Predictors of health activation for patients with chronic kidney disease undergoing hemodialysis

Abstract

Introduction: the quality of self-care in patients with chronic kidney disease (CKD) is important to improve quality of life, increase survival and reduce complications. Self-care can be evaluated by measuring the health activation of these patients. Objectives: evaluating the health activation of patients with CKD undergoing hemodialysis (HD) compared to a normative group (health self-reported subjects), and to identify the social, demographic and clinical determinants that are associated with the health activation. Method: cross-sectional, analytical, descriptive and quantitative study approved by the local ethics committee and conducted in a public and a private outpatient hemodialysis clinic. Participants were patients with CKD on HD (focal group) and subjects on a normative group. All of them answered the questionnaire of sociodemographic and clinical characterization and the instrument "Patient Activation Measure" (PAM13). For scores comparisons were used the Mann-Whitney test. Regarding the evaluation of the linear effect of the variables of profile on PAM13, multiple linear regression was used, including the evaluation of the two groups and only for patients with CKD. Results: the study included in each group. Regarding the characteristics of the CKD patients, there was a predominance of males (59%), incomplete high school or less (68%). Most of them too was from a private administration clinic (53%) and reported having already presented some type of complication stemming from CKD (57%). Regarding the evaluation of activation, the activation scores did not differ between the two groups (median of 56.4 in CKD patients and 56.4 in normative group, p > 0.05) and the activation scores of both groups corresponded to activation level 3 with 34.5% of prevalence (p > 0.05). When the two groups were analyzed together, schooling (Bi = 5.38; p= 0.002), practice physical activity (Bi = 4.2; p= 0.019) and the number of people who co-reside (Bi = -2.22; p= 0.001) influenced the activation score. In the CKD patients, independently, the variables that influenced the activation score were gender (Bi = -4.69; p = 0.050); schooling (Bi = 6.55; p = 0.008); type of clinic of origin (Bi = -5.48; p = 0.02) and the presence of complications related to CKD (Bi = -5.25; p = 0.026). Conclusion: activation scores did not differ between the patients with CKD on HD and the health subjects. Schooling, practice physical activity and number of people residing with the individual were predictors of health activation in both groups. For the CKD patients group, the variables that influenced positively the activation was schooling; and that influenced negatively was the gender, type of clinic of origin and the presence of complications related to CKD.