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      Treatment adherence and perception in patients on maintenance hemodialysis: a cross – sectional study from Palestine

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          Adherence to diet recommendations, fluid restriction, prescribed medications, and attendance at hemodialysis (HD) sessions are essential for optimal and effective treatment of patients with end-stage renal disease. No data regarding this issue are available from Palestine. Therefore, this study was carried out to assess adherence to diet, fluid restriction, medications, and HD sessions.


          A cross-sectional study of HD patients at An-Najah National University Hospital was carried out during summer, 2016. Self-reported adherence behavior was obtained using a valid and reliable questionnaire (End-Stage Renal Disease Adherence Questionnaire: ESRD-AQ). Predialytic serum levels of potassium and phosphate were obtained as clinical indicator of diet and medication adherence respectively. In addition, interdialytic body weight (IDW) was also obtained from medical records and analyzed in relation to reported adherence of fluid restriction.


          A total of 220 patients answered all questions pertaining to ESRD-AQ. The mean age ± standard deviation of participants was 56.82 ± 14.51 years. Dietary adherence was observed in 24% while that of fluid restriction adherence was observed in 31% of studied patients. Reported adherence to HD sessions was 52% while that for medications was 81%. Overall, 122 (55.5%) patients had good adherence, 89 (40.5%) had moderate adherence, and 9 (4.1%) had poor adherence behavior. Male patients had significantly higher overall adherence scores than females ( p = 0.034). A significant correlation between reported diet adherence and serum pre-HD potassium level ( p < 0.01) was observed. A significant correlation between reported fluid restriction adherence and IDW ( p < 0.01) was also found. However, no significant correlation between reported adherence and pre-HD phosphate level. There was significant correlation between overall perception and overall adherence score ( p < 0.001). Counselling of patients regarding importance of adherence modalities was lowest for “staying for the entire dialysis time”. Multivariate analysis indicated that elderly male patients who were city residents had higher odds of having higher adherence score.


          There was a good percentage of patients who had overall moderate or poor adherence. ESRD-AQ could be used to assess some aspects of HD adherence. Counselling and education of patients on HD are important to improve therapeutic outcome.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12882-017-0598-2) contains supplementary material, which is available to authorized users.

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          Most cited references 34

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          A study of the quality of life and cost-utility of renal transplantation.

          The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after renal transplantation at three University-based Canadian hospitals. A total of 168 patients were followed for an average of 19.5 months after transplantation. Health-related quality of life was assessed using a hemodialysis questionnaire, a transplant questionnaire, the Sickness Impact Profile, and the Time Trade-Off Technique. Fully allocated costs were determined by prospectively recording resource use in all patients. A societal perspective was taken. By six months after transplantation, the mean health-related quality of life scores of almost all measures had improved compared to pre-transplantation, and they stayed improved throughout the two years of follow up. The mean time trade-off score was 0.57 pre-transplant and 0.70 two years after transplantation. The proportion of individuals employed increased from 30% before transplantation to 45% two years after transplantation. Employment prior to transplantation [relative risk (RR) = 23], graft function (RR 10) and age (RR 1.6 for every decrease in age by one decade), independently predicted employment status after transplantation. The cost of pre-transplant care ($66,782 Can 1994) and the cost of the first year after transplantation ($66,290) were similar. Transplantation was considerably less expensive during the second year after transplantation ($27,875). Over the two years, transplantation was both more effective and less costly than dialysis. This was true for all subgroups of patients examined, including patients older than 60 and diabetics. We conclude that renal transplantation was more effective and less costly than dialysis in all subgroups of patients examined.
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            Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference.

            Kidney transplantation is the most desired and cost-effective modality of renal replacement therapy for patients with irreversible chronic kidney failure (end-stage renal disease, stage 5 chronic kidney disease). Despite emerging evidence that the best outcomes accrue to patients who receive a transplant early in the course of renal replacement therapy, only 2.5% of incident patients with end-stage renal disease undergo transplantation as their initial modality of treatment, a figure largely unchanged for at least a decade. The National Kidney Foundation convened a Kidney Disease Outcomes Quality Initiative (KDOQI) conference in Washington, DC, March 19 through 20, 2007, to examine the issue. Fifty-two participants representing transplant centers, dialysis providers, and payers were divided into three work groups to address the impact of early transplantation on the chronic kidney disease paradigm, educational needs of patients and professionals, and finances of renal replacement therapy. Participants explored the benefits of early transplantation on costs and outcomes, identified current barriers (at multiple levels) that impede access to early transplantation, and recommended specific interventions to overcome those barriers. With implementation of early education, referral to a transplant center coincident with creation of vascular access, timely transplant evaluation, and identification of potential living donors, early transplantation can be an option for substantially more patients with chronic kidney disease.
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              Self-reported medication adherence and treatment satisfaction in patients with epilepsy.

              Reports about medication adherence and satisfaction in patients with epilepsy in Arab countries are lacking. The objective of this study was to assess medication adherence and its relationship with treatment satisfaction, number of antiepileptic drugs (AEDs) taken, and epilepsy control in a sample of Palestinian patients. This cross-sectional descriptive study was carried out at Al-Makhfya Governmental Outpatient Center in Nablus, Palestine, during the summer of 2010. A convenience sampling method was used to select patients over the study period. Medication adherence was measured using the eight-item Morisky Medication Adherence Scale (MMAS); treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Epilepsy was arbitrarily defined as "well controlled" if the patient had had no seizures in the last 3 months and was defined as "poorly controlled" if he or she had had at least one seizure in the last 3 months. A convenience sample of 75 patients was studied. On the basis of the MMAS, 11 patients (14.7%) had a low rate, 37 (49.3%) had a medium rate, and 27 (36%) had a high rate of adherence. Adherence was positively and significantly correlated with age (P=0.02) and duration of illness (P=0.01). No significant difference in adherence was found between patients with well-controlled and those with poorly controlled epilepsy. Similarly, there was no significant difference in adherence between patients on monotherapy and those on polytherapy. Mean satisfaction with respect to effectiveness, side effects, convenience, and global satisfaction were 73.6±20.7, 82.4±29.8, 69.5±15.5, and 68.4±18.3, respectively. There were significant differences in mean values in the effectiveness (P<0.01) and convenience (P<0.01) domains, but not the side effect (P=0.1) and global satisfaction (P=0.08) domains among patients with different levels of adherence. Patients on monotherapy had significantly higher satisfaction in the effectiveness domain (P=0.04) than patients on polytherapy. Similarly, patients with well-controlled epilepsy scored significantly higher in the Effectiveness (P=0.01) and Global Satisfaction (P=0.01) domains than those with poorly controlled epilepsy. In our convenience sample, we found that adherence to and satisfaction with AEDs were moderate and were not associated with seizure control or number of AEDs. Copyright © 2011 Elsevier Inc. All rights reserved.

                Author and article information

                saedzyoud@yahoo.com , saedzyoud@najah.edu
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                30 May 2017
                30 May 2017
                : 18
                [1 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Department of Medicine, College of Medicine and Health Sciences, , An-Najah National University, ; Nablus, 44839 Palestine
                [2 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Division of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, , An-Najah National University, ; Nablus, 44839 Palestine
                [3 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, , An-Najah National University, ; Nablus, 44839 Palestine
                [4 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, , An-Najah National University, ; Nablus, 44839 Palestine
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                © The Author(s) 2017


                palestine, hemodialysis, clinical outcomes, perception, treatment adherence


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