Objectives To examine indicators of adherence in children aged 5–18 years.
Methods Physical and biochemical indicators of renal replacement therapy (RRT) effectiveness were collected once a month for six months for 79 children recruited in 7 paediatric dialysis centres in England. Three categories of proxies for adherence were examined: potassium and phosphate levels for diet; interdialytic weight gain and systolic blood pressure for fluid; phosphate levels for medication. Allowance was made for potential confounding variables. Logistic regression analysis was used to identify associations between gender, ethnicity (white British and South Asian), age group (5–11 and 12–18), dialysis modality and centre.
Results Only 7/79 children were within therapeutic range for all three proxies over the 6 month period. 41/79 (52%) were out of therapeutic range for a proxy for 2 or more of the 6 months. Children on haemodialysis were statistically significantly more often out of therapeutic range for proxy measures of diet than those on peritoneal dialysis (p<0.005). There were significant differences for proxy measures for medication between centres (p<0.010). Younger children were more often out of range for fluid than older children (p = 0.025). There were no statistically significant differences between gender or ethnic groups.
Conclusions Non-adherence varied across diet, fluid and medication, with different groups of children demonstrating non-adherence in each case. This suggests global categorisation of patients as non-adherent is inappropriate. Further studies should examine problems of adherence by particular groups of patients to specific aspects of the renal replacement therapy regimen.
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