ADHERENCE OF DIALYSIS THERAPY MANAGEMENT IN HEMODIALYSIS

PATIENT
Siti Kholilah Alawiyah A.S1*, Chiyar Edison2*
1
Faculty of Nursing, Universitas Indonesia, Depok, West Java, 16425, Indonesia
2.
Medical and Surgical Department, Faculty of Nursing, Universitas Indonesia, Depok, 16424, Indonesia

*Email: siti.kholilah@ui.ac.id

Abstract

Objective: Patients that suffering End Stage Renal Disease (ESRD) have to adherence on dialysis therapy management. That
management consists of hemodialysis attendance, prescribed medications, fluid restrictions, and dietary intake. Non
adherence to these management can increase the morbidity and mortality rate that will indirectly affect quality of life. This
study was to identify the adherence of dialysis therapy management on hemodialysis patient.

Methods: This study used cross sectional study design, involved 57 hemodialysis patients selected using purposive sampling
technique at major governmental hospitals in Jakarta city. Clinical measures and a valid, reliable End Stage Renal Disease –
Adherence Questionnaire (ESRD-AQ) were used to assess adherence of patients (hemodialysis attendance, prescribed
medications, fluid restrictions, and dietary intake).

Results: The result showed that the proportion of respondents who adhere to dialysis therapy management is 29 respondents
or 50,9%. In addition, the prevalence of hemodialysis patients’ adherence to hemodialysis attendance, prescribed medications,
fluid restrictions, and dietary intake were 50,9%, 56,1%, 61,4%, and 73,7%.

Conclusion: That the adherence patient in dialysis therapy management has a good quality of life. Therefore, it is
recommended to develop nursing interventions to maintain and improve patient compliance in order to improve the quality
of life.

Keywords: adherence of dialysis therapy management, end stage renal disease, hemodialysis, quality of life.

Introduction vomiting, pruritus, and uremia may be occurred.

End Stage Renal Disease (ESRD) is progressive and Therefore, ESRD patients needed management dialysis

irreversible kidney damage in which kidneys are unable to therapy include of hemodialysis program, prescribed

maintain metabolic, fluid, and electrolyte balance meditation, fluid restrictions, and dietary intake
3
characterized by glomerular filtration rate (GFR) ≤ 15 continuously. However, adherence on dialysis therapy

ml/min/1,73 m2 that resulting uremia and requiring management was still a major problem in hemodialysis

replacement kidney therapy to eliminate toxic in the patients.4

body.1,2 In Indonesia, the prevalence of ESRD cases that

Study showed 0% - 32,3% patient non adherence on
following hemodialysis in 2013 to 2014 has increased by
dialysis attendance, 1,2% - 81% patient non-adherence
11.456 inhabitants.1
prescribed meditation, 3,4% - 74% patient non-adherence

Although hemodialysis patients in hemodialysis therapy on fluid restrictions, and 1,2% - 82,4% patient non-

often tend to suffer malnutrition, fluid and electrolyte adherence on diet intake.3 Adherence is the level of

disturbances, and the onset of symptoms from disease such behavior of a person receiving treatment, following a diet,

as hypertension, muscle cramps, fatigue, anemia, nausea, and or implementing lifestyle changes in appropriate with
the recommendations of the health care provider. 5
adherence of dialysis therapy management relation with
nutrition status increased, decrease of depression level and
that will indirectly affect quality of life.6
From the explanation above, we knew that adherence of
dialysis therapy management in hemodialysis patient is a
key to prevent them from complication and make live than
better. Nevertheless, only very little to no studies
particularly in Indonesia reported about adherence in
hemodialysis patient that assess four aspects
(hemodialysis attendance, prescribed medications, fluid
restrictions, and dietary intake). Therefore, we conducted
this study to investigating the adherence of dialysis
therapy management on hemodialysis patients at major
governmental hospital.
Methods
The design of this study was cross sectional, aiming to
identify the adherence of dialysis therapy management on
hemodialysis patient. A purposive sample of 57
respondents participated in the study with the following
criteria: (1) all ESRS patient that undergoing hemodialysis
who have routine hemodialysis at least 2 months; (2)
patient is conscious and able to communicate well;
(3) patient can read and write; (4) patients willing to
be respondents and sign informed consent; (5)
patient who were in good hemodynamic status. Data
were analyzed using the frequencies and cross tabulations
descriptive analysis.
Researcher adhered to the ethical standards, following
principles of research ethics: respect for human dignity;
respect for free and informed consent; respect for privacy
and confidentiality; respect of justice and inclusiveness;
and balancing harms and benefits.
Results
The result of the study showed the mean age of subjects
was 49,05 ± 12,18 years old; range (between 21 to 73
years). About half of patients (52,6%) were male. The
majority of patients had middle education (54,4%), other
patients had low and high educational each (22,8%).
About more than three-fourth of patients are married
(86%).
The mean duration of dialysis was 24 months range
between (2 to 96 months). Over half of the patients were
unemployed (56,1%). Most respondents had high
economic status is ≥ 3.355.750 or in minimum wage rate
in Jakarta.
Most respondent were adherence to management therapy
dialysis (29; 50,9%) compared to (28; 49,1%) of them
were non- adherence to management therapy dialysis.
Table 1: Adherence of Management Therapy Dialysis (n=57)
Variable Frequency Percentage
(%)
Adherence of Management
Therapy Dialysis
a. Adherence 29 50,9
b. Non-adherence 28 49,1
Total 57 100
In each dimension of this management get results: the
majority of patients (29; 50,9%) were adherence to their
hemodialysis attendance; about half of patients (32;
56,1%) adherence to prescribed medications; about two-
third of patients (35; 61,4 %) adherence to fluid restriction
recommendations and only (22; 38,6%) of them were
non-adherence to those recommendations; the majority of
patients (42; 73,7%) were adherence to their diet
restrictions recommendations and only (15; 26,3) of them
were non-adherence to their diet recommendations.
Details of the dimension of adherence on management
therapy dialysis are presented on the table 2.
Table 2: Four Dimension of Adherence of Management respondents in this study had hemodialysis schedule 2
Therapy Dialysis (n=57) times during the week with a duration of 4 - 5 hours /
Variable Frequency Percentage (%)
session. This is in appropriate with the reference set by
Adherence of
Hemodialysis Program 29 50,9 Pernefri (2003).10 Most respondents said after
a. Adherence 28 49,1 hemodialysis of shortness to be reduced, no edema in the
b. Non-adherence
Total 57 100 legs, and sleep soundly. This is according to the theory
Adherence to Prescribed which mentions hemodialysis aims to clean up the rest of
Meditations 32 56,1
a. Adherence 25 43,9 the metabolism of the body; Restore fluid balance,
b. Non-adherence
electrolyte and acid base; And eliminating
Total 57 100
11
Adherence to Fluid
manifestations.
Restrictions 35 61,4
a. Adherence 22 38,6 In the second aspect of adherence on dialysis therapy
b. Non-Adherence
Total 57 100 management the majority of patients were adherence
Adherence to Diet 56.1% of patients are adherence to prescribed treatment
Restrictions 42 73,7
a. Adherence 15 26,3 regimens. The results of this study are not much different
b. Non-adherence from Firmansyah (2016) which showed that 91.5% of
Total 57 100
patients adhere to the treatment regimen.7 Some
respondents explained that they had no difficulty in taking
Discussion drugs because the availability of drugs was always present
In this study showed 50,9% patient adherence to dialysis and covered by the health insurance used and when
therapy management. This study same other research skipping the medication would lead to complaints such as
about relationship between adherence of dialysis therapy dizziness, weakness. Some non adherence patients
management chronic with interdialysis weight gain in mention that they do not take the drug because they forget
hemodialysis patient that showed 61,7% hemodialysis to take the drug, it is inconvenient because it must be
7
patient adherence to dialysis therapy management. This continuous, and considers the drug consumed will cause
equation occurs because the characteristics of an effect that makes his body becomes unfavorable. Many
respondents; inclusion and exclusion criteria data were factors lead to non-compliance with treatment regimens
similar. such as fear of drug effects, drug size and frequency of
taking medication, drug costs, lack of knowledge, low
In the first aspect of adherence on dialysis therapy
communication with health care workers.12
management the majority of patients were adherence
(50.9%) to the hemodialysis attended. This study is in line In the third aspect of adherence on dialysis therapy
with research conducted by Al-Khattabi (2014) which management the majority of patients were adherence
showed that 55.96% of patients adherence to attended 61,4% of patients are adherence to fluid restriction. The
hemodialysis therapy session.9 Adherence on average patient consuming fluid 500 - 750 cc / 24 hours
hemodialysis attendance not only seen from the coupled with the amount of urine output. This result is
respondents' routine following hemodialysis, but also supported on other research study which showed that the
measured from the duration during hemodialysis. All majority of hemodialysis patients were adherence (71.7%)
to fluid restriction.13 Some respondents said there was no
difficulty to control the fluids. Some explain that when
consuming too much liquid fluid makes breathless, tired,
swollen in the body, and difficulty sleeping. This result is
supported by the theory that non-compliance with fluid
restriction will lead to shortness of breath, muscle cramps,
dizziness, anxiety, panic, pulmonary edema, and
hypertension.8 A small percentage of respondents
disobeyed their fluid restrictions with reason they can not
control because they often feel thirsty during hot weather,
dry throat, taking medication with plenty of water. This is
similar to other research which states that fluid restriction
is difficult for clients especially when taking diuretic type
drugs that cause dry mucosa so patients feel thirsty and try
to drink.14
The fourth aspect of adherence on dialysis therapy
management the majority of patients were adherence
73,7% of patients are adherence to diet intake. These
results are similar to those of other study that showed
81.7% of patients were adherence to the diet
recommended by health care providers.15 Most of the
patients admitted there was no difficulty to control the
food and fear of complications arise when eating
prohibited foods. This is according to the theory which
states that adherence to diet can prevent complications
such as hyperkalemia, pulmonary edema, renal
osteodystrophy.2
Conclusion
Our study aiming to identify the adherence of
management therapy dialysis on hemodialysis patient that
most respondents were male (52,6%), the mean age 49,05
years old, the mean duration of dialysis 24 months, had
middle educational status (54,4%), were unemployed
(56,1%), had high economic status (61,4%), and majority
of patients were married (86%). The result, furthermore,
showed that most respondents had adherence in
management therapy dialysis (50,9%). In addition, more
than half of patients adherence in each dimension of
management therapy dialysis were hemodialysis attendant
(50,9%), prescribed medication (56,1%), and fluid and
diet restriction (61,4%; 73,7%) recommendation.
Adherence of management therapy dialysis is important
to hemodialysis patient because can decrease the
morbidity and mortality rate that will indirectly affect
quality of life. Therefore, we recommend the nurses or
clinical care to raise the awareness and improving the
adherence patients. Also, we recommend to always
monitor the patient adherence and giving them an
education about how important of the adherence to the
non-adherence patients.
Acknowledgment
We acknowledged InsympoFest committee who have
facilitated us in disseminating our study.
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