A behavioral model traditionally used to help people quit smoking may also be effective in helping patients with chronic kidney disease decide which treatment is best for them. This is according to a new study published in the Clinical Journal of the American Society of Nephrology.
Chronic kidney disease (CKD) is defined as the progressive loss of kidney function over time. In CKD, the kidney is unable to effectively remove waste products and excess water from the blood, causing them to accumulate.
Symptoms of the condition include fatigue, poor appetite, muscle cramping, inflammation and a frequent need to urinate. CKD also increases the risk of heart attack, stroke and heart disease.
CKD is estimated to affect around 26 million people in the US – approximately 10% of the population – and is the eighth leading cause of death in the country.
Treatment options for patients with advanced CKD, also known as kidney failure or end-stage renal disease (ESRD), include dialysis – in which waste and excess water is removed from the blood and certain chemicals, such as potassium and sodium, are regulated – or kidney transplantation.
Deciding which of these treatments is best, however, can be difficult for patients, with both options presenting different risks and benefits.
With this in mind, Dr. Suma Prakash, of Case Western Reserve University in Cleveland, OH, and her team set out to assess whether the “behavioral stage of change” model – also called the transtheoretical model – could help patients with advanced CKD reach decisions about their treatment options.
This model – developed in the 1970s to help people stop smoking – is made up of five stages of behavior: precontemplation (no intention to take action), contemplation (thinking about taking action), preparation (the intention to take action soon), action (behavioral changes have started and there is an intention to continue) and maintenance (behavioral changes have been in place for a long period and there is an intention to maintain these changes).
Dr. Prakash and her team applied this model to 55 patients with advanced CKD. They found 65% of them were in the precontemplation or contemplation stages in relation to their treatment options, while the remaining 35% were in the preparation or maintenance stages.
A better knowledge of treatment options, fewer lifestyle barriers to home-based dialysis and doctors who fully explained treatment options were identified as factors that increased patients’ readiness to make a decision.
Based on their findings, the researchers say the model may be a useful tool in helping patients with CKD choose the treatment that is best for them, Dr. Prakash adds:
“Focusing on understanding the decision-making process from patients’ perspectives allows us as medical professionals to help patients make timely [decisions] about their options.
Some potential impacts of reaching this goal are that patients might opt more for home dialysis options, and more patients may be able to start their preferred option in a non-urgent manner and not require admission to the hospital to start dialysis.”
In November 2014, Medical News Today reported on a study claiming more patients with pre-dialysis CKD should take statins to lower cholesterol levels.