Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study

Abstract

BackgroundPatients with chronic kidney diseases (CKD) on haemodialysis (HD) have high morbidity and mortality rates, which are also due to the inherent risks associated with nephropathy. Non-adherence (NA) to the different demands of the treatment can have consequences for the outcome of patients undergoing HD; nevertheless, there are still doubts about such repercussions. This study was conducted to evaluate the association between NA to conventional HD and all-cause mortality and cardiovascular mortality.MethodsWe prospectively evaluated mortality in a 6-year period in a cohort of 255 patients on HD in northeast Brazil. The evaluated parameters of NA to HD were interdialytic weight gain (IDWG) ≥ 4% of dry weight (DW), hyperphosphatemia and regular attendance at treatment, assessed as the correlation between the periods on HD completed and those prescribed. We used the Cox multivariate regression model to analyse survival and the predictors of all-cause mortality and cardiovascular mortality.ResultsWith a median follow-up period of 1493 days and a mortality rate of 9.1 per 100 people-years, there were 87 deaths, of which 54% were cardiovascular deaths. IDWG ≥4% of DW was associated with a risk of all-cause mortality however presenting a borderline outcome for cardiovascular mortality, with hazard ratios of 2.02 (CI 95% 1.17–3.49, p = 0.012) and 2.09 (CI 95% 1.01–4.35, p = 0.047), respectively. No significant association was found between other parameters of NA and mortality. Subgroup analysis showed that for patients with IDWG ≥4% of DW, malnutrition, age and diagnosis of cardiovascular and cerebrovascular diseases were associated with higher all-cause mortality.ConclusionsIDWG ≥4% of DW was identified as an independent predictor of all-cause mortality and demonstrated a borderline outcome for cardiovascular mortality in patients on conventional HD. The occurrence of excessive IDWG in the presence of malnutrition represented a significant increase in the risk of death, indicating a subgroup of patients with a worse prognosis.

Exploring the experiences and perceptions of haemodialysis patients observing Ramadan fasting: a qualitative study

“…This finding is consistent with quantitative studies on the HD population showing body weight and interdialytic weight gain (IDWG) decreased significantly during Ramadan for fasting patients [ 15 , 48 ]. IDWG control is critical to HD patients if greater than 4% of total dry weight which may induce higher ultrafiltration rate subsequently leading to increased risk of cardiac mortality for these patients [ 49 ]. However, reduction of total body mass index (BMI) should be misinterpreted as a false positive effect because low BMI could be indicative of muscle wasting associated with higher mortality risk for this patient group [ 50 ].…”

Non-adherence to hemodialysis, perception of the illness, and severity of advanced nephropathy

“…This study evaluated the association between certain psychological aspects and NA to chronic HD therapy after a long period of dialysis, in a sample of patients who had stability in NA behaviors after 6 years in therapy 8 . We found no correlation between the behaviors of NA to HD surveyed and the patient’s perception of the disease and severity of advanced nephropathy.…”

“…The patient’s perception that he/she exercises control over the chronic treatment can motivate the occurrences of absences and reductions in the HD sessions 1 , 5 , 19 . Another possibility is that the rigidity of times for performing HD combined with the time spent in sessions and the occurrence of symptoms after HD, including slow recovery after treatment, are considered motivators for absences, despite the potential risks to patients 6 , 8 , 20 .…”

“…In light of the fact that the HD patient receives individualized supervision, guided by residual renal function (RRF) and nutritional condition, excessive IDWG means failure to comply with these recommendations and risk of hypervolemia with potential complications 8 , 21 , 22 . About a third of the patients had IDWG ≥ 4% DW and 81% had anuria, which can be justified by the long period on HD (108 months).…”

“…We previously identified a stability of the behavior of NA to HD in a cohort through repeated assessments with an interval of 6 years, favoring the hypothesis that patients present behavioral patterns when faced with the demands of renal-replacement therapy (RRT) 8 . Certain psychosocial aspects of patients on RRT are associated with worse quality of life, increased morbidity and mortality, and NA to HD 7,[9][10][11] .…”