FAMILY SUPPORT IS CRUCIAL FOR DIALYSIS PATIENTS COMPLIANCE TO TREATMENT AND QUALITY OF LIFE

  • Mimoza Milenkova University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia
  • Lada Trajceska University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia
  • Daniela Mladenovska University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia
  • Blerim Bedzeti University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia
  • Vladimir Pushevski University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia
  • Irena Rambabova-Busletikj University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia
  • Goce Spasovski University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia
  • Gjulsen Selim University Clinic of Nephrology,Faculty of Medicine, University "Ss.Cyril and Methodius", Skopje, Republic of North Macedonia

Abstract

 Background: Non-compliant dialysis patients are at increased risk of mortality. Compliance and quality of life depends on demographics, education, income, family-support, marital status. Missed dialysis sessions, non-adherence to medications, excessive phosphate levels, inter-dialytic weigh-gain, smoking and non-adherence to medical investigations provide indicators of non-compliance. Aim: Assessing impact of family support on compliance-indicators in dialysis patients. Methods: 134 patients were scored for compliance from 0-2; Summary scores were also assessed. 2-year data was obtained. Patients with mean IDWGs ˃4.5% and/or phosphorous level above 1.6mmol/L-scored 1, patients with IDWG/BW >5.7%, Pi 2.0mmol/L-scored 2. Summary scores were also assessed. Quality of life scored with SF-36 questionnaire. Non-adherence was analyzed for predictors in multivariate analysis. Results: Estimated rates of non-compliance varied: medical investigations 63%, phosphorus 33, IDWG 22, therapy 14%, HD treatment 9%. When dietary fluid, medications and treatment regimen were studied, non-compliance rate was 73%, adding adherence to medical investigations rose rate to 87%. Patients with family support above median level (³25) were significantly more often men (0.049), diabetic (p=0.014), low socioeconomic status (0.001), married (0.003). Poor family support scored significantly worse in quality of life (56.73±26.15vs.39.23±24.05, p=0.0001), and overall non-compliance scores 2.04±1.71vs.2.97±2.06, p= 0.007). In multivariate analysis non-compliance was predicted best in patients of younger age, low social status, lower family support (b=-0.202, p=0.023, b=0.220, p=0.036, b=-0.175, p=0.019, respectively). Conclusion:  Family support is crucial for patients’ compliance to treatment and quality of life. Efforts should be done to meet patients’ needs and help those confronting dialysis burden to improve quality of life.


Key words: family support, compliance, dialysis, quality of life, predictors


 

References

1. Kramer A, Pippias M, Noordzij M, Stel V, Andrusev A, Aparicio-Madre M et al. The European Renal
Association – European Dialysis and Transplant Association (ERA-EDTA) Registry. Annual Report 2016.
Clinical Kidney Journal, 2019, 1–19
2. Ahmadmehrabi S, Tang WHW. Hemodialysis-induced cardiovascular disease. Semin Dial. 2018;31(3):258–67
3. Collins AJ, et al. United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease &
end-stage renal disease in the United States. American Journal of Kidney Diseases. 2012;59(1):A7, 1-420
4. Roberts MA, et al. Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with
the general population. American Journal of Kidney Diseases. 2011;58(1):64-72
5. Saran R, Bragg-Gresham JL, Rayner HC, Goodkin DA, Keen ML, Van Dijk PC, Kurokawa K, Piera L, Saito A,
Fukuhara S, et al: Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice
patterns in the DOPPS. Kidney Int 2003; 64: 254–62.
6. Sharp J, Wild MR, Gumley AI, Deighan CJ: A cognitive behavioral group approach to enhance adherence to
hemodialysis fluid restrictions: a randomized controlled trial. Am J Kidney Dis 2005; 45: 1046–57.
7. Vlaminck H, Maes B, Jacobs A, Reyntjens S, Evers G. The dialysis diet and fluid non adherence questionnaire:
Validity testing of a self-report instrument for clinical practice. J Clin Nurs 2001;10:707-15.
8. World Health Organization: Adherence to Long-Term Therapies. Evidence for Action. Geneva, World Health
Organization, 2003.
9. Pierratos A, McFarlane P, Chan CT, Kwok S, Nesrallah G: Daily hemodialysis 2006. State of the art. Minerva Urol
Nefrol 2006; 58: 99–115.
10. Depner TA, Daugirdas JT: Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates
Hemodialysis Adequacy Peritoneal Dialysis Adequacy Vascular Access, 2006.
11. Leggat JE, Orzol SM, Hulbert-Shearon TE, et al. Noncompliance in hemodialysis: Predictors and survival
analysis. Am J Kidney Dis 2004; 32:139-45.
12. Lindberg M, Prutz KG, Lindberg P, Wikstrom B. Interdialytic weight gain and ultrafiltration rate in
hemodialysis: Lessons about fluid adherence from national registry of clinical practice. Hemodial Int
2009;13:181-8.
13. Leggat JE, Orzol SM, Hulbert-Shearon TE, et al. Noncompliance in hemodialysis: Predictors and survival
analysis. Am J Kidney Dis 2004; 32:139-45.
14. Sharp J, Wild MR, Gumley AI, Deighan CJ: A cognitive behavioral group approach to enhance adherence to
hemodialysis fluid restrictions: a randomized controlled trial. Am J Kidney Dis 2005; 45: 1046–57.
15. Hare J, Clark-Carter D, Forshaw M: A randomized controlled trial to evaluate the effectiveness of a cognitive
behavioral group approach to improve patient adherence to peritoneal dialysis fluid restrictions: a Pilot
study. Nephrol Dial Transplant 2014; 29: 555–64.
16. Howren MB, Kellerman QD, Hillis SL, Cvengros J, Lawton W, Christensen AJ: Effect of a behavioral self-
regulation intervention on patient adherence to fluid-intake restrictions in hemodialysis: a randomized
controlled trial. Ann Behav Med 2016; 50: 167–76.
17. Karamanidou C, Clatworthy J, Weinman J, Horne R. A systematic review of prevalence and determinants of
nonadherence to phosphate binding medication in patients with end stage renal disease. BMC Nephrol
2008;9:1-10.
18. Saran R, Bragg-Gresham JL, Rayner HC, et al. Nonadherence in hemodialysis: Associations with mortality,
hospitalization, and practice patterns in the DOPPS. Kidney Int 2003;64: 254-62.
19. Gerbino G, Dimonte V, Albasi C, Lasorsa C, Vitale C, Marangella M. Adherence to therapy in patients on
hemodialysis. G Ital Nephrol 2011;28:416-24.
20. Stamatakis MK, Pecora PG, Gunel E. Factors influencing adherence in chronic dialysis patients with
hyperphosphatemia. J Ren Nutr 1997;7:144-8.
21. Wang J, Yue P, Huang J, Xie X, Ling Y, Jia L, Xiong Y, Sun F: Nursing Intervention on the Compliance of
Hemodialysis Patients with End-Stage Renal Disease: A Meta-Analysis. Blood Purif 2018;45:102-9.
22. Fukuhara S, Lopes AA, Bragg-Gresham JL, Kurokawa K, Mapes DL, Akizawa T, Bommer J, Canaud BJ, Port FK,
Held PJ. Health-related quality of life among dialysis patients on three continents: the Dialysis Outcomes and
Practice Patterns Study. Kidney Int. 2003;64(5):1903–10.
23. Mapes DL, Lopes AA, Satayathum S, McCullough KP, Goodkin DA, Locatelli F, Fukuhara S, Young EW,
Kurokawa K, Saito A, et al. Health-related quality of life as a predictor of mortality and hospitalization: the
Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int. 2003;64(1):339–49.
24. Akman B, Uyar M, Afsar B, Sezer S, Ozdemir FN, Haberal M. Adherence, depression and quality of life in
patients on a renal transplantation waiting list. Transpl Int. 2007;20(8):682–7.
25. Eneanya, N.D., Maddux, D.W., Reviriego-Mendoza, M.M. et al. Longitudinal patterns of health-related quality
of life and dialysis modality: a national cohort study. BMC Nephrol 20, 7 (2019).
https://doi.org/10.1186/s12882- 018-1198-5
26. Ibrahim S, Mohammed H, Dawalt B. Study of non-compliance among chronic hemodialysis patients and its
impact on patients' outcomes.2015; 3 (1):243-9
27. Schatell D. MATCH-D: a roadmap to home dialysis therapy. Nephrol News Issues. 2007;21(11):41,43-4
28. Renal replacement therapy and conservative management. NICE 2019. https://www.nice.org.uk
29. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Med Care 1992; 0:473-83
30. Zimet G. Powell S, Farley G, Werkman S, Berkoff K. Psychometric properties of the multidimensional scale of
perceived social support. Journal of personality assessment. 1990;55:610-7
31. Taylor, S. E. Social support: A review. Oxford Handbook of Health Psychology. New York, NY: 2011;Oxford
University Press.
32. Eisenberger, N. I., Way, B. M., Taylor, S. E., Welch, W. T., & Lieberman, M. D. MAOA, gender differences, and
social exclusion: Response to Gallardo-Pujol et al. Biological Psychiatry,2008; 63, e11.
33. Taylor, S.E. & Gonzaga, G. Affiliative responses to stress: A social neuroscience model. Tend and befriend:
Biobehavioral bases of affiliation under stress. Current Directions in Psychological Science, 2006;215, 273-7
34. Olga Stavrova. Having a happy spouse is associated with lowered risk of mortality. Psychological Science,
2019; 095679761983514 DOI: 10.1177/0956797619835147
35. Harvard Men’s Health Watch, “Marriage And Men’s Health,” July 2010, accessed at
www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2010/July/marriage-and-mens health ?
utm_source=mens&utm_medium+pressrelease&utm_campaign+mens0710, on July 19, 2010.
36. Kaur H, Kaur H, Venkateashan M. Factors determining family support and quality of life of elderly population.
Int J Med Sci Public Health 2015;4:1049-53
37. Prazeres, F., Santiago, L. Relationship between health-related quality of life, perceived family support and
unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre
cross-sectional study. Health Qual Life Outcomes 2016; 14, 156. https://doi.org/10.1186/s12955-016-0559-7
38. Miller TA, Dimatteo MR. Importance of family/social support and impact on adherence to diabetic therapy.
Diabetes Metab Syndr Obes. 2013;6:421‐426. Published 2013 Nov 6. doi:10.2147/DMSO.S36368
39. Kurniawati N, Wahyuni D, Toulasik, Y. Family Support Improves Hypertensive Patient Drug Compliance.
Indian Journal of Public Health Research & Development 2019;2260 DO -10.5958/0976-5506.2019.02270.8
Published
2020-07-06
How to Cite
MILENKOVA, Mimoza et al. FAMILY SUPPORT IS CRUCIAL FOR DIALYSIS PATIENTS COMPLIANCE TO TREATMENT AND QUALITY OF LIFE. Journal of Morphological Sciences, [S.l.], v. 3, n. 2, p. 29-36, july 2020. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/116>. Date accessed: 09 aug. 2020.
Section
Articles