title: Non-adherence in patients on peritoneal dialysis: a systematic review.
abstract: BACKGROUND
  It 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).
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Non-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.
authors.affiliation: Department of Psychology, National University of Singapore, Singapore ; Unit of Behavioural Medicine, University College London, London, United Kingdom.
authors.forename: Konstadina
authors.initials: K
authors.lastname: Griva
authors.affiliation: Department of Psychology, National University of Singapore, Singapore.
authors.forename: Alden Yuanhong
authors.initials: AY
authors.lastname: Lai
authors.affiliation: Department of Psychology, National University of Singapore, Singapore.
authors.forename: Haikel Asyraf
authors.initials: HA
authors.lastname: Lim
authors.affiliation: Department of Renal Medicine, Khoo Teck Puat Hospital, Singapore.
authors.forename: Zhenli
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Department of Nephrology, Peritoneal Dialysis Centre, Singapore General Hospital, Singapore.
authors.forename: Marjorie Wai Yin
authors.initials: MW
authors.lastname: Foo
authors.affiliation: Unit of Behavioural Medicine, University College London, London, United Kingdom ; Health Services Research Group, City University London, London, United Kingdom.
authors.forename: Stanton P
authors.initials: SP
authors.lastname: Newman
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D012189:Retrospective Studies