Hemodialysis Therapy Adherence and Contributing Factors among End-Stage Renal Disease Patients at Muhimbili National Hospital, Dar es Salaam, Tanzania

Abstract

Maintenance hemodialysis services continue to rise globally. We evaluated adherence to hemodialysis therapy and contributing factors among end-stage renal disease patients at Muhimbili National Hospital, Dar es Salaam, Tanzania. A cross-sectional study was done involving 265 end-stage renal disease patients who were being treated at Muhimbili National Hospital, in Dar es Salaam. The study population selected included adult patients (18 years and above) with end-stage renal disease (ESRD) who were on hemodialysis. Data were entered into SPSS and imported into STATA for analysis. Numeric variables were summarized using the mean and standard deviation, and categorical variables were summarized using frequencies and proportions. A log-binomial regression model was used to estimate the risk factors associated with non-adherence, while multivariable log-binomial regression was used to control for confounders and test for the effect modifiers. All tests were two-tailed and the significance level was set at 5%. The parameters used to assess non-adherence to hemodialysis therapy in this study were the skipping of one or more hemodialysis sessions within the most recent 1 month or shortening one or more hemodialysis sessions by 10 or more minutes within the most recent 1 month. A session missed due to hospitalization or other medical reasons was not considered as non-adherence. All 265 patients were included in the analysis, of whom 191 (72.1%) were males. The rate of full adherence to the hemodialysis sessions was 64.2%. However, factors associated with the adherence to hemodialysis were the source of funding for hemodialysis (RR = 0.70, 95% CI: 0.48, 0.96), the occupation of the respondents (RR = 1.59, 95% CI: 1.44, 1.94), marital status (RR = 1.97, 95% CI: 1.03, 3.77), and monthly income (RR = 0.92, 95% CI: 0.62, 1.51). Adherence to hemodialysis therapy among ESRD patients at Muhimbili National Hospital was high and within the range of most published studies. Hemodialysis attendance among participants depended on the source of funding, marital status, occupation, and monthly income. Patients should be informed by the health care workers on the importance of adhering to hemodialysis sessions. Further studies should be done to explore the factors influencing adherence to hemodialysis, as it was noted that adherence was low among some patients.