LONG-TERM EXPERIENCES OF INCREASING WATER INTAKE IN PEOPLE WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

LONG-TERM EXPERIENCES OF INCREASING WATER INTAKE IN PEOPLE WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Dr Sneha Amin¹, Irene  Sangadi¹, Margaret Allman-Farinelli³, Sunil Badve⁴, Neil Boudville⁵, Sue Coulshed⁶, Mangalee Fernando⁷, Imad Haloob⁸, David Harris², Carmel Hawley⁹, Jane Holt¹⁰, Karthik Kumar¹¹, David  Johnson⁹, Vincent Lee², Jun Mai¹², Anna Rangan³, Simon Roger¹³, Kamal Sud¹⁴, Vincent Torres¹⁵, Eswari Vilayur¹⁶, Gopala Rangan²

¹Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Sydney, Australia, ²Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research; Department of Renal Medicine, Westmead Hospital, Sydney, Australia, ³School of Nursing, The University of Sydney, Sydney, Australia, ⁴Department of Renal Medicine, St George Hospital, Sydney, Australia, ⁵Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth , Australia, ⁶North Shore Nephrology, Sydney, Australia, ⁷Department of Renal Medicine, Prince of Wales Hospital, Sydney, Australia, ⁸Department of Renal Medicine, Bathurst Hospital, Bathurst, Australia, ⁹Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia, ¹⁰Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia, ¹¹Gosford Nephrology, Gosford, Australia, ¹²Department of Renal Medicine, Liverpool Hospital, Sydney, Australia, ¹³Renal Research, Gosford, Australia, ¹⁴Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, Australia, ¹⁵Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, USA, ¹⁶Department of Nephrology, John Hunter Hospital, Newcastle, Australia

Background: Maintaining adequate hydration is recommended in ADPKD to minimise increase in arginine vasopressin.

Aim: The study evaluated the acceptability and experience of increasing water intake in ADPKD patients.

Methods: Participants randomised to increased water intake in the three year PREVENT-ADPKD trial completed a post-trial questionnaire and a semi-structured interview.

Results: Forty-eight participants completed the questionnaire and fifteen completed the interview. Participants were motivated to adherence at the start of the trial but struggled to meet requirements over time. When asked ‘how easy was it to meet the fluid goals without interfering with your lifestyle’, 26% found it ‘very easy’, 20% ‘somewhat easy’, 20% ‘neutral’, 30% ‘somewhat difficult’ and 4% answered ‘very difficult’. The main barrier to consistency was ‘loss of control’ particularly regarding choice of food (e.g. when dining out), environmental factors and societal expectations. Furthermore, the participant’s somatic and emotional state influenced their motivation.  The uptake of self-efficacy aids varied amongst participants and there was no consensus regarding the most useful tool. The act of carrying a water bottle or filling a jug was used by all participants for self-monitoring. Self-monitoring of urine specific gravity and SMS reminders provided positive reinforcement and was perceived as a non-intrusive way to maintain engagement. All participants stated face-to-face dietitian visits enhanced implementation. Upon conclusion of the trial, most participants reported they had the knowledge and habits required but the intention to maintain lifestyle intervention was contingent on a medical benefit.

Conclusion: Participants had good intentions to enact lifestyle changes and the self-efficacy aids helped participants gradually develop habits and self-monitor. However, social expectations and intrinsic factors pose challenges to sustaining increased water intake long-term.

Biography:

Second year renal advanced trainee in the Central/South-West Network in Sydney.