Hemodialysis Adequacy Sacrificed for Business: A Qualitative Study

Abstract

Background: Dialysis adequacy is a predictor for mortality and morbidity in patients undergoing hemodialysis. Previous studies pinpointed several factors as barriers to adequate dialysis. However, there is a scarcity of studies investigating the experiences of patients undergoing hemodialysis and health care providers (e g, dialysis nurses and nephrologists) with regards to high-quality dialysis barriers. The current study aimed at gaining a deeper understanding regarding the experiences of patients undergoing hemodialysis and dialysis professionals about the subjective barriers to hemodialysis adequacy. Methods: The current study was conducted using the conventional content analysis method; 19 patients undergoing hemodialysis, 2 hemodialysis caregivers, 2 hemodialysis nurses, and 2 nephrologists were included and interviewed. Results: Based on the obtained data, 993 initial codes were extracted under four categories: barrier of self, social support insufficiency, hemodialysis mafia, and supervision weakness. Conclusions: Patients undergoing hemodialysis and health care providers have different experiences compared with what is mentioned in textbooks about barriers to high-quality dialysis. The findings highlight the need for immediate re-examination and preparation of the standards for the quality of hemodialysis, as well as attention and focus on non-physiological barriers to dialysis adequacy.