What is it about?
The success of hemodialysis largely depends on adherence to various health behaviors (e.g., treatment sessions 3/4 times a week, dietary and fluid restrictions, vascular access care, polypharmacy intake, regular exercise) that are crucial for the quality of life and survival of people with kidney failure. Previous research on non-adherence in hemodialysis has shown highly variable rates between studies, mainly due to the use of different direct (e.g., clinical biomarkers) and indirect (e.g., questionnaires) measures. This systematic review and meta-analysis helped to establish the criterion validity of self-report measures of adherence in hemodialysis by analyzing the results of 29 primary studies reporting the strength of associations between test results and clinical biomarkers.
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Why is it important?
Although self-reported adherence in hemodialysis has been widely explored, it is still unclear which is the most accurate questionnaire to assess this outcome. Optimizing the measurement of adherence in hemodialysis is decisive for several reasons. For research, the use of valid measures is necessary for targeting and rigorously evaluating the growing number of clinical trials that aim to maximize adherence in people on hemodialysis. Improving adherence reporting in this population is also fundamental to supporting evidence-based public health decision-making, as policymakers often rely on prevalence rates and prediction studies to identify high-risk patients and fund the development of innovative interventions.
Perspectives
The current study shown that the End-Stage Renal Disease–Adherence Questionnaire (ESRD–AQ) and the Dialysis Diet and Fluid Non–Adherence Questionnaire (DDFQ) had the strongest associations with interdialytic weight gain, serum phosphorus, and potassium levels, indicating that these patient-reported outcome measures have reasonable concurrent criterion validity to assess non-adherence in hemodialysis. The decision to use one questionnaire over another should be made with caution, as researchers and/or clinicians need to consider sample characteristics (e.g., level of health literacy) and study objectives (e.g., type of adherence to be measured) to select the most suitable tool.
Daniela Figueiredo
Universidade de Aveiro
Read the Original
This page is a summary of: Establishing the criterion validity of self-report measures of adherence in hemodialysis through associations with clinical biomarkers: A systematic review and meta-analysis, PLoS ONE, October 2022, PLOS,
DOI: 10.1371/journal.pone.0276163.
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