Enhancement of Adherence to Therapeutic and Lifestyle Recommendations Among Hemodialysis Patients: An Umbrella Review of Interventional Strategies

Ther Clin Risk Manag. 2020 Apr 6;16:233-243. doi: 10.2147/TCRM.S240125. eCollection 2020.


Objective: To systematically retrieve and condense the best possible evidence on the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in hemodialysis patients (HDPs).

Design: An umbrella review of interventional studies.

Data sources: A comprehensive search of the Cochrane Database of Systematic Reviews, Ovid, PubMed, Scopus, EMBASE and Web of science databases to identify relevant publications in 2000-2018 (June) timeframe.

Study selection: Two reviewers independently applied inclusion criteria to select potential systematic reviews assessing the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in HDPs. Data were summarized for information about the first author(s)' names, year of publication, type(s) of the intervention and output variables, main findings and also the applied quality appraisal tools in the retrieved research evidence.

Data extraction: Eligible studies were selected and data were extracted independently by two reviewers. The Joanna Briggs Institute (JBI)'s critical appraisal tool for systematic reviews was used to assess the quality of the identified publications, and discrepancies were resolved by consensus with a third reviewer.

Data synthesis: Thirteen systematic reviews (12 solely systematic reviews and 1 systematic review with meta-analyses) were eligible to be enrolled in the study. The range of interventions that had been reported to boost therapeutic and lifestyle recommendations adherence in HDPs' included psycho-educational programs, physical activity enhancement initiatives, information technology (IT)-based interventions and aromatherapy. Depression, diet biomarkers and interdialytic weight gain (IDWG) were among the myriad of output variables that had been measured as proxies to assess impacts of the implemented interventions. Psycho-educational interventions were among the prevalent initiatives to boost therapeutic and lifestyle recommendations adherence among the HDPs.

Conclusion: This umbrella review revealed that various intervention approaches and strategies can be used for HDPs' better therapeutic and lifestyle recommendations adherence with considerable methodological heterogeneity. The pinpointed research evidence is also supporting application of multifaceted interventional modalities to reach an improved acquiescence form the patients' side and their families. Further studies are recommended to address the interactions across various interventions in discordant socio-cultural contexts.

Keywords: adherence; cognitive; exercise; hemodialysis; intervention; psychosocial.

Publication types

  • Review

Grant support

This research was supported partially by Tabriz University of Medical Sciences (grant number: 5-D-193090- 1397-06-10).