title: The Effect of Psychological Intervention on Thirst and Interdialytic Weight Gain in Patients on Chronic Hemodialysis: A Randomized Controlled Trial.
abstract: OBJECTIVE
  Patients on hemodialysis (HD) are unable to eliminate excess fluid and must adhere to a regimen of dietary fluid restriction to prevent volume overload. Thirst represents a major obstacle to the achievement of such a goal. The aim of our study was (1) to assess the association of thirst and xerostomia, measured by validated questionnaires, Dialysis Thirst Inventory and Xerostomia Inventory with interdialytic weight gain (IDWG) and (2) to evaluate in a randomized controlled trial (RCT), the effect of psychological intervention on IDWG and thirst.
  
  
  METHODS
  Cross-sectional evaluation of association of thirst and IDWG and single-blind RCT of psychological intervention on IDWG management.
  
  
  METHODS
  Outpatient dialysis unit.
  
  
  METHODS
  The cross-sectional evaluation included 117 patients on HD (age, 71 ± 13 years); among these, 54 were selected for the RCT.
  
  
  METHODS
  The questionnaires were administered to all the participating patients; IDWG (4-week average), Kt/V, predialysis blood pressure, dialyzate sodium, hematocrit, serum electrolytes, parathyroid hormone, and patients' medications were recorded. Fifty-four patients were randomized on a 1:1 basis to usual treatment (including dietary advice) or psychological intervention, consisting of group sessions, held once a week for 5 weeks; IDWG and all the other parameters were rechecked after 6 weeks and 6 months.
  
  
  METHODS
  IDWG change from baseline.
  
  
  RESULTS
  Dialysis Thirst Inventory score was correlated with IDWG (ρ = 0.575; P < .001), body mass index (ρ = 0.257; P = .005), and inversely with age (ρ = -0.344; P < .001). A small but significant decrease of IDWG compared to baseline was observed in the intervention group (baseline 1332 ± 338 g/day; at 6 weeks, 1183 ± 258 g/day; at 6 months, 1203 ± 284 g/day; P < .001). No IDWG changes with respect to baseline occurred in controls (baseline 1310 ± 333 g/day; at 6 weeks, 1336 ± 340 g/day; at 6 months, 1323 ± 328 g/day; P = .57). The secondary outcomes were not affected by the intervention.
  
  
  CONCLUSIONS
  The findings of our study show that a psychological support may help managing IDWG in HD patients.
authors.affiliation: Nephrology and Dialysis Unit, Media Valle del Tevere Hospital, Department of Specialistic Medicine, Todi, Perugia, Italy. Electronic address: gianni.bellomo@uslumbria1.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Bellomo
authors.affiliation: Nephrology and Dialysis Unit, Media Valle del Tevere Hospital, Department of Specialistic Medicine, Todi, Perugia, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Coccetta
authors.affiliation: Nephrology and Dialysis Unit, Media Valle del Tevere Hospital, Department of Specialistic Medicine, Todi, Perugia, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Pasticci
authors.affiliation: Nephrology and Dialysis Unit, Media Valle del Tevere Hospital, Department of Specialistic Medicine, Todi, Perugia, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi
authors.affiliation: Nephrology and Dialysis Unit, Media Valle del Tevere Hospital, Department of Specialistic Medicine, Todi, Perugia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Selvi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000378:metabolism; D004573:Electrolytes / Q000097:blood; D006400:Hematocrit; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects / Q000523:psychology*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013894:Thirst; D015430:Weight Gain; D014987:Xerostomia / Q000175:diagnosis / Q000209:etiology / Q000523:psychology
chemical_list: D015314:Dialysis Solutions; D004573:Electrolytes; D010281:Parathyroid Hormone