Prevalence and Consequences of Nonadherence to Hemodialysis Regimens

Abstract

Adherence to fluid restrictions and dietary and medication guidelines as well as attendance at prescribed hemodialysis sessions of a hemodialysis regimen are essential for adequate management of end-stage renal disease. A literature review was conducted to determine the prevalence and consequences of nonadherence to the different aspects of a hemodialysis regimen and the methodological obstacles in research on nonadherence. Nonadherence to the prescribed regimen is a common problem in hemodialysis and is associated with increased morbidity and mortality. Research on nonadherence is associated with 2 major obstacles: inconsistencies in definitions and invalid measurement methods. Further research is needed to validate measurement methods and to establish clinically relevant operational definitions of nonadherence.

Nonadherence in Dialysis Patients: Prevalence, Measurement, Outcome, and Psychological Determinants

“…The range of estimates of nonadherence in the HD population is due to the lack of standardized definitions . Dichotomizing adherence is particularly contentious.…”

“…For example, while it is agreed that IDWG is a suitable indicator of fluid adherence and sodium intake , multiple cut‐off points have been used. One common classification for nonadherence is an average IDWG ≥2.5 kg , with other cut‐offs ranging from 1 to 3.0 kg . Significantly, IDWG is influenced by several factors including residual kidney function , dry weight and nutritional state .…”

“… and Akman et al. did take into account body size considering fluid nonadherence as an IDWG ≥5.7% of dry weight, but there is no consensus on its clinical significance of this and other definitions .…”

“…Published rates of nonadherence vary according to the methods used to define and assess adherent behavior. Lack of standardized measurement in the dialysis population is problematic . Nonadherence may be specific to a particular aspect of ESKD medication, dietary guidelines fluid intake, and dialysis prescription .…”

Dietary Adherence in Children With Chronic Kidney Disease: A Review of the Evidence

“…Denhaerynck et al . () has identified that the lack of officially adopted renal diet adherence criteria has led mainly to the use of biochemical markers and self‐reported scoring (0–6: representing poor to excellent) for this purpose. In the present review, we aim to study the dietary adherence of children with CKD, after they and their parents were provided with guidance regarding nutrition.…”