title: Lack of motivation: a new modifiable risk factor for peritonitis in patients undergoing peritoneal dialysis?
abstract: OBJECTIVE
  Can we identify modifiable risk factors for peritonitis in patients undergoing peritoneal dialysis (PD)? We aimed to determine whether housing standard, PD exchange technique or patient motivation might be modifiable risks for peritonitis. We also explored the relationship between lack of motivation and depression.
  
  
  METHODS
  Nurse home visits assessed PD exchange technique, environment and patient motivation. Motivation scores were correlated separately with an Apathy Evaluation Score and a depression score using PHQ-9 questionnaires.
  
  
  RESULTS
  Home hygiene, exchange technique and motivation were above average in 53%, 56% and 60%, respectively in 104 patients undergoing PD. After 15 months, 25.9% patients developed peritonitis but nurses' ratings of homes and exchange techniques were not predictive. Low patient motivation was predictive. Patients rated to have above or below median motivation had significantly different Apathy Scores (p = 0.0002). Unmotivated depressed patients were significantly more likely to develop peritonitis compared to motivated depressed patients.
  
  
  CONCLUSIONS
  Lack of motivation predicted peritonitis particularly if associated with depression. Further studies are required focusing on specific motivation scoring schemes and the psychosocial support that might lead to better outcomes.
authors.affiliation: Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK.
authors.forename: Klara
authors.initials: K
authors.lastname: Paudel
authors.forename: Girish
authors.initials: G
authors.lastname: Namagondlu
authors.forename: Nasreen
authors.initials: N
authors.lastname: Samad
authors.forename: Khadija
authors.initials: K
authors.lastname: McKitty
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D057565:Apathy; D003863:Depression / Q000451:nursing / Q000523:psychology; D005260:Female; D006792:House Calls; D006798:Housing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000451:nursing* / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic / Q000458:organization & administration / Q000592:standards; D010530:Peritoneal Dialysis / Q000451:nursing* / Q000523:psychology* / Q000592:standards; D010538:Peritonitis / Q000451:nursing* / Q000517:prevention & control* / Q000523:psychology; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D012307:Risk Factors; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Peritoneal dialysis; Peritonitis; Risk factors