Evaluation of Therapy Adherence Among Patients With End Stage Renal Disease at Kenyatta National Hospital

Abstract

Background: End stage renal disease (ESRD) is a major non-communicable killer disease globally. It is estimated that more than 1.4 million patients worldwide are affected by ESRD. Renal Replacement Therapy (RRT) is important for the survival of patients with ESRD. For RRT to be successful there is need for patients to adhere to therapy regimens that are immensely demanding. Lack of adherence predisposes patients to increased morbidity, mortality, cost and burden on the healthcare system. Globally, it is estimated that 50% of ESRD patients are non-adherent to therapy. Main objective: To determine the level of adherence to therapy among patients with ESRD at Kenyatta National Hospital. Methodology: Cross-sectional descriptive design was used for this study. A total of 103 participants were selected and interviewed. This sample size was calculated using Fisher’s formula and the participants were selected using multistage (cluster then simple random) sampling technique. Data was collected through a structured questionnaire and analysed by use of descriptive and inferential statistics. Results: This study revealed that 67% (n=69), 69.9% (n=72), 42.7 % (n=44) and 57.3% (n=59) of the study participants had high levels of adherence to haemodialysis session attendance, prescribed medications, fluid and diet recommendations respectively, with 51.5% (n=53) demonstrating overall adherence to therapy. The study also revealed that 62.1% (n=64), 48.5 % (n=50), 62.1% (n=64) and 65% (n=67) of the study participants were knowledgeable on their dialysis schedule, prescribed medications, fluid and diet recommendations respectively. Other findings showed that 60.25% (n=62), 61.2% (n=63), 58.3% (n=60) and 69.9% (n=72) of the study participants had a positive attitude towards their dialysis schedule, prescribed medications, fluid and diet recommendations respectively. Conclusion: Adherence levels to haemodialysis session attendance, prescribed medications and diet recommendations among ESRD patients attending haemodialysis at KNH were high whereas that of fluid restriction was sub-optimal. Overall adherence was 51.5%. Generally, the patients were knowledgeable and had a positive attitude on their therapeutic modalities. Recommendation: There is need for embracing a holistic approach in the management of ESRD patients on haemodialysis at KNH so as to have optimal levels of adherence in all the four therapy modalities so as to reduce the associated morbidity and mortality to non-adherence.