Association of Patient-Percieved Difficulty in Adherence and Actual Non-Adherence with Hemodialysis Treatment Recommendations Open Access

Snyder, Rachel (Spring 2019)

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Association of Patient-Perceived Difficulty in Adherence and Actual Non-Adherence with Hemodialysis Treatment Recommendations

By Rachel Lee Snyder


Background: Non-adherence to recommendations is common among patients on in-center hemodialysis and is associated with increased risk for poor outcomes. Patient-reported difficulty in adherence may predict non-adherent behaviors. We used data from a cohort of in-center hemodialysis patients to determine whether patients’ perceived difficulty with adherence to dialysis recommendations are associated with actual non-adherence to recommendations.


Methods: We included 799 in-center hemodialysis patients initiating treatment 2/10-10/16 at Emory Dialysis clinics. Patient-perceived difficulty with adherence across multiple domains (coming to dialysis, completing dialysis sessions, fluid restrictions, diet restrictions, taking medications) was obtained from baseline social worker assessments (yes vs. no). Actual adherence in coming to dialysis, completing dialysis sessions, fluid restrictions (interdialytic weight gain), diet restrictions (potassium levels, phosphorus control), and taking medications (phosphorus control) was estimated over the 12 weeks following social worker assessment, using medical record data. Crude agreement was assessed via percent agreement and kappa estimates. Multivariable logistic regression was used to estimate the associations between these measures with adjustment for potential confounders.


Results: In our cohort of 799 patients, agreement between perceived difficulty and non-adherence was generally poor across all domains [percent agreement (kappa): coming to dialysis, 65.3% (0.06); completing dialysis sessions, 52.9% (-0.02); fluid restrictions, 65.1% (0.07); diet restrictions, 61.1% (0.01); and taking medications/diet restrictions, 58.1% (-0.01) and 62.2% (0.04)]. After adjustment, patients reporting difficulty with fluid restrictions were 62% more likely to be actually non-adherent than those not reporting difficulty (OR: 1.62, 95% CI: 1.08, 2.43). Patients reporting difficulty with coming to dialysis were 41% more likely to have actual non-adherence in this measure; however, this association was not statistically significant (OR: 1.41, 95% CI: 0.96, 2.07). The magnitudes of associations between perceived difficulty and actual non-adherence in other categories were close to null and not statistically significant.


Conclusion: Our findings show that perceived difficulty with only fluid restrictions and coming to dialysis appear to be associated with actual non-adherence. These results suggest that using patient-reported measures of difficulty may not be sufficient to target interventions to the patients most at risk for non-adherence.

Table of Contents

Background. 7

Methods. 10

Data Sources and Study Population. 10

Study Variables. 11

Statistical Analysis. 14

Results. 15

Patient Characteristics. 15

Association Between Perceived Difficulty and Actual Non-Adherence. 16

Discussion. 18

References. 24

Figures and Tables. 26

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