Development and Validation of a Knowledge, Attitude, and Practice (KAP) Questionnaire and its utility study towards Nutritional Habits among Non-Dialytic CKD Patients: A Prospective Study.

Introduction: Knowledge, attitude, and practices (KAP) related to dietary habits play a critical role in managing disease progression in chronic kidney disease (CKD) patients, yet these aspects remain understudied. This study focused on developing, validating, and assessing the utility of a tailored KAP questionnaire specifically designed for CKD patients.

Methodology: This prospective study was conducted from November 2022 to November 2023 among CKD stage 3 to non-dialytic stage 5 patients attending a nephrology outpatient department. A multiple-choice KAP questionnaire, developed with input from 10 nephrologists, included 33 knowledge items (diet 23, disease 10), 33 attitude items on a Likert scale, and 11 practice items on dietary intake. Validity was assessed in a pilot group of 30 CKD patients. A total of 199 patients aged 18-60 years were enrolled and randomized into three diet groups: normal protein intake (0.8-1.0 g/kg/day), low protein intake (0.6 g/kg/day), and very low protein intake with ketoanalogues supplementation (0.3 g/kg/day). Baseline demographic, socioeconomic, dietary data, and KAP scores were recorded, followed by dietary counselling. KAP scores were reassessed at 6 months and compared to baseline.

Results: Among 199 enrolled CKD patients (60% male, 74.7% literate), post-counselling KAP scores showed significant improvements: knowledge increased from 29.5 ± 21.3 to 53.3 ± 19.8, attitude from 108.8 ± 16.2 to 133.9 ± 20.2, and practice from 17.0 ± 3.2 to 20.1 ± 2.8 (p < 0.05). Additionally, all KAP components and eGFR significantly improved across different CKD stages following the 6-month dietary intervention.

Conclusion: The validated KAP questionnaire revealed significant improvements in knowledge, attitude, and practice over six months following dietary counselling. These findings underscore the necessity of integrating dietary counselling into the management of CKD at all stages.