Nonadherence in Hemodialysis Patients and Related Factors: A Multicenter Study

10.1097/jnr.0000000000000309

Nurten OZEN；Fatma Ilknur CINAR；Dilek ASKIN；Dilek MUT；Turker TURKER

nonadherence ； treatment ； hemodialysis ； dietary and fluid restrictions ； medication

The Journal of Nursing Research

27卷4期（2019 / 08 / 01）

1 - 11-008

英文

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.

1. Ahrari, S.,Moshki, M.,Bahrami, M.(2014).The relationship between social support and adherence of dietary and fluids restrictions among hemodialysis patients in Iran.Journal of Caring Sciences,3(1),11-19.
2. Akman, B.,Uyar, M.,Afsar, B.,Sezer, S.,Ozdemir, F. N.,Haberal, M.(2007).Adherence, depression and quality of life in patients on a renal Transplantation waiting list.Transplant International,20(8),682-687.
3. Allen, D.,Wainwright, M.,Hutchinson, T.(2011).‘Non-compliance’ as illness management: Hemodialysis patients' descriptions of adversarial patient–clinician interactions.Social Science & Medicine,73(1),129-134.
4. Aydemir, Ö.,Güvenir, T.,Küey, L.,Kültür, S.(1997).Validity and reliability of Turkish version of hospital anxiety and depression scale.Turkish Journal of Psychiatry,8(4),280-287.
5. Chan, Y. M.,Zalilah, M. S.,Hii, S. Z.(2012).Determinants of compliance behaviours among patients undergoing hemodialysis in Malaysia.PLoS One,7(8),e41362.
6. Clark, S.,Farrington, K.,Chilcot, J.(2014).Nonadherence in dialysis patients: Prevalence, measurement, outcome, and psychological determinants.Seminars in Dialysis,27(1),42-49.
7. Cukor, D.,Coplan, J.,Brown, C.,Friedman, S.,Newville, H.,Safier, M.,Kimmel, P. L.(2008).Anxiety disorders in adults treated by hemodialysis: A single-center study.American Journal of Kidney Disease,52(1),128-136.
8. Daugirdas, J. T.(1993).Second generation logarithmic estimates of single-pool variable volume Kt/V: An analysis of error.Journal of the American Society of Nephrology,4(5),1205-1213.
9. Denhaerynck, K.,Manhaeve, D.,Dobbels, F.,Garzoni, D.,Nolte, C.,De Geest, S.(2007).Prevalence and consequences of nonadherence to hemodialysis regimens.American Journal of Critical Care,16(3),222-235.
10. Durose, C. L.,Holdsworth, M.,Watson, V.,Przygrodzka, F.(2004).Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance.Journal of the American Dietetic Association,104(1),35-41.
11. Eker, D.,Arkar, H.(1995).Factorial structure, validity, and reliability of the multidimensional scale of perceived social support.Turkish Journal of Psychology,10(34),45-55.
12. Eker, D.,Arkar, H.,Yaldız, H.(2001).Factorial structure, validity, and reliability of revised form of the multidimensional scale of perceived social support.Turkish Journal of Psychiatry,12(1),17-25.
13. Feroze, U.,Martin, D.,Reina-Patton, A.,Kalantar-Zadeh, K.,Kopple, J. D.(2010).Mental health, depression, and anxiety in patients on maintenance dialysis.Iranian Journal of Kidney Diseases,4(3),173-180.
14. Fincham, D.,Kagee, A.,Moosa, M. R.(2008).Dietary and fluid adherence among haemodialysis patients attending public sector hospitals in the Western Cape.South African Journal of Clinical Nutrition,21(2),7-12.
15. Frykholm, P.,Pikwer, A.,Hammarskjöld, F.,Larsson, A. T.,Lindgren, S.,Lindwall, R.,Akeson, J.(2014).Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive CareMedicine.Acta AnaesthesiologicaScandinavica,58(5),508-524.
16. Hemodialysis Adequacy 2006 Work Group(2006).Clinical practice guidelines for hemodialysis adequacy, update 2006.American Journal of Kidney Diseases,48(1, Suppl.),S2-S90.
17. Higgins, M.(2006).Adherence or compliance?.World of Irish Nursing and Midwifery (WIN),14(10),28-29.
18. Ibrahim, S.,Hossam, M.,Belal, D.(2015).Study of non-compliance among chronic hemodialysis patients and its impact on patients' outcomes.Saudi Journal of Kidney Diseases and Transplantation,26(2),243-249.
19. Jin, J.,Sklar, G. E.,Min Sen Oh, V,Chuen Li, S.(2008).Factors affecting therapeutic compliance: A review from the patient's perspective.Therapeutics and Clinical Risk Management,4(1),269-286.
20. Kammerer, J.,Garry, G.,Hartigan, M.,Carter, B.,Erlich, L.(2007).Adherence in patients on dialysis: Strategies for success.Nephrology Nursing Journal,34(5),479-486.
21. Karamanidou, C.,Clatworthy, J.,Weinman, J.,Horne, R.(2008).A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease.BMC Nephrology,9,2.
22. Khanderia, U.,Townsend, K. A.,Erickson, S. R.,Vlasnik, J.,Prager, R. L.,Eagle, K. A.(2008).Medication adherence following coronary artery bypass graft surgery: Assessment of beliefs and attitudes.Annals of Pharmacotherapy,42(2),192-199.
23. Kim, Y.,Evangelista, L. S.,Phillips, L. R.,Pavlish, C.,Kopple, J. D.(2010).The end-stage renal disease adherence questionnaire (ESRD-AQ): Testing the psychometric properties in patients receiving in-center hemodialysis.Nephrology Nursing Journal,37(4),377-393.
24. Krueger, K. P.,Berger, B. A.,Felkey, B.(2005).Medication adherence and persistence: A comprehensive review.Advances in Therapy,22(4),313-356.
25. Kugler, C.,Maeding, I.,Russell, C. L.(2011).Non-adherence in patients on chronic hemodialysis: An international comparison study.Journal of Nephrology,24(3),366-375.
26. Madeiro, A. C.,Machado, P. D. L. C.,Bonfim, I. M.,Braqueais, A. R.,Lima, F. E. T.(2010).Adherence of chronic renal insufficiency patients to hemodialysis.Acta Paulista de Enfermagem,23(4),546-551.
27. Matteson, M. L.,Russell, C.(2010).Interventions to improve hemodialysis adherence: A systematic review of randomized controlled trials.Hemodialysis International,14(4),370-382.
28. McDonald, H. P.,Garg, A. X.,Haynes, R. B.(2002).Interventions to enhance patient adherence to medication prescriptions: Scientific review.Journal of the American Medical Association,288(22),e2868-e2879.
29. Mellon, L.,Regan, D.,Curtis, R.(2013).Factors influencing adherence among Irish haemodialysis patients.Patient Education and Counseling,92(1),88-93.
30. Morgan, L.(2000).A decade review: Methods to improve adherence to the treatment regimen among hemodialysis patients.Nephrology Nursing Journal,27(3),299-304.
31. Morisky, D. E.,Green, L. W.,Levine, D. M.(1986).Concurrent and predictive validity of a self-reported measure of medication adherence.Medical Care,24(1),67-74.
32. Rambod, M.,Peyravi, H.,Shokrpour, N.,Taghi Sareban, M.(2010).Dietary and fluid adherence in Iranian hemodialysis patients.The Health Care Manager,29(4),359-364.
33. Russell, C. L.,Cronk, N. J.,Herron, M.,Knowles, N.,Matteson, M. L.,Peace, L.,Ponferrada, L.(2011).Motivational interviewing in dialysis adherence study (MIDAS).Nephrology Nursing Journal,38(3),229-236.
34. Sabaté, E.(2003).Adherence to long-term therapies: Evidence for action.Geneva, Switzerland:World Health Organization.
35. Safdar, N.,Baakza, H.,Kumar, H.,Naqvi, S. A. J.(1995).Noncompliance to diet and fluid restrictions in haemodialysis patients.Journal of the Pakistan Medical Association,45(11),293-295.
36. Saran, R.,Bragg-Gresham, J. L.,Rayner, H. C.,Goodkin, D. A.,Keen, M. L.,Van Dijk, P. C.,Port, F. K.(2003).Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS.Kidney International,64(1),254-262.
37. Sharp, J.,Wild, M. R.,Gumley, A. I.,Deighan, C. J.(2005).A cognitive behavioral group approach to enhance adherence to hemodialysis fluid restrictions: A randomized controlled trial.American Journal of Kidney Diseases,45(6),1046-1057.
38. Unruh, M. L.,Evans, I. V.,Fink, N. E.,Powe, N. R.,Meyer, K. B.,Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) Study(2005).Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients.American Journal of Kidney Diseases,46(6),1107-1116.
39. Wells, S. A.(2015).Occupational deprivation or occupational adaptation of Mexican Americans on renal dialysis.Occupational Therapy International,22(4),174-182.
40. Zigmond, A. S.,Snaith, R. P.(1983).The hospital anxiety and depression scale.Acta Psychiatrica Scandinavica,67(6),361-370.
41. Zimet, G. D.,Dahlem, N. W.,Zimet, S. G.,Farley, G. K.(1988).The multidimensional scale of perceived social support.Journal of Personality Assessment,52(1),30-41.

1. Miaofen YEN,Melyza PERDANA(2021).Factors Associated With Adherence to Fluid Restriction in Patients Undergoing Hemodialysis in Indonesia.The Journal of Nursing Research,29(6),1-8.