Assessment of Knowledge, Attitudes, and Practices Among Patients with End-Stage Kidney Disease Towards Hyperkalemia Management at the Dialysis Center In Ibb City, Yemen
This cross-sectional study of 246 end-stage kidney disease patients in Ibb City, Yemen, reveals moderate knowledge and practices alongside positive attitudes regarding hyperkalemia management, with significant variations driven by demographic and clinical factors such as education level, age, and comorbidities, highlighting the urgent need for tailored educational interventions.
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For millions of people around the world, the kidneys have stopped working. These organs are the body's natural filters, quietly removing waste and balancing minerals in the blood. When they fail, a condition known as end-stage kidney disease, the body cannot survive without help. Patients must undergo dialysis, a process that mechanically cleans the blood, or receive a kidney transplant. Even with this life-saving treatment, a dangerous complication can arise: hyperkalemia. This occurs when the level of potassium in the blood rises too high. Potassium is a mineral found in many healthy foods like bananas and potatoes, but for someone with failing kidneys, too much of it can disrupt the heart's rhythm and lead to sudden cardiac death. Managing this risk requires a delicate balance of diet, medication, and constant vigilance.
In a dialysis center in Ibb City, Yemen, a team of researchers set out to understand how patients living with this life-threatening condition are handling it. Yemen has faced years of conflict, which has strained its healthcare system and limited access to resources. The researchers wanted to know if patients there truly understood the dangers of high potassium, what they believed about managing their health, and whether they were actually taking the right steps to stay safe. They did not just look at medical records; they asked the patients directly about their daily lives, their knowledge, and their habits.
The study involved 246 adults receiving dialysis at the Al-Thawra Hospital. The researchers used a detailed questionnaire to measure three things: what the patients knew about hyperkalemia, how they felt about managing it, and what they actually did to control it. The group was diverse, but most were under fifty years old, male, and had limited formal education. Many had been living with kidney disease for more than five years and were taking medication for high blood pressure or heart issues.
When the researchers analyzed the answers, they found a picture that was both encouraging and concerning. On average, the patients had a moderate level of knowledge about hyperkalemia. They knew that certain foods could raise potassium levels and that they needed to be careful, but there were significant gaps. For instance, fewer than half of the patients knew that some common medicines, like certain diuretics, could actually help lower potassium. Even fewer understood that kidney failure was not the only cause of high potassium levels. The researchers noted that patients with more education and those who were younger tended to know more. Interestingly, patients who had undergone surgery to remove a kidney actually knew less about the condition than those who still had their kidneys, suggesting that the specific medical history of a patient can shape their understanding in unexpected ways.
The patients' attitudes, however, were overwhelmingly positive. Nearly three-quarters of the group expressed a strong belief that managing their condition was important and that they could trust their doctors. They were willing to follow medical advice and share their experiences with other patients. This positive outlook is a powerful asset. The study found that when patients believed they could manage their health, they were more likely to take action. Yet, a gap remained between what they believed and what they did. While most patients were good at following strict medical routines, such as showing up for dialysis and taking their prescribed pills, they struggled with the daily, independent work of self-care.
Only a small portion of the patients were recording their daily food intake or preparing their own meals specifically to control potassium levels. Many did not seek out reliable health information or join support groups. The researchers observed that patients were much more likely to follow instructions given directly by a doctor than to take initiative on their own. For example, while most patients knew they should avoid high-potassium foods, fewer than sixty percent reported actually adjusting their diet based on their recent blood test results. This disconnect suggests that knowing the rules is not enough; patients need practical skills and confidence to apply that knowledge in their own kitchens and lives.
The study also highlighted how deeply a patient's background influenced their ability to manage the disease. Education was the strongest predictor of success. Patients with university degrees scored significantly higher in knowledge, attitude, and practice than those who were illiterate. Age and employment status also mattered, with younger and working patients generally doing better. The researchers found that having high blood pressure was linked to a more positive attitude toward management, perhaps because these patients were already accustomed to managing a chronic condition. However, the very act of taking regular medication was surprisingly linked to lower scores in practical self-management behaviors, a finding that suggests patients might rely too heavily on their pills and neglect the lifestyle changes needed to stay safe.
In a setting where resources are scarce and the healthcare system is under immense pressure, these findings offer a clear path forward. The researchers concluded that simply telling patients what to eat is not enough. Because the link between positive attitudes and actual behavior is so strong, future efforts should focus on building confidence and teaching practical skills. Instead of just handing out information sheets, healthcare providers could train nurses to teach patients how to read food labels, plan low-potassium meals, and solve problems when they arise. By tailoring these lessons to the literacy levels and daily realities of the patients, and by leveraging the strong trust they already have in their doctors, it may be possible to bridge the gap between knowing and doing. In a place where every advantage counts, helping patients take control of their own daily choices could mean the difference between a manageable life and a life-threatening crisis.
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