ปัจจัยที่มีผลต่อการเลือกบำบัดทดแทนไตของผู้ป่วยไตวายเรื้อรัง ตามแบบแผนความเชื่อทางสุขภาพในอำเภอศรีสงคราม จังหวัดนครพนม

Factors Associated with the Selection of Renal Replacement Therapy among Patients with Chronic Renal Failure as Based on the Health Belief Model Employed in Sri Songkhram District, Nakhon Phanom Province

Abstract

The purpose of this applied research was to study the occurrences of chronic renal failure (CRF) and to determine the factors associated with the selection of renal replacement therapy (RRT) by the retrospective reviewing of 4367 registered patients with CRF in Sri Songkhram Hospital between 2018 and 2020. Screening was based on the standard criteria of the estimated glomerular filtration rate (eGFR) in 507 patients. The relevant descriptive and inferential statistics were applied for data analysis. Multiple logistic regression was used to determine factors associated with the selection of RRT among patients with CRF. In-depth interviews and group discussions took place among 15 CRF patients, while 12 CRF patients were examined for qualitative data collection. A context analysis was then applied for the purpose of a qualitative data analysis.

The study findings found that 507 patients were end-stage CRF patients (11.6%), 52.90% of whom were classified into stage 4, and 47.10% in stage 5, respectively. It was commonly found among female patients (60.20%), at an average age of 68.94 years (S.D.= 11.8 years), while their average eGFR was 15.93 ± 8.91 ml/min/1.73m² . The RRT patients were classified into 2 groups: 1) Dialysis patients and 2) Palliative-care patients. Among dialysis patients, the eGFR was 7.22 ± 6.75 ml/min/1.73m² . When compared to the standard values of eGFR, palliative-care patients were able to maintain higher eGFR than standard values of eGFR at 18.05 ± 8.05 ml/min/1.73m² and were able to take care of themselves sufficiently well to have a higher eGFR than the standard values. Factors associated with the selection of RRT were eGFRs, comorbidities, patient ages and the service areas. Patients dwelling in the service areas presented a good level of eGFR, which was mostly found in older age groups. They were mainly selected for palliative care rather than dialysis, while CRF patients who were dwelling outside of service areas tended to be selected for dialysis treatments provided at the hospital renal clinic than for palliative care.