Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach

Aims. To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain varies between patients in groups with different cognitive profiles. Background. Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control, and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions. Design. Explorative cross-sectional multicentre survey. Methods. The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One-way analysis of variance (anova) or Pearson's chi-square test was used for comparing subgroups. Results. Three distinct subgroups were found and subsequently labelled: (1) low self-efficacy, (2) distraction and depressive symptoms and (3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output or in receiving any fluid intake advice. Conclusions. Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms. Relevance to clinical practice. Based on this study, we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient's fluid control, is introduced.