Adherence to Treatment Regimens Among End-Stage Renal Disease Patients: A Cross-Sectional Study

Fatima Sameer Belhmer,1 Mohammed Abdullah Al Amad,1 Mogahed H Albitahi,2 Fatma K Babattah3 1Yemen-Field Epidemiology Training Program, Ministry of Public Health and Population, Sana’a City, Yemen; 2Nephrology and Dialysis Center, Thawra Tertiary Hospital, Sana’a City, Yemen; 3Family Medicine Center, Hadramout University, Hadramout, YemenCorrespondence: Fatima Sameer Belhmer, Email [email protected]: Adherence to treatment regimens is crucial to enhance the clinical outcomes of patients with End-Stage Renal Disease (ESRD). In Yemen, there is a gap in information about this issue. Hence, this study aimed to assess the adherence and associated factors of ESRD patients to the four adherence domains, including HD session attendance, medication, dietary modification, and fluid management.Patients and Methods: A descriptive cross-sectional study of ESRD patients was conducted. End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was used to collect data through face-to-face interviews. The scoring system was used. The mean of the gained scores was calculated and divided by expected maximum scores and the resulting percentage was used to rank the level of adherence as good ≥ 83%, moderate ≥ 58- < 83% and poor < 58%). Non-parametric tests to assess the mean differences with selected variables at p-value < 0.005.Results: The overall (mean ±SD) scores of 393 patients for the four adherence domains (HD, medication, fluid restrictions, and dietary recommendations) were 933.5+210 indicating an overall moderate level of adherence. Good adherence to HD and moderate adherence to medication, diet and fluids were observed (88.5%, 76.7%, 61.9%, and 61.6%, respectively). Significantly higher mean scores among patients with urban residency (941.8 vs 869.4, p=0.03), HD duration < 5 years (949.2 vs 908.0, p=0.02), the overall perception of treatment (956.7 vs 653.3, p=< 0.001), patients who had a perception of medication (942.0 vs 734.3, p=0.002), fluid restriction (958.9 vs 727.3, p=< 0.001), and diet recommendations (969.8 vs 715.2, p=< 0.001). Significantly lower mean scores were observed among patients who had not received counseling regarding the importance of dietary and fluid restriction (962.8 vs 920.5, p=0.02) and (965.6 vs 919.0, p=0.02, respectively).Discussion: This study is the first in our country to provide baseline information on adherence toward different treatment domains and their associated factors among patients with ESRD. The adherence level among patients with ESRD was moderate in general and good for HD. There was a significant association between adherence and residency, HD duration, overall perception of treatment, perception of medication, fluid and dietary restrictions, and poor counseling. Regular counseling should be provided to enhance adherence levels. A multicenter study is recommended to assess the causal relationship between adherence and the factors affecting adherence.Keywords: adherence, end stage renal disease, ESRD-AQ, hemodialysis, Yemen