Home-Based Self-Care and Facility-Based Caregiver Support for Patients with End-Stage Kidney Disease

Abstract

Background: End-Stage Kidney Disease (ESKD) is a major global public health challenge. Patients receiving renal replacement therapy (RRT) often experience poor quality of life, frequent complications, and high healthcare costs due to inadequate self-management and fragmented continuity of care. Objective: This mixed-methods study aimed to examine home-based self-care and healthcare facility-based caregiver support for patients with ESKD undergoing RRT. Methods: The study was conducted at the Sriratanakosin Foundation and the KDKC Peritoneal Dialysis Center, Thailand. Quantitative data were collected from 148 patients receiving hemodialysis or peritoneal dialysis using standardized measures of self-management behaviors, functional status (Karnofsky Performance Status), and health-related quality of life (9-THAI). Qualitative data were obtained through in-depth interviews with eight key informants, including patients, family caregivers, and healthcare professionals. Results: Regarding home-based care (Objective 1), while patients adhered well to medications and appointments, significant deficits remained in exercise and dietary modifications, which correlated with reduced quality of life scores, further exacerbated by economic constraints. For facility-based care (Objective 2), multidisciplinary teams effectively functioned as clinical coaches, offering essential guidance to manage hyperkalemia, fluid overload, and septicemia. Crucially, this clinical support was complemented by psychosocial reinforcement from families and peer networks, which helped alleviate burnout and reinforce self-efficacy. Conclusion: The integrated mixed-methods findings provide empirical evidence that supports patient empowerment, strengthens self-management capacity, reduces clinical complications, and offers sustainable strategies for improving the quality of life of patients with End-Stage Kidney Disease.