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Controlled fluid intake is an important aspect of living with end stage renal disease (ESRD), and is complicated by depression, the most common mental health issue affecting individuals with ESRD. Factors that mitigate the deleterious effects of depression are underexplored. This study sought to identify potential mediators between depression and fluid adherence in 107 individuals with ESRD aged 50 years and older by comparing four logistic regression models. Age was associated with an increase in fluid adherence (adjusted odds ratio [AOR]=1.08, 95% confidence interval [CI]=1.02-1.14), whereas depression was associated with a decrease in fluid adherence (AOR=0.82, 95% CI=0.67-0.99), but when self-efficacy was entered into the model, the association between depression and fluid adherence weakened. Findings suggest that self-efficacy and age are important factors in fluid adherence, and self-efficacy can potentially mediate the negative effects of depression in older adults with ESRD.
Key Words: End stage renal disease, depression, fluid adherence, older adults.
Controlled fluid intake is an important aspect of achieving optimal health outcomes in older adults with end stage renal disease (ESRD) who are undergoing in-center hemodialysis (HD). It often requires that individuals engage in self-management activities that are congruent with recommendations from healthcare professionals, which may be challenging for many older adults undergoing in-center HD. About 74% of individuals undergoing HD experience fluid intake difficulties (Clark, Farrington, & Chilcot, 2014) largely due to thirst and sodium intake (Lai et al., 2012; Sarkar, Kotanko, & Levin, 2006). Not maintaining recommended fluid intake may result in pulmonary edema, congestive heart failure, hypertension, and mortality (Christensen & Ehlers, 2002; Howren, Cozad, & Christensen, 2017; Lai et al., 2012; Sarkar et al., 2006; Welch, 2001). Interventions to manage fluid intake, such as using visual aids to educate patients about typical fluid volume (Pace, 2007), self-efficacy training (Tsay & Hung, 2004), and interactive water bottles (Kullgreen, Scholl, Kidwell, & Hmiel, 2015), have shown some success. Still, for several reasons (e.g., depression, limited social support, environment), the issue of fluid levels between treatments continues to be a struggle for many individuals undergoing HD.
Fluid management can be complicated by depression. Depression is common in adults undergoing HD, with approximately 30% of this population experiencing depression (Cukor, Rosenthal, Jindal, Brown, & Kimmel, 2009; Khalil, Frazier, Lennie, & Sawaya, 2011)....