An assessment of adherence to management modalities by ambulant end stage renal disease patients undergoing haemodialysis at the Kenyatta National Hospital.
Abstract
Background: Treatment of patients with End Stage Renal Disease (ESRD), entails regular
dialysis sessions and medical management of complications of kidney failure. Globally, rates
of non-adherence to treatment amongst ESRD patients are high. Implications of nonadherence include an increase in hospitalisations, Intensive Care Unit admissions, mortality,
and financial burden to the healthcare system. It is vital to study the level of adherence to
ESRD care, as a basis to evaluate whether or not patients will be subjected to the dire
consequences of non-adherence. No such study has been conducted in Kenya.
Objective: To determine patient’s adherence to their ESRD care, by utilising the ESRD
Adherence Questionnaire (ESRD-AQ).
Study Design: Descriptive Cross Sectional Study.
Setting: Renal Unit of Kenyatta National Hospital.
Subjects: Adult ESRD patients undergoing haemodialysis at KNH Renal Unit.
Methodology: Adherence to ESRD care was assessed by utilising the ESRD-AQ, which
utilises an alphanumerical approach to score patients level of adherence to treatment.
Predialytic serum potassium level & mean Interdialytic weight gain,(IDWG) were obtained
from patient’s Haemodialysis Flow Sheet. Serum potassium, and IDWG are routine measures
of effective management in ESRD care. The association between adherence to dietary
restrictions and serum potassium levels, and association between adherence to fluid
restriction and patient’s IDWG was determined.
Data Analysis: Demographic & clinical characteristics were summarised. Utilising data from
ESRD-AQ, the level of adherence to ESRD care, as an aggregate, was computed .
Correlations between adherence to dietary recommendations and serum potassium level, &
between adherence to fluid restrictions & IDWG were computed. P values of<0.05 were
considered significant. Confidence Intervals were calculated.
Results: During the 2 month study period between 2nd october-29th November 2019, 87
patients undergoing chronic haemodialysis at the Renal Unit of Kenyatta National Hospital
were studied. All patients were black Africans; 51 (59%) were male, with a male: female
ratio of 1:0.7. Ages ranged from 18 to 79 years, with 62% of patients aged 50 years or below.
Prevalent comorbidities included Hypertension in 97% , Diabetes Mellitus in 26%, polycystic
kidney disease in 1.14%,whilst 24.13% had both Diabetes Mellitus and Hypertension.
The overall adherence to ESRD Care was Good in 48% (95% CI 38-59) of patients,
Moderate in 43% (95% CI 33-53) and Poor in 9 % (95% CI 5-17).
A total of 70% (95% CI 60-79) of the ESRD population studied, were adherent to their twice
weekly haemodialysis sessions in the month preceding the study period. The magnitude of
non-adherence was, such that, among the 26 non-adherent patients, 16 (61.5%) patients
missed a single haemodialysis session of the total possible 8 sessions in a month; 7 (27%)
patients missed 2 sessions, whilst 3(11.5%) patients missed 3 sessions. A total of 72( 83%;
95%CI 73-89) patients reported adherence to their medications, whilst 59(68% ; 95% CI 57-
78) patients were adherent to their fluid restrictions and,61( 70%;95% CI 60-79) patients
were adherent to their dietary restrictions. IDWG was significantly higher amongst the
patients who were non-adherent to their fluid restrictions as compared to those who were
adherent to fluid restrictions.
Conclusion: Overall adherence to ESRD care amongst patients undergoing haemodialysis at
KNH Renal Unit is suboptimum; with 52% of patients having overall Moderate or Poor
adherence. Amongst the four parameters contributing to ESRD care, adherence to fluid
restrictions was poorest , followed by adherence to haemodialysis. IDWG was significantly
higher amongst patients who were non-adherent to fluid restrictions.
The implications of non-adherence, to a twice weekly schedule, is longer interdialytic
intervals, which puts patients at increased risk of all-cause mortality (62). Secondly, high
IDWGs above 3Kg, implies the patients are constantly in a hypervolemic state, and apart
from risks of predialysis hypertension, uncontrolled intradialytic blood pressures, pulmonary
oedema and even death, there are also the risks of hemodynamic instability in subsequent
haemodialysis sessions when ultrafiltration is being performed.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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