http://doi.org/10.33698/NRF0269- Pratibha Thakur, Shruti , Manju Dhandpani , Deepesh B Kenwer

ABSTRACT:

Background: Renal transplant is the best treatment of choice for most end stage renal disease patients (ESRD). Renal transplant is the best treatment of choice for end stage renal disease. Lack of knowledge regarding post transplant management may lead to serious complications including rejection of transplanted kidney.

Objectives: To assess pre transplant knowledge of renal transplant recipients Methodology: The study was conducted in renal transplant surgery units in PGIMER, Chandigarh during the month of August-November 2018. Ethical approval was taken from institute Ethics Committee, PGIMER, Chandigarh. Permission from Head, Department of Renal Transplant Surgery was PGIMER, Chandigarh was taken and written informed consent was obtained from renal transplant recipients. Total 60 transplant recipients were taken by total enumeration sampling technique. Data was collected by administering questionnaire consisting of (1) Socio demographic prole (2) Personal prole and clinical prole (3) Questionnaire on pre transplant knowledge. Result: Majority of the respondents (83%) of patients undergoing renal transplant have poor level of knowledge and 15 % patients exhibit good level of knowledge. Majority of the study participants (88%) lacking knowledge about infection prevention practices. Only 15% study participants knew about sign and symptoms of rejection.

Conclusion: Knowledge of the study participant found poor. Hence it is recommended to educate patients during pre transplant period for getting better outcomes.

Key words: Renal transplantation, self-management guidelines, ESRD

Address for Correspondence

Ms. Shruti Lecturer

National Institute of Nursing Education PGIMER, Chandigarh

Introduction

An illness like renal failure is a stressful event to a person or his/her family. Renal transplantation is the best treatment of choice for patients with end stage renal disease (ESRD). But kidney transplantation leads to changes in life roles in most areas of renal transplant recipients lives.

Renal transplant recipients are at risk of infections, cardiovascular disease, diabetes and certain type of cancers and also face many psychological problems like anxiety, depression. Life with renal disease and its treatment can be stressful, particularly in the early weeks and months. Most patients and families go through a period of grieving as they try to adjust to changed life roles. 1 These problems can be due to lack of knowledge regarding disease condition, its treatment and further self- management after transplant.

Renal transplant is a life changing event in patients with end stage renal disease although it improves the quality of life of patients but successful management of renal transplantation requires management of few things and some precautions which are important for the long life span of transplanted kidney. After Renal transplant, recipients lives a life style which is different from their previous life style and this can be achieved by proper knowledge and practices Many studies have shown that lack of proper knowledge among renal transplant recipient can leads to many complications in post transplant phase which can leads to rejection of transplanted kidney and some time patients go back to dialysis and which decrease the quality of life of a renal transplant recipients life.

Strict medication adherence, therapeutic compliance, precautions from infections, dietary management and regular follows etc are very important in these patients and self management practices among renal transplant recipients can be achieved through adequate knowledge regarding the disease processes its treatment and post transplant self management activities after. With the proper knowledge patient can perform self management activities effectively. But before making any health educational packages for the renal transplant patients it is important to assess the level of knowledge regarding disease its treatment and management to know that which area need more emphasis and what skills and practices they need to be learn Hence present study was conducted.

Objectives: To assess pre transplant knowledge of renal transplant recipients

Material and method:

Research approach was quantitative and design was descriptive research design. Target population was patients undergoing renal transplant. The study was conducted in Renal Transplant Surgery Unit of PGIMER, Chandigarh during the month of August- November 2018 . Total 60 transplant recipients were taken in the study by total enumeration sampling technique. Patients willing to participate were included in the study. Ethical approval was taken from institute Ethics Committee, PGIMER, Chandigarh. Permission from Head, Department of Renal Transplant Surgery was PGIMER, Chandigarh was taken written informed consent was obtained from renal transplant recipients. Data was collected by administering questionnaire consisting of (1) Socio demographic prole (2) Personal prole and clinical prole (3) Questionnaire on pre transplant knowledge. Questionnaire was administered to renal transplant recipients one day prior to surgery and taken back from them after 40-45 minutes. Analysis was done using SSPSS version 23 software. Data was analyzed by descriptive and inferential statistics and presented in form of tables and gures.

Result

Table1: Socio demographic profile of the study participants undergoing renal transplant

Table1 shows the socio demographic distribution of study patients. The mean age of the patients was in the range of 21-71 year with mean age of 37.7± 12.92. More than half of the study patients were male i.e. 80%. About 28% of patients were educated up to post high school and 47% of patients in control group had graduation and above. 67% of patients were unmarried. 80% patients were belongs to Hindu religion. Occupation wise 30% patients were self- employed and 37% patients were private employee and 37% patients were not employed. Majority of patients were living in nuclear families. 50% of patients were living in urban areas and 50% were living in rural areas. Most of the study participants having per capita income is between Rs 5001-10,000.

Variable n=60 (%)
Age (years)*
18-33 29(48.3)
34-49 23(38.3)
50-65 06(10)
66 and above 02(3.3)
Gender
Male 48(80)
Female 12(20)
Qualification

Un educated

 

01(2)

Up to middle school 04(7)
High School 10(17)
Intermediate/post high 17(28)
Graduation and above 28(47)
Marital status

Unmarried

 

40(67)

Married 20(33)
Religion

Hindu

 

48(80)

Sikh 10(17)
Other 02(3.3)
Type of Family

Nuclear family

 

34(53)

Joint family 26(47)
Habitat

Rural

 

28(50)

Urban 42(50)
Occupation

Govt. employee

 

08(20)

Private employee 17(37)
Self employed 13(13)
Not working 16(30)
Housewife 05
Per capita income of family**

<5000

 

27(47)

5001-10,000 22(40)
10001-20,000 05(10)
>20,000 02(3)

Age*(Mean±SD,range) = 35. 3 ± 11.6 , 20-71

Incomepercapita**(Mean±SD,range)=Rs 19648 ± 96078.4, 1711-750000

Table 2: Personal profile of the study participants undergoing renal transplant

 

Variable n=60 (%)
Dietary Habits Vegetarian Non-vegetarian Eggetarian

History of addiction:

Alcohol

Smoking/Tobacco chewing Addiction to any substance/drug*

 

25 (35)

29 (57)

06 (10)

 

14 (27)

06 (10)

01 (02)

*= Heroin

Variable n=60 f(%)
Chief complaints of patient on diagnosis

Ÿ High blood pressure

Ÿ Decreased urine output

Ÿ Edema

Ÿ Dysponea Ÿ Hameturia Ÿ UTI

Ÿ Vomiting

Ÿ Fever

Ÿ Weakness

Ÿ Any others (Headache, loss of appetite, diarrhea, shrunken kidney on USG)

 

06 (10)

04 (07)

22 (36)

07 (12)

04 (07)

04(07)

12(20)

09(15)

15(25)

13(22)

Co morbidities

Ÿ Diabetes

Ÿ Hypertension

Ÿ Any other (HCV, Pleural effusion, seizures, hyperthyroidism, sarcoidosis, nephritic syndrome, tuberculosis)

 

14(23.3)

27 (45)

12 (20)

Type of dialysis

Haemodialysis

 

60 (100)

Duration since on dialysis

1-12month 13-24month 25-36month

37monthandabove

 

32 (53.3)

23 (38.3)

03 (05)

02 (3.3)

Type of kidney donor

Living donor Cadaver donor

 

41(68)

19(32)

 

Table 3: Clinical Profile of study participants undergoing renal transplant

Table 2 representing that majority of study patients in were non-vegetarian (57%). 27 % of study patients were alcoholic and 10% of study patients were smoker and chewing tobacco. Only 2 % of study patients were addict to other substance/ drug

Table 3 depicts frequency and percentage of clinical variable of the study patients. 36% study patients were presented with chief complaint of edema. Majority of patients were present with co morbidity such as hypertension and diabetes. Each patient in underwent hemodialysis. 53 % patients having duration of dialysis between 1-12 months and 38 % of study participants having duration of dialysis between 13-24 months. Majority of the patients i.e. 68% underwent living donor renal transplant.

Table 4 depicts item wise frequency percentage of pre transplant knowledge of study participants. Majority of patients had poor knowledge regarding transplant. Only 48% were aware regarding functions of transplanted kidney. Only 30% knew about normal body temperature and 37% had knowledge of side effects of anti rejection medications, Only 28% study participants were aware that they should take calcium diet after transplant and 33% have idea what to avoid in diet after kidney transplant. Only 12% knew about what infection prevention precautions they should take after renal transplant.

Table 5 presents the frequency percentage, Mean, SD and range of knowledge score. 83% of patients undergoing renal transplant have poor level of knowledge and 15 % patient exhibit good level of knowledge. Only 2% of patients having very good level of knowledge in pre transplant phase. Mean level of knowledge was 7.16 with standard deviation of 3.36 and range was between 2- 19.

 Table 4: Frequency distribution of pre transplant knowledge of patients undergoing renal transplant.

Statements Percentage of patients answered correct

n=60 (%)

Transplanted kidney takes over the job of ltering blood after transplant. 29 (48)
Normal temperature of human body is 37° C or 98.6° F 18 (30)
Anti-rejection medications increase risk of infection 22 (37)
Consult your transplant team if side effects of anti-rejection medications occur. 26 (43)
Consult transplant team before taking other medications because these can interfere with action of anti-rejection medications. 15 (25)
Post Renal transplant patients should:
Ÿ Wash hands properly, wear mask and avoid contact with unwell persons as precautions to prevent from infection 07 (12)
Ÿ Report immediately to transplant team if fever of 101°F or greater, decreased urine output, pain or tenderness over transplant site is present 09 (15)
Ÿ Take low sodium and low fat diet after kidney transplant 14(23)
Ÿ Avoid eating maize, potatoes, breads after kidney transplant 20 (33)
Ÿ Take calcium rich items in diet after kidney transplant because long term use of steroids weaken the bones 19 (28)
Ÿ Drink 3-4 liter/day water on daily basis after their kidney transplantation 16 (27)
Ÿ Start doing physical activity and exercise usually six weeks after transplant or according to condition of patient. 17 (27)
Ÿ Do brisk walk daily for at least 30 minutes 25 (42)
Ÿ Keep in mind that they should wait at least 1½ hours after eating a meal before starting any exercise. 24 (40)
Ÿ Avoid activities like pushing heavy objects and chores such as raking, shoveling, and mowing after kidney transplant 40 (67)
Ÿ Follow up regularly to check proper functioning of transplanted kidney 18 (30)
Ÿ Come for follow up according to follow up card 17 (27)
Ÿ Bring complete medical records to you follow up 37 (60)
Ÿ Report immediately to transplant team in case of sores, wounds, or injuries especially those that don’t heal or if any discharge from incision site, or paint tenderness, swelling around the incision 08 (13.3)
Ÿ Take oral rehydration solution (ORS) in case of minor diarrhea at home. 19 (43.3)

Table 5: Level of knowledge of patients undergoing renal transplant

 

Knowledge score n=60 f(%)
Poor (1-10) 50 (83)
Good (11-15) 9 (15)
Very good (16-20) 1 (2)

Mean±SD, range = 7.16 ± 3.36, 2-19

Discussion

Renal transplant is the blessing of science for human population and a life changing procedure for patients with end stage renal living donors from family for young adolescents and adults are more as compare to old people.

In relation to gender the present study showed that, majority of the study participants were male (80%) This nding is in agreement with Kunitoshi Isek who reported women seems to be somewhat protected from developing ESRD and the cumulative incidence of ESRD remains low in female during the reproductive ages and begins to rise 10 years later in women than disease (ESRD).The survival rate of the in men.2    And also one reason for more patients within ESRD has improved a lot after the renal transplant surgeries. Although renal transplant is becoming very common in twenty rst century but in the absence of proper knowledge regarding care and self-management there are many complications associated with it. Lack of knowledge among renal transplant recipients leads to decreased prognosis, decrease the quality of life and increased complications and increased chances of rejection of transplanted kidney. So it is important to educate before they undergo transplant so that they can manage themselves during post transplant period. But before educating patients it is very important to assess their level of knowledge and understanding.

In present study, most of study participants were in age group of 18-33 years (48%) with a mean age of 35.3. Yoseria Attia Ameen Omar in her study also found majority of study participants were with a number of male recipients can be that in India male are thought to be bread earner of the family and got living donor from family members more easily as compared to females patients and also in some cases female patients are not taken to hospital for treatment

Regarding the Co-existing diseases, the present study found more than half of study participants were suffering from co- morbidities like diabetes mellitus (23%) and hypertension (45%). Literature reports that hypertension and diabetes mellitus are the leading causes of renal failure, uncontrolled or untreated hypertension and diabetes mostly affect the kidneys. Seyed Bahman Ghaderian also found in his study that diabetic nephropathy and hypertensive nephrosclerosis are also the most common cause of ESRD.3 Another study done by Haghighi et al. (2000) also supports the same ndings that the diabetic nephropathy and hypertension are the common reason mean age of 35.4 years.1 Many studies for the ESRD 4 showed that chances of ESRD increase with advance age. One reason for more number of patients in this age group can be that

The result of the study had shown that majority of the respondents (83%) of patients undergoing renal transplant had poor level of knowledge. In present study only 43% of study participant were aware of side effects of anti rejection medication and 25% were aware of interaction of anti rejection medications with other medications, which put them at risk of rejection and other complications. According to National Kidney foundation report non adherence to immune suppressive drugs accounts for 20% of late acute rejections and 16% of graft losses.5

Most of the study participants (88%) lacking knowledge about infection prevention practices and only 15% study participants were aware that if fever of 101°F or greater, decreased urine output, pain or tenderness over transplant site is present they should report immediately to transplant team sign and symptoms of rejection. Yoseria Attia Ameen Omar in her study also demonstrated that patient’s pre- intervention knowledge and practices regarding infection control and self monitoring was decient1. Few study patients (23%) had knowledge that they should avoid eating few things like maize, potatoes, breads after kidney transplant. Only 23% study participants were aware about taking low sodium diet. Only 28% study participants were aware that they should take calcium diet after transplant. Only 33% knew about what diet they should avoid after transplant. Nolte J F and Moore LW reported in their study that dietary patterns change over time and monitoring risk factors for developing metabolic complications post-transplant should be a clinical priority. Post-transplant weight gain, particularly visceral fat gain, increases the risk of developing new onset of diabetes after transplant (NODAT), dyslipidemia, and cardio vascular accidents (CVD) 6. So knowledge regarding dietary management in renal transplant recipient is a i m p o r t a n t p a r t o f o v e r a l l s e l f management.

Only few study participants (27%) knew that they should Drink 3-4 liter/day water on daily basis after their kidney transplantation after renal transplant Wenzel UO, Hebert LA et. al concluded in their study that patients with CKD should not “push uids.” Normal thirst guided intake should determine water intake, unless there is a specic reason to increase uid intake7.

Regular follow ups are very important after renal transplant for monitoring the functioning of transplanted kidney and in present study only 30% study patients had knowledge regarding the importance of regular follow-ups so transplant patient should be taught the importance regular follow ups.

Conclusion:

Patients undergoing renal transplant had poor knowledge regarding self monitoring, dietary management, infection control precautions, physical activities, medical adherence and regular follow ups which is very important for  transplant  recipients. R e j e c t i o n a n d c o m p l i c a t i o n s o f transplanted kidney can be prevented by educating the patients in pre transplant period for better outcomes and to improve the quality of life of transplant recipients and these patients should be educated in pre transplant period for better outcomes in post transplant period.

References:

  1. Omar YA, Allah ES, Abo AR. Effect of A Nursing Health Education Program On Kidney Recipients’ Knowledge And Practice. [Internet]. [Cited 2018 Aug 11]. Available from: http://www.iosrjournals.org
  2. Iseki K.Gender differences in chronic kidney disease. Kidneyinternational. 2008 Aug 2; 74 (4): 415-7.
  3. Ghaderian S B,Beladi Mousavi S The role of diabetes mellitus and hypertension in chronic kidney disease. J Ren Inj Prev. 2014 Dec 1;3(4):109–10.
  4. Haghighi AN, Broumand B, D Amico M, Locatelli F, Ritz E. The epidemiology of end-stage renal disease in Iran in an international perspective. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc- Eur Ren Assoc. 2002Jan;17(1):28–32.
  1. When a Transplant Fails [Internet]. National Kidney Foundation. 2014 [cited 2018 Oct 2]. Available from: https://www.kidney.org.
  2. Nolte JF, Moore Nutrition Trends in Kidney Transplant Recipients: the Importance of Dietary Monitoring and Need for Evidence-Based Recommendations. Frontiers in medicine. 2018;5.
  3. Wenzel UO, Hebert LA, Stahl RA, Krenz I. My doctor said I should drink a lot! Recommendations for uid intake in patients with chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2006 Mar 1;1(2):344-6.