Revista de Nefrología, Diálisis y Trasplante (Jun 2014)
Skipping one or more dialysis sessions significantly increases mortality: measuring the impact of non-adherence
Abstract
Introduction: Non-adherence to the prescribed dialysis sessions frequency ranges from 2% to 50% of patients. The objective of this study was to evaluate the impact of detecting and measuring the non-adherence to the prescribed dialysis frequency and to determine the importance of a multidisciplinary approach with the aim of improving adherence. Methods: longitudinal cohort study including 8,164 prevalent hemodialysis patients in April 2010, with more than 90 days of treatment, in Fresenius Medical Care Argentina units that were monitored for 3 years. The survey evaluated: interruption of at least one dialysis session in a month or reduction at least 10 minutes of a dialysis session in a month, during 6 months prior to the survey. Relative mortality risks were evaluated among groups. Results: 648 patients (7.9%) interrupted dialysis sessions: 320 (3.9%) interrupted one session per month and 328 (4.01%) interrupted more than one session per month. After 3 years monitoring, 349 patients (53.8 %) remained active in hemodialysis and 299 were inactive due to different reasons: 206 deceased (31.8 %), 47 transfers or monitoring losses (7.25 %), 36 transplanted (5.55 %), 8 changes to PD modality (1.2%) and 2 recovered their kidney function (0.3 %).Interrupting one session per month significantly increased the mortality risk comparing both groups (interrupters and non-interrupters): RR 2.65 (IC 95% 2.24 – 3.14). Interrupting more than one dialysis session also increased significantly mortality risk comparing to the non-interrupters: RR 2.8 (IC 95% 2.39 – 3.28). After 3 years monitoring, 41.6 % of interrupters at the beginning had improved their adherence through a multidisciplinary program of quality improvement. Conclusion: Global mortality was greater among patients who interrupted dialysis sessions. A considerable proportion of interrupter patients at the beginning modified their behavior through the implementation of a multidisciplinary program of quality improvement.
