Compliance in Hemodialysis, Influence of Comorbid Axis-I Psychiatric Disorders and Temperament and Character Features on Compliance

INTRODUCTION: Success in hemodialysis treatment mainly depends on patient’s compliance. At least 50% of patients believed to be non-compliant. This study aims to investigate the factors associated compliance in hemodialysis. Sociodemographic features, social support levels, quality of life, cognitive impairments, comorbid Axis-I disorders and stressors according to DSM-IV, symptom scales, temperament and character features according to Cloninger’s psychobiological model, will be determined and compared between compliant and non-compliant patients. METHODS: Diagnostic interviews of 61 patients -undergoing 4-hour thrice weekly hemodialysis for more than six months- were performed via SCID-I, on the following day of the last session. Standardized Mini Mental State Examination (MMSE), Hamilton Anxiety and Depression Rating Scales, and Temperament and Character Inventory (TCI) were performed. Proportion of ‘inter-dialytic weight gain’ to ‘end session patient weight’ was calculated as percentage and mean of previous 3 months’ data were collected. Patients divided in to two groups (IDWG (%) <3.5: compliant, ≥ 3.5: non-compliant). All the data compared between the two groups. RESULTS: Age, age of hemodialysis onset, MMSE scores, TCI-Harm Avoidance scores were higher; blood pressure levels and TCI-Reward Dependency Total scores were lower in complaints. Psychiatric medication history, family history, stressor rates and current recurrent depression rates were higher in non-complaints. All of the chronic recurrent depressives were non-compliant. DISCUSSION AND CONCLUSION: Being young, early onset of hemodialysis, current recurrent and chronic depression, past history of psychiatric medication, family history of psychiatric illness, stressors, decrease in cognitive functions and high blood pressure levels are the risk factors for noncompliance. Low harm avoidance and high reward dependency are the prominent temperament features of the non-compliant patients. It should be considered that these results may guide interventions to increase treatment compliance in hemodialysis patients.