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American Journal of Critical Care. 2007;16: 222-235
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CE Article

Prevalence and Consequences of Nonadherence to Hemodialysis Regimens

By Kris Denhaerynck, RN, PhD, Dominique Manhaeve, MNS, Fabienne Dobbels, PhD, Daniela Garzoni, MD, Christa Nolte, RN and Sabina De Geest, RN, PhD. Kris Denhaerynck is a postdoctoral fellow and Sabina De Geest is a professor of nursing with the Institute of Nursing Science, University of Basel, Basel, Switzerland. Dominique Manhaeve is a clinical trial leader with Tibotec BVBA, Mechelen, Belgium. Fabienne Dobbels is a postdoctoral fellow at the Center for Health Services and Nursing Research, School of Public Health, Katholieke Universiteit Leuven, Leuven, Belgium. Daniela Garzoni and Christa Nolte are an attending physician and a study nurse from the Department of Transplant Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.

Corresponding author: Sabina De Geest, RN, PhD, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland (e-mail: sabina.degeest{at}unibas.ch).

Adherence to fluid restrictions and dietary and medication guidelines as well as attendance at prescribed hemodialysis sessions of a hemodialysis regimen are essential for adequate management of end-stage renal disease. A literature review was conducted to determine the prevalence and consequences of nonadherence to the different aspects of a hemodialysis regimen and the methodological obstacles in research on nonadherence. Nonadherence to the prescribed regimen is a common problem in hemodialysis and is associated with increased morbidity and mortality. Research on nonadherence is associated with 2 major obstacles: inconsistencies in definitions and invalid measurement methods. Further research is needed to validate measurement methods and to establish clinically relevant operational definitions of nonadherence.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Compare the differences between interdialytic weight gain and intradialytic weight loss.
  2. Describe the consequences of nonadherence to hemodialysis regimens.
  3. Identify nursing strategies to assist patients with compliance and adherence to hemodialysis regimens.

To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue."






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