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Adherence to Treatment by African Americans Undergoing Hemodialysis
Abstract
End stage renal disease (ESRD) affects African Americans more than any other ethnic group. Adherence is a challenge. Patients with ESRD must adhere to medication, diet, fluid restrictions, and dialysis treatment schedules if they do not receive a kidney transplant. The purpose of this exploratory, descriptive study was to assess adherence in 120 African Americans with ESRD undergoing hemodialysis (HD). Participants completed a demographic questionnaire and the ESRD Adherence Questionnaire (ESRD-AQ). Biomarkers were collected from medical records. Few participants (24%) adhered to dietary restrictions; however, fluid restriction was reported as the most difficult to manage, which was consistent with the interdialytic weight gain biomarker. Older participants were more adherent. Participants were adherent with HD attendance and medication. Participants reported frequent communication with the healthcare team, but a more formal process needs to be implemented with follow up to ensure understanding and reinforce adherence.
... HD therapy includes two important steps: fluid and food restriction and the regular removal of waste metabolites from the blood by dialysis [3]. A successful HD therapy requires patients to comply with the prescribed drugs, dialysis regimen, and food and fluid restrictions [4]. Failure to comply causes an increase in HD-related complications and health expenses and may lead to a decrease in quality of life and survival [5,6]. ...
... The patients had been using 4 (3-6) drugs per day (Table 1). In terms of the clinical characteristics of the patients, the patients had been diagnosed with end-stage renal disease for 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) years and had been receiving HD therapy for 4 (2)(3)(4)(5)(6)(7)(8) years. Seven of these patients had been diagnosed with endstage renal disease in the past year. ...
... The patients had been using 4 (3-6) drugs per day (Table 1). In terms of the clinical characteristics of the patients, the patients had been diagnosed with end-stage renal disease for 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) years and had been receiving HD therapy for 4 (2)(3)(4)(5)(6)(7)(8) years. Seven of these patients had been diagnosed with endstage renal disease in the past year. ...
... The questionnaires used to measure adherence were valid and reliable; however, only fourteen studies (48%) reported reliability results using the study sample. Internal consistency was mostly assessed with Cronbach's alpha [7,8,12,38,42,45,48,49,55,58] while studies using the ESRD-AQ calculated the inter-class and/or the item-total scale correlation coefficient [9,11,41,54]. ...
... Lastly, four studies (14%) did not provide information on how/when clinical biomarkers were collected [39,41,45,49]. It is important to emphasize that there was great variability in this regard, which may introduce bias, as some studies (n = 6, 21%) stated that data collection took place in the same week as the self-report measure was applied, while others averaged the clinical results of the last weeks before the questionnaire administration (n = 7, 24%). ...
... range: 40.3-66.4). Six studies [7,8,30,31,40,41,46] reported categorical data, suggesting that patients with more than three months on dialysis were included in their analysis. Most participants were men (54%), with an average of 58.5 years old (SD = 6.91, range: 40.3-66.4), ...
Accurate measurement of adherence is crucial to rigorously evaluate interventions aimed at improving this outcome in patients undergoing in-center hemodialysis. Previous research has shown great variability in non-adherence rates between studies, mainly due to the use of different direct (e.g., clinical biomarkers) and indirect (e.g., questionnaires) measures. Although self-reported adherence in hemodialysis has been widely explored, it is still unclear which is the most accurate questionnaire to assess this outcome; therefore, the question of how to optimize adherence measurement in research and clinical practice has emerged as a key issue that needs to be addressed. This systematic review and meta-analysis aimed to explore the criterion validity of self-report measures of adherence in hemodialysis established through the association between test scores and clinical biomarkers (the criterion measure). The protocol was registered in PROSPERO (2021 CRD42021267550). The last search was performed on March 29th, 2022, on Web of Science (all databases included), Scopus, CINHAL, APA PsycInfo, and MEDLINE/PubMed. Twenty-nine primary studies were included, and thirty-eight associations were analyzed. The Hunter-Schmidt’s meta-analysis was computed for the associations with more than two studies (n = 20). The results showed that six associations were large (16%), 11 were medium (29%) and the remaining were of small strength. The test scores from the End-Stage Renal Disease Adherence Questionnaire (range: 0.212
... All patients who met the inclusion criteria were included in the study without using any sampling method. However, in the post hoc power analysis of the study, if the effect size is =0.50, α=0.05, and the power is determined as 90%, the sample size was calculated as 140 (19,20). ...
... In the questionnaire, 20 questions concerning information on drug taking were chosen and correct knowledge and appropriate behavior were scored by 1 point. In the study, the mean number of correct answers was 15.46±2.1 (min-max [10][11][12][13][14][15][16][17][18][19] according to the knowledge score analysis. The median Total Knowledge Score was 16 (IQR= 3) in the group with Kt/V≥1.2, while 15.5 (IQR=3) in the group with Kt/V<1.2, ...
... Treatment adherence scores were measured by ESRD-(AQ) in hemodialysis patients. Many countries around the world use this survey (19). Treatment adherence scores of all our patients were quite high due to regular patient training on treatment adherence in dialysis units. ...
INTRODUCTION: This study aimed to evaluate treatment adherence and rational drug use in hemodialysis patients and investigate predictive factors on dialysis adequacy. MATERIAL AND METHOD: This is a cross-sectional descriptive study. The data were obtained by examining face-to-face questionnaires and patient files. The Hospitalized Patient Questionnaire and the End Stage Kidney Disease Compliance Questionnaire (ESRD-AQ) were administered to the patients. Kt/V was used for dialysis proficiency. By examining the obtained data, the variables that can be associated with the Kt/V value were investigated. RESULTS: A total of 145 patients were included in the study, 69% of the participants were over 51 years of age and 54.5% were male. Median Kt/v level was 1,38 (Q1=1,25; Q3=1,54). As for the medications, those with Kt∕V≥1.2 were found to be using more antihypertensive agents, folic acid, vitamin B12, and vitamin C but less levocarnitine concerning the group with Kt/V
... Pasien yang menjalani hemodialisis pasti akan mengalami perubahan dalam pola kehidupan sehari-harinya (Daniels et al., 2018). Partisipan memahami adanya asupan makanan yang dianjurkan dan yang tidak dianjurkan. ...
This study aims to gather information about the life experiences of patients with chronic kidney disease undergoing hemodialysis in adhering to their diet and fluid intake. The method used is a phenomenological approach involving 15 patients undergoing hemodialysis at the H. Adam Malik General Hospital Medan selected by purposive sampling technique. Data collection was carried out using a qualitative approach in the form of in-depth interviews. Data were analyzed using the Colaizzi method. The results showed that there were seven themes regarding patient experience, namely; 1) changes in the patient's physiological condition; 2) expression of the patient's feelings regarding changes in health conditions; 3) the need to obtain support; 4) changes in meeting the nutritional needs of patients; 5) changes in fulfilling the patient's fluid needs; 6) the need to obtain information about treatment; and 7) patient's obstacles in following diet and fluid rules. In conclusion, each patient's experience in following diet and fluid intake is different. Keywords: Fluid Intake, Diet Intake, Hemodialysis
... Additionally, diet is a critical component for the hemodialysis patient. Research shows that this clientele has difficulties in adhering to dietary restrictions (27) . On the other hand, maintaining a healthy body mass index is a challenge to be achieved, since a low body mass index is an independent predictor of death in these patients (28) . ...
Objective:
To analyze the content of the diagnostic proposition risk of excessive fluid volume in patients undergoing hemodialysis.
Method:
Content validity study, with 48 judges who assessed the content of the diagnostic proposition risk of excessive fluid volume, using an electronic data collection instrument. The judges' answers were analyzed through the calculation of the Content Validity Index and the T test.
Results:
The risk of excessive fluid volume was considered adequate, containing 23 risk factors: increased sodium concentration in the dialysate; missing hemodialysis sessions; insufficient water; low self-efficacy for fluid restriction; deficient knowledge; altered body mass index; excessive intake of fluids, proteins and sodium; lower kt/v index; inadequate removal of fluids in hemodialysis; thirst; xerostomia; older people; comorbidities; renal function decline; decreased urinary volume; inflammatory status; hospitalization; low serum level of albumin and lymphocytes, and high level of phosphorus; and use of antihypertensive drugs.
Conclusion:
The content of the diagnostic proposition risk of excessive fluid volume was considered adequate by the judges.
... The dietary adherence behaviours of patients were assessed primarily using a validated questionnaire, known as End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which has been widely used to study HD patients' adherence behaviours [51][52][53][54]. The original questionnaire consists of 4 subscales pertaining to dialysis, medication, dietary and fluid adherence, with all four subscales having reported content validity above 0.86 and good reliability (ICCs ≥ 0.83) [55]. ...
Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110–0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103–0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.
... The Turkish version of the ESRD-AQ has strong test-retest stability (Ok & Kutlu, 2019a). The ESRD-AQ is used in various countries, including Turkey, to evaluate treatment compliance in hemodialysis patients (Daniels et al., 2018;Ok & Kutlu, 2019b;Poveda et al., 2016;Seyyedrasooli et al., 2013). In the current study, item-total scale correlation coefficients ranged from 0.48 to 0.76. ...
The aim of this study was to determine the effect of motivational interviewing (MI) on adherence to treatment and quality of life in chronic hemodialysis patients. This study was conducted with a randomized controlled pretest, posttest, and follow-up design from March to July 2016 in the hemodialysis center. After the intervention (n = 30) and control groups (n = 30) completed a pretest, patients in the intervention group received four individual face-to face MI sessions per month. Then both groups participated in a posttest, 3 months after which a follow-up was conducted. A significant increase in adherence to treatment (according to both subjective and objective data) was observed in the experimental group compared to the control group. No significant difference was found between the two groups in their quality of life scores; however, within the experimental group, there was a significant increase in these scores between the posttest and the 3-month follow-up.
Background
End stage kidney disease (ESKD) requires complex medical management. To ensure the success of management plan, patient’s adherence to medication is fundamental. However, adherence to medication is challenging for patients with ESKD.
Objective
This study aimed to describe adherence to medication and to identify demographic and clinical determinants in Jordanian patients with ESKD.
Methods
Cross-sectional correlational design was performed using a sample of 188 patients with ESKD who attended haemodialysis units in five hospitals in Amman between March and June 2021. Medication adherence was measured using Morisky Medication Adherence Scale (MMAS).
Results
The mean age of the participants was 50.9 years (SD=15.64), more than half of the participants were males 109 (58.0%) and were non-smokers 115 (61.2%). The mean score of the MMAS was 5.18 (SD=2.024) which indicates high prevalence of inadequate adherence to medication. Younger age, longer duration on hemodialysis, and higher number of medications were risk factors for inadequate adherence to medication among patients with ESKD.
Conclusion
ESKD patients who are younger in age, have longer duration on hemodialysis, and have higher number of medications should be targeted as they have medication adherence challenges. Those patients should be taken into consideration when planning and developing interventions to enhance medication adherence in patients with ESKD.
Forecasting techniques are evaluated with past data before forecasting future figures. Error series of past periods are used to calculate error statistics to evaluate accuracy of forecasting technique or to compare different methods. Forecast accuracy measures of MSE, RMSE, MPE, MAPE, SMAPE and Theill’s U will be evaluated with Turkish gasoline cars sales data set. ARIMA, ANN and exponential smoothing forecasting techniques will be used to generate forecasts of past periods. These forecasts are evaluated with the given forecast accuracy measures. Selected forecast accuracy measures presented consistent results about selected forecasts.
The objective of study is to explore nurses’ experiences in their role as educators in improving adherence to fluid and dietary restrictions in hemodialysis patients. This study used a qualitative phenomenological method with a purposive sampling method. Eight nurses were selected for in-depth interviews. Data analysis was conducted using the Colaizzi method. The study found five themes. (1) Intensive interaction with patients to optimize the role of nurses. (2) Various methods are used in delivering education. (3) Various obstacles are experienced in delivering education. (4) Nurses are required to improve their abilities and (5) Benefits for nurses. It is important for nurses to improve their role continuously. Hospitals and health facilities need to encourage nurses in their efforts to develop themselves and their clinical roles, so the quality of nursing care can be improved.
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