Health-related hope and reduced distress associated with fluid and dietary restrictions in advanced chronic kidney disease and dialysis: a cohort study

Rationale & ObjectiveIn chronic kidney disease (CKD), the durability of patient adherence to fluid and dietary restrictions may depend on the degree to which they have hope that they will enjoy life. However, few studies have examined the long-term role of health-related hope (HR-Hope) on distress from fluid and dietary restrictions.Study Design Prospective cohort study.Setting & ParticipantsA total of 444 non-dialysis stage 3-5 patients and stage 5D patients attending one of five Japanese nephrology centers.ExposureAn 18-item HR-Hope scale with a score ranging from 0 to 100.OutcomesTwo-item measures of restrictions on fluid and dietary intake from the Japanese version of the Kidney Disease Quality of Life Short Form, Version 1.3, with each score ranging from 0 to 100.Analytical ApproachMultivariate linear mixed models were used to estimate the association of baseline HR-Hope with distress from fluid and dietary restrictions at baseline and follow-up.ResultsThe mean age of participants was 67 years, 31.1% were female, and 124, 98, and 222 had non-dialysis CKD, peritoneal dialysis, and hemodialysis, respectively. Baseline HR-Hope buffered the growing distress from fluid restriction after one year (−18.01 pts [95% CI, -28.24 to -7.79]) per 10-pt increase, 2.59 pts [95% CI, 1.05 to 4.13]. The distress from fluid restriction at 2 years did not differ from baseline. Baseline HR-Hope buffered the growing distress from dietary restriction after one year (−12.4 pts [95% CI, -22.68 to -2.12]) per 10-pt increase, 1.96 pts (95% CI, 0.34 to 3.57). The distress from dietary restriction at 2 years did not differ from baseline.LimitationsUse of self-reported measures as proxies for adherence.ConclusionsOur study shows that HR-Hope, regardless of depression, can potentially mitigate the long-term distress from fluid and dietary restrictions in patients with a wide range of CKD severities.