Authors (including presenting author) :
Loo KM, Wong RYM, Yeung THM, Chik MY, Choy WY, Lee KY, Chan WS, Lau LW, Ozaki R
Affiliation :
Department of Medicine & Therapeutics
Introduction :
In Hong Kong, diabetes mellitus accounts for more than half of incident cases of renal replacement therapy. Evidence shows that besides aggressive medical management to meet metabolic targets, the implementation of comprehensive educational intervention to increase patient knowledge on chronic kidney disease (CKD) management can effectively delay the need for dialysis, improve clinical outcome and extend survival. Unfortunately, recent studies have shown that diabetic patient knowledge of chronic kidney disease remains inadequate. Patients with diabetic kidney disease should be well informed on the staging of their kidney disease, its related symptoms, the need to avoid nephrotoxic drugs and adhere to a renal diet, understand own risk factors and treatment targets (blood pressure, blood glucose and lipids) as well as actively engage in diabetes self-management. Post DCS SEP serves as an excellent platform for patients with DKD to learn about and receive feedback on their metabolic control and risk factors, presence of DM complications, if any and in particular on kidney disease progression and to become empowered on self-care management. A continuous quality improvement programme is conducted to explore patients’ perception of DKD and feedback on SEP improvement.
Objectives :
1. To understand patients’ perceived knowledge and stress level on DKD and its management 2. To understand patients’ compliance to diabetes management 3. To evaluate patients’ knowledge, and collect feedback for programme improvement
Methodology :
Arrangements are made routinely for all patients aged < 75 to attend a SEP 6 to 8 weeks after DCS, either in a general or DKD class based on their glomerular filtration rate (GFR) levels. Should the patient’s GFR be < 60 mL/ min/1.73 m2 , a DKD class will be arranged. Formal DKD empowerment class has been established at PWH Diabetes Centre since 2018. It is a 2-hr interactive programme during which patients receive their own DCS reports and a Chinese DCS handbook with supplementary information. Both general class and DKD class provide education on treatment targets, signs and symptoms of various complications and self-management strategies. Whereas DKD class focuses more on the understanding of kidney functions and dysfunctions, signs and symptoms and management of CKD ranging from G3 to G5, principles of renal diet, drugs that help or damage kidney function, sharing of experience on diabetes management strategies amongst patients in order to retard the progression of DKD and other diabetes complications. To further improve upon patient-centred education and understand patients’ perception of DKD, a CQI programme was conducted. A self-administered questionnaire was distributed to literate patients with CKD staging of G3 to G4 before and after the DKD class during the period Nov 2018 to Jan 2019. 8 out of 10 questions were adopted and translated from the Perceived Kidney Knowledge Survey (PiKS). The questions include 10 topics relating to kidney disease, such as knowledge on medications that help or damage the kidney, treatment targets of glucose, blood pressure and lipids, food to avoid in chronic kidney disease. Patients were also asked to provide self-rating of anxiety level with kidney disease.
Result & Outcome :
A total of 37 pre- and post- questionnaires from 4 DKD classes were collected for analysis. 13 questionnaires were discarded due to patient’s failure to answer the questionnaire after DKD class as they left prior to the end of the class. In this cohort , 11 were female and 26 were male with mean age 61.5±9.6 and only 22% of them were working either full time or part time. HbA1c < 7%, 7.1% - 8%, > 8% were 38% (N=14), 16% (N=6), 46% (N=17) respectively. Only 30% of patients achieved BP < 130/80mmHg (N=11) and 46 % achieved LDL < 1.8mmol/L (N=17). Kidney staging of G3a, G3b, G4 were 38% (N=14), 49% (N=19), 13.5% (N=5) respectively. 58% of G3a patients were without microalbuminuria. 7 out of 37 patients (19%) were not aware that they had chronic kidney disease. The two areas in which patients scored the least were in drugs that help and harm the kidneys. From the 10 renal disease knowledge topics, 70% reported they” don’t know or know a little amount”. However, after attending the DKD class, there was a 30% increase in scoring on “know more or a good amount knowledge”. In the diabetes self-management section, 5% (N=2) were current smokers, 86% and 64% performed home blood glucose (N=32) and blood pressure (N=24) monitoring. 86% reported good drug compliance (N=32). Patients had lowest compliance to physical activity with only 27% (N=10) of patients adhering to moderate intensity of physical activity for up to 150 min or less per week although 68% of patients were classified as obese or morbidly obese (BMI > 25 kg/m2, N=25). Patients’ rating on anxiety about kidney disease was 4.1 pre-programme (likert scale from to 10) and increased to 5.2 post programme. 97% of patients commented that they were satisfied or very satisfied with the programme content, its length and its usefulness. A limitation of this survey is low in the number of respondents. Motivation of patients to engage in physical activity and obesity management remain the most challenging task for most diabetes teams. The low adherence to physical activity warrants further exploration on how these hurdles for lifestyle modification can be overcome. Nevertheless, the programme led to some increase in our patients’ awareness of and anxiety towards CKD without negative impact. We hope this small dose of anxiety will fuel the motivation of our patients to further improve in their metabolic controls.
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