Brown Bag Talk by A/P Konstadina Griva on 29 August


Speaker: A/P Konstadina Griva

Title: HED SMART – the hemodialysis self management randomized trial. A brief low intensity intervention to improve outcomes in hemodialysis patients

Date: 29 August 2014, 1-2pm

Venue: AS4/02-08 (Psychology Department Meeting Room)


Introduction and Aims: Adherence to treatment recommendations on diet, fluid and medication is important to maximize good clinical outcomes in Hemodialysis yet it remains suboptimal and not well-understood. This trial set out to examine the effect of the HED- SMART intervention, a four-session, group-delivered self-management intervention on treatment adherence indicators.

Methods: Eligible HD patients were randomized to either usual care (N= 133) or HED-SMART intervention (n=102). Measures of self-report adherence, self-management skills and biochemical markers were collected at baseline, immediately and at 3 and 9 months post-intervention. The intervention was facilitated by renal healthcare professionals and involved problemsolving and goal-setting for fluid control, diet and medication. 

Results: A total of 235 participants were enrolled [mean age ± 53.46 (±10.41) years]. The study was completed by 74.8%. Significant differences between groups were found in change in interdialytic weight gains, potassium and phosphate levels during the intervention phase and the 3-month follow-up indicating improved dietary/fluid control and medication intake for the intervention participants (all p <.01). The Improvements in weight gains were maintained by 9 months yet the change in phosphate and potassium levels at 9 months was small and not significant (p = 0.08). Significant differences between groups were found in secondary outcomes across all time points: self-reported adherence, self-management skills and self- efficacy. There were no adverse effects.

Conclusions: These analyses indicate the efficacy of the HED-SMART program with significant post-intervention improvements in both clinical markers and self-report adherence. These observed improvements, if supported and maintained at the longer follow-up (18 months), could significantly reduce ESRD-related complications in the longer term. Given the feasibility of this kind of program, it has strong potential for providing effective support to many hemodialysis patients in the future.

About the Speaker:

Dr. Konstadina Griva is an Associate Professor in Psychology at NUS. She received her MSC Health Psych (1997) and PhD (2004) from University College London UK where she worked as a Senior Research Fellow until 2008. A/P Konstadina Griva joined NUS in 2008.

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