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Behavioral compliance with dialysis prescription in hemodialysis patients
P L Kimmel1, R A Peterson, K L Weihs
1Department of Medicine, George Washington University Medical Center, Washington, D.C. 20037, USA.
Insights
Hemodialysis patient compliance is complex, with depression and social support influencing behavior. Skipping and shortening dialysis are distinct noncompliant actions, impacting phosphorus levels but not potassium or weight gain.
Area of Science:
- Nephrology
- Psychology
- Medical Compliance
Background:
- Understanding hemodialysis (HD) patient compliance is crucial but challenging due to a lack of standardized measurement.
- Psychological factors, medical status, and adherence behaviors are interconnected in HD patients.
Purpose of the Study:
- To investigate the interrelationships between psychological factors, medical indicators, and behavioral compliance in hemodialysis patients.
- To explore different facets of noncompliance, including treatment shortening and skipping behaviors.
Main Methods:
- Assessed psychological factors using the Beck Depression Inventory, Cognitive Depression Index, Perception of Illness Effects scale, and Multidimensional Scale of Perceived Social Support.
- Measured behavioral compliance through percent time compliance (shortening), percent attendance (skipping), and percent total time compliance.
- Analyzed standard compliance indicators: predialysis serum potassium and phosphorus, and interdialytic weight gain.
Main Results:
- A significant prevalence of mild depression (25.5%) was observed, correlating with illness perception and social support.
- Skipping and shortening behaviors were independent, indicating distinct noncompliant patterns.
- Total time compliance averaged 95.8%, with younger patients more prone to skipping treatments.
- Time compliance correlated with phosphorus levels but not with potassium or interdialytic weight gain.
- Behavioral compliance patterns demonstrated stability over time and varied by gender and dialysis unit.
Conclusions:
- Psychological well-being, particularly depression and social support, significantly influences hemodialysis patient compliance.
- Distinct noncompliant behaviors (skipping vs. shortening) require separate consideration.
- Compliance measurement in hemodialysis is multifaceted, with behavioral adherence showing specific correlations with biochemical markers like phosphorus.
Abstract:
The relationship between compliance and outcome is poorly understood, partially because there has been no gold standard for measuring compliance in hemodialysis patients. To investigate interrelationships between psychological, medical, and compliance factors, hemodialysis (HD) patients were studied with the Beck Depression Inventory, and a subset, the Cognitive Depression Index, the Perception of Illness Effects scale, and the Multidimensional Scale of Perceived Social Support. Behavioral compliance was measured in three ways: (1) percent time compliance (signifying "shortening behavior"); (2) percent attendance (signifying "skipping behavior) (3) percent total time compliance, assessing patients' time on dialysis normalized for prescribed time, including all shortenings and absences. Standard compliance indicators (predialysis serum potassium and phosphorus concentrations and interdialytic weight gain) were also analyzed. The patients' mean Beck Depression Inventory was in the range of mild depression. The prevalence of depression was 25.5%. Both depression indices correlated with Perception of Illness Effects scale scores. In general, social support was related to both measures of depression and perception of illness effects. Total time compliance was 95.8 +/- 5.0%. Younger patients were more likely to skip treatments compared with older patients. Time compliance comprised a wide spectrum, with most patients relatively compliant, whereas a small proportion received far less than their prescribed dialysis. Skipping and shortening behaviors did not correlate, suggesting that these constitute two separate types of noncompliant behaviors. Time compliance parameters did not correlate with potassium levels or interdialytic weight gain, but did correlate with phosphorus levels. Interrelationships between behavioral compliance measures and other parameters varied between units and patients of different gender. Finally, behavioral compliance patterns were stable over months in patients.(ABSTRACT TRUNCATED AT 250 WORDS)