Abstract
OBJECTIVES: To investigate the knowledge, attitudes and practices (KAP) among patients with end-stage kidney disease (ESKD) towards hyperkalaemia. DESIGN: A cross-sectional study. SETTING: This study was conducted between September and November 2023 at the Department of Nephrology, Shenzhen Third People's Hospital and the Second Affiliated Hospital of Southern University of Science and Technology. PARTICIPANTS: The study included 568 patients with ESKD who were undergoing haemodialysis, peritoneal dialysis or both, recruited through convenience sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: This study was conducted using a self-administered questionnaire, which assessed participants' KAP towards hyperkalaemia management. The questionnaire comprised four sections: demographic information, knowledge (13 items), attitudes (9 items) and practices (9 items), with responses evaluated using a 5-point Likert scale. A cut-off value of 70% of the total score was applied, with thresholds for sufficient knowledge, favourable attitudes and proactive practices set at 6.3, 31.5 and 31.5 points, respectively. The higher the KAP scores, the better the levels of knowledge, attitude and practice. A structural equation model (SEM) was constructed to analyse the effects of demographic characteristics on KAP dimensions. Path coefficients (standardised estimates) were used to assess the strength of relationships between variables, with coefficients>0.2 generally considered moderate effects and >0.5 strong effects. RESULTS: A total of 568 participants were enrolled in this study, including 369 (64.69%) males, and 249 (43.84%) have been diagnosed with ESKD for more than 5 years. The median (IQR) KAP scores of the participants were 9 (3-9) (possible range: 0-9), 34 (24-45) (possible range: 9-45) and 32 (10-45) (possible range: 9-45), respectively. SEM demonstrated that the frequency of dialysis had direct effects on knowledge (coefficient=0.113, p=0.039), education had direct effects on attitudes (coefficient=0.257, p<0.001), knowledge had direct effects on practices (coefficient=-0.130, p=0.016), attitudes had direct effects on practices (coefficient=0.549, p<0.001) and education had direct effects on practices (coefficient=0.112, p=0.007). CONCLUSION: Patients with ESKD enrolled in this study have sufficient knowledge, favourable attitudes and proactive practices towards the hyperkalaemia. Nevertheless, it is still recommended to enhance clinical practice in hyperkalaemia management among patients with ESKD by tailoring education for those with lower education levels, emphasising the importance of regular dialysis and implementing strategies to bridge the knowledge-practice gap.