Determinants of Adherence to Haemodialysis among Patients with Chronic Kidney Disease at Mbagathi and Avenue Hospitals in Nairobi County, Kenya

Abstract

Globally chronic kidney disease (CKD) is on the increase and has become a health concern in many countries. Diabetes mellitus (DM), hypertension (HTN) and Human immunodeficiency virus (HIV) have been associated with an increased prevalence of CKD. Haemodialysis (HD) remains the preferred modality of treatment since it is less expensive when compared to other renal replacement treatment modalities like kidney transplantation. Poor adherence to HD is a common problem in CKD patients and is associated with many factors. Consequently, poor adherence is associated with an increase in morbidity, mortality and poor health related quality of life (HRQOL) in CKD patients. The purpose of this study was to establish the determinants of adherence to HD among patients with CKD at Mbagathi and Avenue hospitals in Nairobi County. An analytical cross-sectional study was carried out at Avenue and Mbagathi hospitals. A total of 37 patients were recruited in the study. Data was collected through a researcher administered modified end stage renal disease adherence questionnaire (ESRD-AQ) and a self-administered Beck’s depression inventory (BDI) questionnaire. Data was analyzed using Statistical package for social scientists (SPSS) version 22.0. Descriptive statistics were used to analyze and describe socio-demographic characteristics, adherence to HD, therapy and health system related factors. Fischer’s exact test and ordinal logistic regression were computed to determine associations between the independent and the dependent variables. Statistical significance was set at <0.05 at 95% Confidence intervals. The study was approved by Nairobi Hospital Bioethics and Research Committee (NHBRC) and licenced by National Commission for Science Technology and Innovation (NACOSTI). The findings revealed that 51.85% of the participants in Avenue hospital had high adherence to HD while 80% of the participants in Mbagathi hospital had low adherence to HD. In Avenue hospital, presence of cramping (p=0.002) and distance to hospital (p=0.005) were significantly associated with non-adherence to HD. In Mbagathi hospital, distance to hospital (p=0.022) was significantly associated with non-adherence to HD. In conclusion, the study demonstrated that 48.5% of the participants in Avenue hospital and 80% of the participants in Mbagathi hospital were non-adherent to HD treatment. Presence of cramping and distance to hospital were associated with non-adherence to HD. Based on the findings, the study recommends that there is need to educate the patients on the importance of adherence to HD. Nurses should calculate adequate ultrafiltration to prevent cramping. Referring of patients to alternate nearby dialysis facilities is recommended.