Griva Konstadina, Lai Alden Yuanhong, Lim Haikel Asyraf, Yu Zhenli, Foo Marjorie Wai Yin, Newman Stanton P
Department of Psychology, National University of Singapore, Singapore ; Unit of Behavioural Medicine, University College London, London, United Kingdom.
Department of Psychology, National University of Singapore, Singapore.
PLoS One. 2014 Feb 25;9(2):e89001. doi: 10.1371/journal.pone.0089001. eCollection 2014.
It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions).
A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool.
The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment.
Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.
人们越来越认识到，不依从是决定腹膜透析（PD）治疗效果的一个重要因素。因此，有必要确定患者对PD治疗方案不同方面（透析操作、药物治疗以及饮食/液体限制）的不依从程度。
2013年5月，按照PRISMA指南在PubMed、PsycINFO和CINAHL数据库中对同行评议文献进行了系统评价。两名 reviewers 根据预先确定的纳入和排除标准独立选择有关PD不依从的出版物。提取了有关患者特征、测量方法、不依从率及相关因素的数据。两名 reviewers 还根据有效公共卫生实践项目评估工具的修订版对研究质量进行了独立评估。
检索到204项研究，其中共有25项研究符合纳入标准。各研究报告的不依从率有所不同：透析换液的不依从率为2.6%-53%，药物治疗为3.9%-85%，饮食/液体限制为14.4%-67%。观察到的差异源于不依从测量和定义方面的方法学差异。显示出一定一致性的与不依从相关的因素大多是社会人口统计学因素，如年龄、就业状况、种族、性别以及PD治疗时间。
PD患者对透析治疗方案不同方面的不依从似乎很普遍。需要进一步开展高质量研究，更详细地探究这些因素，以便为干预设计提供信息，促进该患者群体的依从性。
