Understanding Lifestyle in Patients on Haemodialysis: A Multicultural Perspective

Healthy lifestyle plays a crucial role in improving comorbidities and decreasing mortality in haemodialysis (HD) patients. However, there is no comprehensive study to address the status of lifestyle especially cross culture comparison. This thesis aimed to understand the difference of HD patients’ lifestyle between the UK and China in aspects of nutritional and physical status. Methods: Dietary intake was assessed by 24-hour diet recall interviews in 40 UK and 43 Chinese HD patients. Physical function and activity were examined by a combination of questionnaires (1156 UK and 542Chinese HD patients) and objective measures (30 UK and 40 Chinese HD patients, with additional evaluation of Quality of Life [QoL], symptoms and body composition). In addition, 10 UK and 44 Chinese healthy controls were evaluated for objective measures. Results: A high prevalence of dietary insufficiency in general was revealed, but UK HD patients had a better management of micronutrients (such as iron) than Chinese HD patients. Both UK and Chinese HD patients had impaired physical function and activity that were worse in UK patients than Chinese patients. Factors influencing physical function and activity include demographic (age, gender, muscle and fat mass), clinical (nutrition, inflammation and bone derangement) and psychological factors (perceived benefits and barriers to exercise), QoL and symptoms. UK HD patients’ lower protein status and bone metabolism, higher fat mass and symptom burden, and fewer perceived exercise benefits may contribute to the lower physical function and activity than in Chinese HD patients. Conclusion: Malnutrition and low physical function and activity existed in both UK and Chinese HD patients, with a better management of micronutrients in UK and higher physical function and activity in China. Healthy lifestyle behaviors should be improved in both cultures. Promoting communication of lifestyle between UK and China is required.