Naalweh Karam Sh, Barakat Mohammad A, Sweileh Moutaz W, Al-Jabi Samah W, Sweileh Waleed M, Zyoud Sa'ed H
Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
Division of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
BMC Nephrol. 2017 May 30;18(1):178. doi: 10.1186/s12882-017-0598-2.
Adherence to diet recommendations, fluid restriction, prescribed medications, and attendance at hemodialysis (HD) sessions are essential for optimal and effective treatment of patients with end-stage renal disease. No data regarding this issue are available from Palestine. Therefore, this study was carried out to assess adherence to diet, fluid restriction, medications, and HD sessions.
A cross-sectional study of HD patients at An-Najah National University Hospital was carried out during summer, 2016. Self-reported adherence behavior was obtained using a valid and reliable questionnaire (End-Stage Renal Disease Adherence Questionnaire: ESRD-AQ). Predialytic serum levels of potassium and phosphate were obtained as clinical indicator of diet and medication adherence respectively. In addition, interdialytic body weight (IDW) was also obtained from medical records and analyzed in relation to reported adherence of fluid restriction.
A total of 220 patients answered all questions pertaining to ESRD-AQ. The mean age ± standard deviation of participants was 56.82 ± 14.51 years. Dietary adherence was observed in 24% while that of fluid restriction adherence was observed in 31% of studied patients. Reported adherence to HD sessions was 52% while that for medications was 81%. Overall, 122 (55.5%) patients had good adherence, 89 (40.5%) had moderate adherence, and 9 (4.1%) had poor adherence behavior. Male patients had significantly higher overall adherence scores than females (p = 0.034). A significant correlation between reported diet adherence and serum pre-HD potassium level (p < 0.01) was observed. A significant correlation between reported fluid restriction adherence and IDW (p < 0.01) was also found. However, no significant correlation between reported adherence and pre-HD phosphate level. There was significant correlation between overall perception and overall adherence score (p < 0.001). Counselling of patients regarding importance of adherence modalities was lowest for "staying for the entire dialysis time". Multivariate analysis indicated that elderly male patients who were city residents had higher odds of having higher adherence score.
There was a good percentage of patients who had overall moderate or poor adherence. ESRD-AQ could be used to assess some aspects of HD adherence. Counselling and education of patients on HD are important to improve therapeutic outcome.
坚持饮食建议、液体限制、遵医嘱服药以及按时参加血液透析（HD）治疗对于终末期肾病患者的最佳有效治疗至关重要。巴勒斯坦尚无关于此问题的数据。因此，开展本研究以评估患者在饮食、液体限制、药物治疗及血液透析治疗方面的依从性。
2016年夏季，在纳贾赫国立大学医院对血液透析患者进行了一项横断面研究。使用有效且可靠的问卷（终末期肾病依从性问卷：ESRD-AQ）获取自我报告的依从性行为。分别获取透析前血清钾和磷水平作为饮食和药物依从性的临床指标。此外，还从病历中获取透析间期体重（IDW），并分析其与报告的液体限制依从性的关系。
共有220名患者回答了所有与ESRD-AQ相关的问题。参与者的平均年龄±标准差为56.82±14.51岁。24%的患者饮食依从性良好，31%的患者液体限制依从性良好。报告的血液透析治疗依从率为52%，药物治疗依从率为81%。总体而言，122名（55.5%）患者依从性良好，89名（40.5%）患者依从性中等，9名（4.1%）患者依从性差。男性患者的总体依从性得分显著高于女性（p = 0.034）。观察到报告的饮食依从性与透析前血清钾水平之间存在显著相关性（p < 0.01）。还发现报告的液体限制依从性与IDW之间存在显著相关性（p < 0.01）。然而，报告的依从性与透析前磷水平之间无显著相关性。总体认知与总体依从性得分之间存在显著相关性（p < 0.001）。就“全程透析时间”而言，关于依从方式重要性的患者咨询最少。多因素分析表明，城市居民中的老年男性患者具有较高依从性得分的几率更高。
相当比例的患者总体依从性中等或较差。ESRD-AQ可用于评估血液透析依从性的某些方面。对患者进行血液透析方面的咨询和教育对于改善治疗效果很重要。
