Nonadherence in Hemodialysis Patients and Related Factors: A Multicenter Study

Abstract

Background Nonadherence to dietary and fluid restrictions, hemodialysis (HD), and medication treatment has been shown to increase the risks of hospitalization and mortality significantly. Sociodemographic and biochemical parameters as well as psychosocial conditions such as depression and anxiety are known to affect nonadherence in HD patients. However, evidence related to the relative importance and actual impact of these factors varies among studies. Purpose The aim of this study was to identify the factors that affect nonadherence to dietary and fluid restrictions, HD, and medication treatment. Methods This descriptive study was conducted on 274 patients who were being treated at four HD centers in Turkey. The parameters used to determine nonadherence to dialysis treatment were as follows: skipping multiple dialysis sessions during the most recent 1-month period, shortening a dialysis session by more than 10 minutes during the most recent 1-month period, and Kt/V < 1.4. The parameters used to determine nonadherence to dietary and fluid restriction were as follows: serum phosphorus level > 7.5 mg/dl, predialysis serum potassium level > 6.0 mEq/L, and interdialytic weight gain > 5.7% of body weight. The Morisky Green Levine Medication Adherence Scale was performed to determine nonadherence to medication treatment. A patient was classified as nonadherent if he or she did not adhere to one or more of these indices. The Hospital Anxiety and Depression Scale was used to identify patient risk in terms of anxiety and depression. Logistic regression was used to determine the predictors of nonadherence. Results The nonadherence rate was 39.1% for dietary and fluid restrictions, 33.6% for HD, and 20.1% for medication. The risk of nonadherence to dietary and fluid restriction was found to be 4.337 times higher in high school graduates (95% CI [1.502, 12.754], p = .007). The risk of nonadherence to HD treatment was 2.074 times higher in men (95% CI [1.213, 3.546], p = .008) and 2.591 times higher in patients with a central venous catheter (95% CI [1.171, 5.733], p = .019). Longer duration in HD resulted in 0.992 times decrease in risk of nonadherence to treatment (95% CI [0.986, 0.998], p = .005). Conclusions/Implications for Practice Educational status, being male, having a central venous catheter, and having a short HD duration were found to be risk factors for nonadherence. Nurses must consider the patient's adherence to the dietary and fluid restrictions, HD, and medication treatment at each visit.

The effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms: A prospective, randomized controlled trial

“…Increased interdialytic weight in HD patients causes increased risk of death due to cerebrovascular events and cardiovascular diseases 4 and leads to an increase in morbidity and mortality together with a deterioration of the patient's quality of life. Interdialytic weight gain (IDWG) reflects incompliance with fluid control as a result of the secondary excessive consumption of liquid and food and is an important surrogate outcome 5 . Various studies have reported incompliance with fluid therapy in 30% to 60% of HD patients 5,6 .…”

“…Interdialytic weight gain (IDWG) reflects incompliance with fluid control as a result of the secondary excessive consumption of liquid and food and is an important surrogate outcome 5 . Various studies have reported incompliance with fluid therapy in 30% to 60% of HD patients 5,6 . Other factors affecting the compliance with fluid treatment are psychological and social reasons and lack of knowledge about the foods that can be consumed 6 .…”

<p>Association of Patient-Reported Difficulty with Adherence with Achievement of Clinical Targets Among Hemodialysis Patients</p>

“…9 Despite these risks, 50% of patients are estimated to be non-adherent to at least one aspect of their treatment recommendations. 11 Because of the complexity of dialysis care and the clinical importance of treatment adherence, as well as the association between psychosocial factors and treatment adherence, 12,13 social workers play an important role in helping to educate patients about their treatment and access resources that might help them to improve adherence. 14 However, in order to provide the best care to patients, non-adherent patients must be reliably identified by dialysis providers.…”

Development, reliability and validity of health action process approach questionnaire for predicting treatment adherence among Iranian hemodialysis patients

“…Poor adherence to HD reduces patients' quality of life and brain function and leads to depression, lung edema and chronic anemia (7), as well as higher mortality rate and financial costs on health care systems (8,9). The role of psychological factors has been suggested as the determinants predicting non-adherence behavior in HD patients; however, this factor has not been established (1).…”