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

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

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

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Acknowledgements

Preparation of this article was supported in part by NIDDK grant R01DK072325 awarded to Alan J. Christensen. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Author information

Authors and Affiliations

  1. VA Iowa City Healthcare System, Iowa City, IA, USA

    M. Bryant Howren PhD, MPH & Stephen L. Hillis PhD

  2. Department of Psychology, The University of Iowa, Iowa City, IA, USA

    M. Bryant Howren PhD, MPH

  3. VA Minneapolis Healthcare System, Minneapolis, MN, USA

    Quinn D. Kellerman PhD

  4. Departments of Radiology and Biostatistics, The University of Iowa, Iowa City, IA, USA

    Stephen L. Hillis PhD

  5. Rush University Medical Center, Chicago, IL, USA

    Jamie Cvengros PhD

  6. Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA

    William Lawton MD

  7. Departments of Psychology and Internal Medicine, The University of Iowa, 11 Seashore Hall East, Iowa City, IA, 52242, USA

    Alan J. Christensen PhD

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  1. M. Bryant Howren PhD, MPH
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  2. Quinn D. Kellerman PhD
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  6. Alan J. Christensen PhD
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Correspondence to Alan J. Christensen PhD.

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Howren, M.B., Kellerman, Q.D., Hillis, S.L. et al. Effect of a Behavioral Self-Regulation Intervention on Patient Adherence to Fluid-Intake Restrictions in Hemodialysis: a Randomized Controlled Trial. ann. behav. med. 50, 167–176 (2016). https://doi.org/10.1007/s12160-015-9741-0

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  • DOI: https://doi.org/10.1007/s12160-015-9741-0

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