Adherence to Hemodialysis Regimen and Biochemical Outcomes in Patients on Maintenance Dialysis: A Comparative Analysis Across Three Avenue Hospitals DOI: https://dx.doi.org/10.4314/ajhs.v38i3.2

Abstract

Background: Chronic Kidney Disease (CKD) affects approximately 13.4% of the global population, with up to 7 million patients requiring hemodialysis (HD). Adherence to HD schedules, medications, fluid limits, and diet is essential, as non-adherence increases morbidity and mortality. At Avenue Hospitals in Thika, Kisumu, and Nairobi, internal reports showed annual HD patient mortality rates of 9.2%, 12.4%, and 11.1%, respectively. The objective of the study was to assess adherence to the HD regimen and compare key biochemical and clinical markers among maintenance dialysis patients across three Avenue Hospitals.
Methodology: An analytical cross-sectional study was conducted between April and June 2024 involving 129 adult CKD patients at Avenue Hospitals (Thika, Nairobi and Kisumu). Patients were grouped into: Site A (Thika, n=54) and Site B (Nairobi/Kisumu, n=75). Data were collected using a modified End-stage Renal Disease Adherence Questionnaire ESRD-AQ and a data abstraction tool. Analysis in SPSS version 27 included descriptive statistics for socio-demographics and adherence, and independent t-tests to compare biochemical and clinical markers. Statistical significance was set at p<0.05.
Results: Unsatisfactory adherence was seen in 81.5% of the participants in site A and 73.3% of the participants in site B. The mean composite adherence score was marginally higher in site B (Mean = 110.03, 95% CI: 107.24-112.81). Dietary adherence was lower at Site A (Mean=18.26, 95% CI:17.06- 19.46). The mean serum potassium was significantly higher in site A (mean = 4.99 ± 0.864 mmol/L, P <0.001) compared to site B. Conversely, the mean serum sodium level was significantly lower in site A (Mean=134 ± 5.178 mmol/L, P <0.001) than in site B.
Conclusion: The study found similar overall adherence across sites but significant differences in key biochemical markers, particularly potassium and sodium, indicating gaps in dietary and fluid management. These findings highlight the need for targeted, site-specific interventions and support the development of a standardised adherence assessment tool to strengthen dialysis care and patient education.