Background: Issues with hemodialysis initiation in patients with diabetic nephropathy can
be largely attributed to difficulty in accepting this procedure. Vascular access construction
is essential for initiation of dialysis, but there has been no focus on the patient’s condition
at the time of treatment.
Purpose: This study was performed to create a structural model of the effect of vascular
access construction for maintenance of dialysis and how it influences the acceptance of
dialysis in patients with diabetic nephropathy.
Methods: Type 2 diabetes patients with diabetic nephropathy who began receiving
hemodialysis less than 5 years prior to the start of the study were included. Patients were
surveyed by completing an anonymous self-recorded questionnaire and data were analyzed
using exploratory factor analysis and structural equation modeling.
Results: Data of 90 patients were analyzed. A number of factors related to self-care
behaviors adopted in response to vascular access construction, including “body-conscious
dialysis treatment life,” “hoping that one’s body is still fine,” and “recollection of the
feeling of having distanced vascular access construction,” were identified and subsequently
inserted into our structural model. The structural model by which vascular access
construction directly affected dialysis acceptance was then elucidated. The chi-squared
value was 117.358, Goodness of Fit Index (GFI) was 0.863, Adjusted Goodness of Fit Index
(AGFI) was 0.814, Comparative Fit Index (CFI) was 0.945, and Root Mean Square Error
Approximation (RMSEA) was 0.044, indicating slightly lower values for GFI and AGFI.
GFI was higher than AGFI and RMSEA was < 0.050. Therefore, the model was suggested
to show goodness of fit.
Conclusion: The structural model by which vascular access construction affects dialysis
acceptance in patients with diabetic nephropathy was clarified.
The structural model on the effect of vascular access construction in dialysis acceptance in patients with diabetic nephropathy
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