention vs. active control condition using a parallel-group randomized clinical trial with a sample of center hemodialysis patients with chronic kidney disease. Method Participants were recruited from 8 hemodialysis treatment centers in the Midwest. Eligible patients were (a) fluid nonadherent as defined by an interdialytic weight gain >2.5 kg over a 4-week period, (b) >18 years of age, (c) English-speaking without severe cognitive impairment, (d) treated with center-based hemodialysis for >3 months, and (e) not living in a care facility in which meals were managed. Medical records were used to identify eligible patients. Patients were randomly assigned to either a behavioral self-regulation intervention or active control condition in which groups of 3–8 patients met for hour-long, weekly sessions for 7 weeks at their usual hemodialysis clinic. Primary analyses were intention-to-treat. Results Sixty-one patients were randomized to the intervention while 58 were assigned to the attention-placebo support and discussion control. Covariate-adjusted between-subjects analyses demonstrated no unique intervention effect for the primary outcome, interdialytic weight gain ( β  = 0.13, p  = 0.48). Significant within-subjects improvement over time was observed for the intervention group ( β  = −0.32, p  = 0.014). Conclusions The present study found that participation in a behavioral self-regulation intervention resulted in no unique intervention effect on a key indicator of adherence for those with severe chronic kidney disease. There was, however, modest within-subjects improvement in interdialytic weight gain for the intervention group which meshes with other evidence showing the utility of behavioral interventions in this patient population. ClinicalTrials.gov Identifier: NCT01066949