Treatment Adherence in Patients Undergoing Dialysis
Pp. 112-137 (26)
Alden Y. Lai and Konstadina Griva
Patient non-adherence is a pertinent issue as it induces adverse disease
outcomes, poor prognosis, and diminished quality of life. Concerns for non-adherence
are further pronounced in End-Stage Kidney Disease (ESKD) patients as treatment is
highly complex and demanding with dialysis sessions, multiple medications, and
lifestyle restrictions related to dietary and fluid management. Summarising literature on
adherence in dialysis patients, this chapter starts by introducing the treatment rationale
and regime for ESKD patients undergoing dialysis, followed by a delineation of
relevant measures and criteria related to, and rates of non-adherence. An assortment of
methods is being used to assess adherence rates in dialysis patients, among which the
examining of biochemical markers and patient self-report are the most prevalent. Rates
of non-adherence in dialysis patients warrant urgent attention as they can be as high as
18% for missed dialysis sessions, 22.4% for shortened treatment time, 80.4% for
medication, 75.3% for fluid restrictions and 81.4% for dietary restrictions. There is a
disproportionate emphasis on haemodialysis over peritoneal patients. Paramount to
drive efforts to improve treatment adherence in this patient population, demographic,
clinical and psychosocial determinants of non-adherence are also highlighted. This
chapter concludes with a brief overview on educational and psycho-educational
interventions used to improve treatment adherence in patients undergoing dialysis.
End-stage kidney disease, kidney failure, dialysis, adherence,
compliance, haemodialysis, peritoneal, diet, fluid, medication.
Faculty of Arts & Social Sciences, Department of Psychology, National University of Singapore, Singapore.