Health-related hope and reduced distress associated with fluid and dietary restrictions in advanced chronic kidney disease and dialysis: a cohort study

Rationale & Objective In chronic kidney disease (CKD), the durability of patient adherence to fluid and dietary restrictions may depend on the degree to which they have hope that they will enjoy life. However, few studies have examined the long-term role of health-related hope (HR-Hope) on distress from fluid and dietary restrictions. Study Design Prospective cohort study. Setting & Participants A total of 444 non-dialysis stage 3-5 patients and stage 5D patients attending one of five Japanese nephrology centers. Exposure An 18-item HR-Hope scale with a score ranging from 0 to 100. Outcomes Two-item measures of restrictions on fluid and dietary intake from the Japanese version of the Kidney Disease Quality of Life Short Form, Version 1.3, with each score ranging from 0 to 100. Analytical Approach Multivariate linear mixed models were used to estimate the association of baseline HR-Hope with distress from fluid and dietary restrictions at baseline and follow-up. Results The mean age of participants was 67 years, 31.1% were female, and 124, 98, and 222 had non-dialysis CKD, peritoneal dialysis, and hemodialysis, respectively. Baseline HR-Hope buffered the growing distress from fluid restriction after one year (−18.01 pts [95% CI, -28.24 to -7.79]) per 10-pt increase, 2.59 pts [95% CI, 1.05 to 4.13]. The distress from fluid restriction at 2 years did not differ from baseline. Baseline HR-Hope buffered the growing distress from dietary restriction after one year (−12.4 pts [95% CI, -22.68 to -2.12]) per 10-pt increase, 1.96 pts (95% CI, 0.34 to 3.57). The distress from dietary restriction at 2 years did not differ from baseline. Limitations Use of self-reported measures as proxies for adherence. Conclusions Our study shows that HR-Hope, regardless of depression, can potentially mitigate the long-term distress from fluid and dietary restrictions in patients with a wide range of CKD severities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by JSPS KAKENHI (Grant Number: JP16H05216 and JP18K17970). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The HOTDOC study was conducted in accordance with the Declaration of Helsinki and was approved by the institutional review boards of Fukushima Medical University (number 2417) and St. Marianna University (number 3209). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript.