Adherence to Management in Patients With End Stage Renal Disease

Abstract

Objective: To document overall adherence to haemodialysis, medications, fluid restriction and dietary prescription in patients with end-stage renal disease and to study factors that could predict poor adherence.
 Study Design: Cross-sectional analytical study.
 Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi, from Jul to Sep 2018.
 Methodology: Adult patients on haemodialysis for at least three months were selected using consecutive sampling technique. Patients with acute kidney injury, patients on haemodialysis for less than 3 months, those on infrequent haemodialysis and unwilling patients were excluded. Demographic data was recorded. Adherence to management was assessed by administering End Stage Renal Disease Adherence Questionnaire in direct face- to-face interviews.
 Results: There were a total of 101 patients having a mean age of 51.05 ± 13.80 years. Median haemodialysis vintage was 9 months (interquartile range 3-24 months). Mean adherence scores were 970.54 ± 149.43. Mean perception scores were 7.22 ± 1.37. Only 49 (48.51%) patients had good adherence, whereas 52 (51.49%) had poor adherence to management. Increasing age was associated with poor adherence (β=-0.038; Odds Ratio=0.963, 95% CI 0.928- 1.000, p=0.048). No other demographic parameter could predict poor adherence.
 Conclusion: Non-adherence to different aspects of management plan was a significant problem, more so in younger patients.

Knowledge, Adherence, and Perception of Patients on Maintenance Hemodialysis to Treatment Regimens at a Tertiary Care Hospital in Pakistan

“…However, the methods used to determine these rates differed across the studies analyzed. In our study, the ESRD-AQ-based HD session adherence score of 246.64 ± 94.49 was comparable to the score of 259.90 ± 75.84 in a study from Rawalpindi [ 4 ] and much lower than the score of 296.36 ± 26.78 in the study conducted by Naalweh et al in Palestine [ 6 ]. Additionally, in our study, 21.8% of patients considered their dialysis schedule to be inconvenient, and 13.45% of patients said that their work was affected by their dialysis schedule.…”

“…Adherence to medication intake ranged from 19% to 98.8% in different studies [ 4 , 6 , 8 , 18 ]. Nearly 58% of the patients were completely compliant with the medication, and the most common reason to miss the medication, highlighted by 21% of the patients, was the medication cost.…”

“…Worldwide, it contributed to 956,000 fatalities in 2013, up from 409,000 in 1990 [ 3 ]. According to the 2017 Global Burden of Disease research, renal disorders cause 1.2 million fatalities globally, and the all-age mortality rate linked to CKD increased by 41.5% from 1990 to 2017 [ 4 ]. Regarding the eGFR level, patients with CKD go through several stages of the disease, labeled from one to five [ 1 ].…”

“…The increasing prevalence of diabetes and hypertension in Pakistan makes CKD a prevalent health problem here [ 5 ]. There are more than 100 newly diagnosed cases of ESRD annually per million people, and the prevalence is estimated to range from 16.6% to 25% in Pakistan [ 4 ].…”

“…A study in Karachi found that 13.4% of patients attended hemodialysis sessions irregularly, while 18% of patients discontinued their hemodialysis treatment [ 12 ]. Shehryar Raashid et al used the End Stage Renal Disease-Adherence Questionnaire (ESRD-AQ) to assess adherence among patients at a hospital in Rawalpindi [ 4 ].…”