Predictors of Adherence to Treatment Regimen Among Hemodialysis Patients at Kenyatta National Hospital

Abstract

Background: Adherence in hemodialysis has been a significant factor that helps in modifying the quality of life among patients undergoing hemodialysis. Adherence to hemodialysis treatment regimen encompasses four-components, which include hemodialysis treatment, medication adherence, fluid, and dietary restriction. There are clear guidelines that patients undergoing hemodialysis are expected to abide by to increase adherence. The increasing non-adherence provides a difficult context, and it is therefore essential to understand the underlying predictors of hemodialysis adherence. The purpose of the study: To determine the predictors of adherence to the treatment regimen among hemodialysis patients attending Kenyatta National Hospital. Methodology: A cross-sectional study was conducted among 97 patients with End-Stage Renal Disease, selected purposefully. A standardized ESRD Adherence questionnaire consisting of five sections: General information, dialysis, medication, dietary, and fluid restriction was used to collect quantitative data. Descriptive and binary logistic regression were conducted to meet the research objectives. The level of significance was assessed at 0.05. Results: The prevalence of adherence to hemodialysis treatment regimen was 39.2%. The prevalence of each of the component of hemodialysis treatment was assessed, which revealed that 55.7% of the respondents adhered to medication, 39.2% adhered to fluid intake, 35.1% adhered to dietary restriction while 47.4% adherence to hemodialysis treatment. Education was the only patient related significant predictor of hemodialysis adherence (p = 0.048, OR= 0.433, 95% CI [0.189,0991]. Distance from facility (p <0.001, OR= 1.39, 95% CI [0.649,2.977] and communication between healthcare provider and hemodialysis patients (p = 0.017, OR= 1.659, 95% CI [1.096,2.496] were significant health system related predictors of adherence to hemodialysis. Hypotension was the only therapy related significant predictor of adherence to hemodialysis (p <0.001, OR= 7.216, 95% CI [2.456,21.167]. Conclusion: Adherence to hemodialysis treatment is still low prompting the need to integrate better strategies for improved healthcare for hemodialysis patients. Low level of education, longer distance to health facility, lack of communication between patients and healthcare providers and hypotension were associated with non- adherence to hemodialysis treatment regimen. Therefore, there is need to focus on controlling these factors which have a greater influence on adherence to hemodialysis treatment regimen.