SP637FACTORS AFFECTING ADHERENCE IN INDONESIAN END STAGE RENAL DISEASE PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS

Abstract

INTRODUCTION AND AIMS: End Stage Renal Disease (ESRD) have become a wellknown public health problem and the treatment modalities often involve long term dialysis which requires adherence from the patients. Failure to achieve proper adherence in hemodialysis (HD) patients can lead to increase morbidity and mortality rate. However, there is very limited information regarding this issue and its associating factors from developing countries such as Indonesia. The aim of this study is to identify the factors affecting adherence in ESRD patients undergoing maintenance HD. METHODS: This is a multicenter cross sectional study that took place in four HD clinics in Jakarta, Indonesia from October to December 2016. Adherence was measured using the modified End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ). We classified adherence as adherence to HD, medication, fluid restrictions and dietary restrictions. Patients were categorized as having either good or poor adherence. Clinical characteristics of the patients were also noted. Depression, anxiety, cognitive function, symptoms burden was measured using Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Montreal Cognitive Assessment (MoCAIna) and Dialysis Symptom Index Questionnaire respectively. Analysis for categorical variables was done using Chi-square test. Analysis to find the mean difference between two groups was done using Students' T-test. RESULTS: A total of 138 patients were included in our study, out of which 86 (62.3%) were male. Median age of the patients was 54 (25-84) years. The most common etiology of chronic kidney disease was hypertension (56.5%) and diabetes (29.7%). There were 117 (84.8%), 107 (77.5%), 92 (66.7%) and 99 (71.7%) patients that were good adherers to HD, medication, fluid restrictions and dietary restrictions respectively. Higher cognitive function had significant association with better adherence to HD (P =0.026). Symptoms burden had significant association with adherence to medications (P = 0.014). Frequency of HD per week had significant association with adherence to fluid restrictions (P = 0.048). Cognitive function (P = 0.008) and depression (P= 0.046) had significant association with adherence to dietary restrictions. Age, duration of HD, income levels and educational levels did not have any significant association with adherence levels. CONCLUSIONS: Cognitive function, symptoms burden, depression and frequency of HD per week are the factors affecting adherence in Indonesian ESRD patients undergoing HD. Physicians should give more attention to these factors in order to improve the adherence in HD patients.