Interventions to improve hemodialysis adherence: a systematic review of randomized-controlled trials.
Over 485,000 people in the United States have chronic kidney disease, a progressive kidney disease that may lead to hemodialysis. Hemodialysis involves a complex regimen of treatment, medication, fluid, and diet management. In 2005, over 312,000 patients were undergoing hemodialysis in the United States. Dialysis nonadherence rates range from 8.5% to 86%. Dialysis therapy treatment nonadherence, including treatment, medication, fluid, and diet nonadherence, significantly increases the risk of morbidity and mortality. The purpose of this paper is to systematically review randomized-controlled trial intervention studies designed to increase treatment, medication, fluid, and diet adherence in adult hemodialysis patients. A search of Cumulative Index of Nursing and Allied Health Literature (CINAHL) (1982 to May 2008), MEDLINE (1950 to May 2008), PsycINFO (1806 to May 2008), and all Evidence-Based Medicine (EBM) Reviews (Cochran DSR, ACP Journal Club, DARE, and CCTR) was conducted to identify randomized-controlled studies that tested the efficacy of interventions to improve adherence in adult hemodialysis patients. Eight randomized-controlled trials met criteria for inclusion. Six of the 8 studies found statistically significant improvement in adherence with the intervention. Of these 6 intervention studies, all studies had a cognitive component, with 3 studies utilizing cognitive/behavioral intervention strategies. Based on this systematic review, interventions utilizing a cognitive or cognitive/behavioral component appear to show the most promise for future study.
Matteson
Michelle L
ML
Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA. mattesonml@health.missouri.edu
Russell
Cynthia
C
D000328:Adult; D015928:Cognitive Behavioral Therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000451:nursing / Q000523:psychology / Q000628:therapy; D010349:Patient Compliance / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000451:nursing / Q000523:psychology*