Diet non-adherence, fluid overload “substantially high” among patients on hemodialysis
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A meta-analysis of studies between 2000 and 2020 revealed a “substantially high” percent of patients on hemodialysis do not adhere to diet and fluid restrictions.
“Non-adherence to the prescribed diet and fluid restrictions is a severe health problem that limits the benefits of routine therapies. It can cause electrolyte imbalance, fluid overload, exacerbation of symptoms, poor quality of life, repeated hospitalization, higher [health care] costs, and high mortality,” V.R. Vijay, RN, MSN, MBA, FACEN, FCCS, from All India Institute of Medical Sciences in Bhubaneswar, India, and colleagues wrote. “No meta-analyses are known to have been undertaken to evaluate the prevalence of non-adherence to diet and fluid restriction in hemodialysis patients.”
In a meta-analysis of 23 studies written between 2000 and 2020 on non-adherence to diet and fluid restrictions in patients on hemodialysis, researchers evaluated 11,209 patients (mean age,55.85; 57.74% men) to estimate the pooled prevalence of non-adherence to diet and fluid restrictions.
Using the random-effects model of meta-analysis, researchers determined the methodological quality of the studies. Researchers conducted meta-regressions and analyses of subgroups. Additionally, Egger’s test and visual analysis of the symmetry of funnel plots measured publication bias.
Analyses revealed an approximate pooled prevalence of 60.2% of the world population exhibited non-adherence to diet and 60.6% exhibited non-adherence to fluid restrictions. Researchers found significant publication bias, and the risk of bias score positively correlated with the occurrence of non-adherence to fluid restrictions.
“This meta-analysis found that non-adherence to diet and fluid restrictions is highly prevalent among hemodialysis patients. However, the pooled estimate should be interpreted with caution as the prevalence of individual studies is highly inconsistent due to methodological or measurement variations,” Vijay and colleagues wrote. “This is a worrisome issue because non-adherence will result in higher [health care] expenditure, more frequent hospitalizations, morbidity, and mortality. The health care team must recognize the factors and barriers influencing adherence and develop holistic interventions to yield desirable health outcomes among hemodialysis patients.”
The limitations of this study include publication bias and self-reported data that may have affected the definition of adherence.
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