Abstract
BackgroundIt has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions).MethodsA systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool.ResultsThe search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6–53% for dialysis exchanges, 3.9–85% for medication, and 14.4–67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment.ConclusionNon-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.
Highlights
It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy
While the majority of End-Stage Renal Disease (ESRD) patients undergo in-center maintenance hemodialysis (HD) in most settings, chronic peritoneal dialysis (PD) is the dominant home dialysis therapy utilized by 11% of the dialysis population worldwide [1]
With increasing numbers of ESRD patients in need of Renal Replacement Therapy (RRT) and the need to expand dialysis delivery in home settings away from overburdened hospital and tertiary care settings, there is renewed interest in outcomes in patients who are established on PD regimes
Summary
It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. With increasing numbers of ESRD patients in need of Renal Replacement Therapy (RRT) and the need to expand dialysis delivery in home settings away from overburdened hospital and tertiary care settings, there is renewed interest in outcomes in patients who are established on PD regimes. The term adherence was introduced to recognize patients’ right to choose whether or not to follow advice, calling attention to the importance of patients’ active participation in their treatment regimes. It is important and increasingly recognized that a distinction needs to made between intentional and unintentional non-adherence [13]. Intentional and unintentional non-adherence behaviors will be explored
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