Nutrición Hospitalaria (Apr 2006)
Determinación de los factores condicionantes en la adhesión y cumplimiento de la dieta de protección renal en pacientes con insuficiencia renal crónica: estudio previo para la elaboración de una guía dietética Determination of factors conditioning adherence and accomplishment of renal protection diet in patients with chronic renal failure: pilot study for the elaboration of a dietary guideline
Abstract
Son escasos los estudios sobre el comportamiento alimentario en los pacientes con Insuficiencia Renal Crónica (IRC). El objetivo de este estudio, a través de una encuesta previamente validada, ha sido conocer cuales son los factores psico-socio-culturales, y en que grado inciden a la hora de asumir y cumplir el tratamiento dietoterápico, determinando, además, el grado de percepción de la enfermedad y de los diversos factores relacionados con ella. La población estudiada estaba formada por 81 pacientes de la consulta de nefrología del hospital "12 de Octubre" de Madrid, con IRC en prediálisis. A las preguntas relacionadas con el autoconocimiento y percepción de la enfermedad el 77,74% respondió dentro de los niveles "bien o muy bien". Los factores emocionales y de autocontrol tienen escasa relevancia, según afirma el 69,87% de los pacientes. El 59,26% siente en alto grado el apoyo familiar y el 35,77% altera el seguimiento dietético cuando cambian las condiciones medioambientales. La gran mayoría de los entrevistados, un 87,65%, no tienen dificultad en encontrar los alimentos pautados y para el 70,37% de la población su coste no es excesivo. Para casi la mitad de los pacientes (48,76%) la dieta de protección renal supone una variación de sus hábitos alimentarios, un porcentaje similar expresa, además, dificultad con la preparación. La palatabilidad de los alimentos no es un problema en el 67,90% de los casos. El 51,24% no percibe dificultad en los procesos culinarios. El 70,99% se siente apoyado, deuna u otra forma, por el personal sanitario, aunque sólo un 56,79% refiere que no le ha sido explicada la dieta. Únicamente el 18,51% cuestiona la efectividad de la dieta en relación con la evolución de su enfermedad. Dentro de la variable sexo, se observaron diferencias significativas (p There are seldom studies on dietary behavior of patients with chronic renal failure (CRF). The aim of this study has been to know, by means of a previously validated questionnaire, which are the psycho-sociocultural factors that affect, and to what extent, assumption and adherence the dietary therapy while determining the degree of disease perception and several factors related with it. The study population is comprised by 81 patients from the nephrology clinic of the "12 de Octubre" Hospital of Madrid, with CRF in a pre-dialysis status. Seventy-seven point seventy-four percent answered "well" or "very well" to questions relating to disease knowledge and perception. Emotional and auto-management factors have little relevance according to 69.87% of patients. Fifty-nine point twenty-six percent feel a high level of familial support, and 35.77% alters dietary behavior when environmental conditions change. Most of the interviewees (87.65%) do not have difficulties finding the prescribed foods, and 70.37% considers their cost is not excessive. For almost half of the patients (48.76%), renal protection diet represents a variation in their dietary habits, a similar percentage expresses difficulty with elaboration. Food palatability is not a problem in 67.90% of the cases. Fifty-one point twenty-four percent does not perceive difficulty with cooking procedures.Seventy point ninety-nine percent feels support in one way or the other, by health care staff, although just 56.79% reports that the diet has not been explained to them. Only 18.51% questions the diet effectiveness as regards to their disease course. As for the gender variable, there were significant differences (p < 0.05), with a higher influence on men, in sections relating to disease knowledge, and influence of apathy and family support, the women those having the highest scores for food management, diet transgression at family meetings, and less information received about the prescribed diet. As for family support, there are significant differences only by age groups, patients aged more than 65 years being those feeling more this psychological support. The group of patients with a creatinine clearance less than 25 mL/min is the one expressing less categorically their appreciation on diet effectiveness. There are factors in which significant difficulty percentages are observed and that may induce diet transgression,in some cases without the patient being completely aware of, such as environmental changes, change in traditional habits, the degree of diet explanation, the organoleptic characteristics, and the lack of knowledge of appropriate cooking procedures. All these indicators confirm the need for enhancing nutritional education of these patients and their family environment, also showing the need for a nutritional intervention that completely supports patients in the process of adaptation and maintenance of their new dietary habit.
