(I, II, or III)

II

II

I

II

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). Non-Adherence in Hemodialysis Patients And Related Factors Essay

The parameters used to determine nonadherence to dialysis treatment included skipping multiple dialysis sessions during the most recent 1-month period, shortening a dialysis session by more than 10 minutes during the most recent 1-month period, and Kt/V < 1.4. The parameters used to determine nonadherence to dietary and fluid restriction were as follows: serum phosphorus level > 7.5 mg/dl, predialysis serum potassium level > 6.0 mEq/L, and interdialytic weight gain > 5.7% of body weight. The Morisky Green Levine Medication Adherence Scale was performed to determine nonadherence to medication treatment. A patient was classified as nonadherent if he or she did not adhere to one or more of these indices.

Patient-reported difficulty with adherence (yes vs no) across multiple domains (coming to dialysis, completing dialysis sessions, fluid restrictions, diet restrictions, taking medications) was obtained from baseline social worker assessments. Achievement of clinical targets for coming to dialysis (missing ≥ 3 expected sessions), completing dialysis sessions (shortening > 3 sessions by ≥ 15 min), fluid restrictions (mean interdialytic weight gain ≥ 3 kg), diet restrictions (mean potassium ≥ 5.0 mEq/L, mean phosphate > 5.5 mg/dL), and taking medications (mean phosphate > 5.5 mg/dL) was estimated over the following 12 weeks, using electronic medical record data.

This proof of concept study explored using a novel digital-messaging platform, EpxDialysis, to improve patient-to-dialysis center communication via widely available text messaging and telephone technology. A randomized controlled trial was conducted through Washington University-affiliated hemodialysis centers involving ESRD patients with poor attendance, defined as missing 2-6 sessions over the preceding 12 weeks. A cross-over study design evaluated appointment adherence between intervention and control groups.

Data were collected from 412 in-center hemodialysis patients through patient surveys and from the participants’ medical records.

The number and characteristics of

patients, attrition rate, etc.

Setting: Four HD centers in Ankara, Turkey.

Setting: Emory Dialysis Center in Atlanta, Georgia (USA).

Setting: Chromalloy American Kidney Center (CAKC), within Washington University School of Medicine at Barnes-Jewish Hospital; and the affiliated Forest Park Dialysis Unit, near CAKC.

Setting: In-center HD centers.

List and define dependent and independent variables

Dependent variable: Poor patient renal outcomes such as a low Kt/V.

Dependent variable: Occurrence or otherwise of poor patient renal outcomes such as high blood BUN (uremia).

Dependent variable: Improvement or otherwise in the adherence to HD requirements.

Dependent variable: Adherence or non-adherence to dialysis treatment.

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

·         Kolmogorov–Smirnov test.

·         The Mann–Whitney U test

·         Multivariable logistic regression. Non-Adherence in Hemodialysis Patients And Related Factors Essay

·         Chi-squared or Fisher’s exact tests

·         Percentages

·         Kappa statistics

·         Logistic regression

·         T-tests

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data). Non-Adherence in Hemodialysis Patients And Related Factors Essay

General findings and recommendations of the research

The lack of consistency between reported difficulties with adherence and failure to meet therapeutic goals points to a gap that should be investigated in order to develop and target educational interventions aimed at promoting adherence among dialysis patients.

Future studies should focus on addressing adherence by incorporating more adherence factors and different treatment modalities for ESRD.

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

The strength of the study is that it is a primary study with a solid methodology. The sample population was affected by a number of other major, concomitant conditions, such as diabetes, hypertension, and cardiovascular disease, which is one of the study’s limitations.

No direct risk can be associated with implementing the findings of the study.

The feasibility of using the findings in practice is high.

Its strengths lie in the large sample size and also the fact that it is a primary study.

Limitations include that the measures for achievement of clinical targets for diet, fluid, and medications were indirect and simplified. The design also did not account for the fact that sodium intake from diet could also affect IDWG or that other aspects of dietary restrictions exist beyond potassium intake.

No risks are associated directly with the implementation of the findings.

The findings are feasible to implement.

It is a primary study with a robust methodology.

The major limitation is the small sample size that may affect generalizability.

There are no obvious risks associated with implementation of findings.

Researchers were able to demonstrate the feasibility of implementing EpxDialysis within the chronic hemodialysis population.

Its strengths are a good sample size and the fact of being a primary study.

The inclusion of only two non-adherence indicators may make the results non-generalizable and hence constitute a limitation.

No risks can be identified linked to implementation.

The implementation of findings is feasible in practice.

Key findings

Outcomes Non-Adherence in Hemodialysis Patients And Related Factors Essay