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Non-adherence in patients on chronic hemodialysis: an international comparison study.
MedLine Citation:
PMID:  20954134     Owner:  NLM     Status:  In-Data-Review    
Background: Adherence to diet and fluid restrictions by adults on hemodialysis treatment is challenging. This study compared non-adherence (NA) to diet and fluid restrictions between adult US and German hemodialysis patients, and assessed potential predictors for NA. Methods: A cross-sectional multicenter comparative study of 456 adult hemodialysis patients was conducted in 12 outpatient-based hemodialysis centers in the United States and Germany. NA was based on self-report using the Dialysis Diet and Fluid Non-adherence Questionnaire (DDFQ). Laboratory marker, interdialytic weight gain (IDWG) and dialysis adequacy (Kt/V) information were obtained from medical records. Mean time on dialysis was 50 months (range 3-336); mean age was 62 years (range 19-91), with the majority of patients (89.7%) being white. Results: Self-reported frequency of NA to diet was 80.4% and to fluid 75.3% in the total sample. The degree of NA to diet and fluid differed significantly, with the US patients (68.1% vs. 61.1%) reporting less NA when compared with German (81.6% vs. 79.0%) patients (p<0.0001). Phosphorus, albumin, IDWG and Kt/V levels were higher in the US compared with the German subsample (all p<0.0001; IDWG p<0.003). Generalized regression models revealed that education (p<0.01) and smoking (p<0.01) predicted NA to diet, whereas single marital status (p<0.008) and male sex (p<0.04) were independent predictors for NA to fluid. Conclusions: NA persists as one of the most challenging tasks in health care of patients with chronic conditions, including hemodialysis patients. Our findings suggest that patient, condition-related, socioeconomic and health care system-related factors may contribute to NA to diet and fluid restrictions.
Christiane Kugler; Ilona Maeding; Cynthia L Russell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nephrology     Volume:  24     ISSN:  1724-6059     ISO Abbreviation:  J. Nephrol.     Publication Date:    2011 May-Jun
Date Detail:
Created Date:  2011-05-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  366-75     Citation Subset:  IM    
1 Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, ?Hannover - Germany.
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