Objectives: 

This systematic review aims to identify influencing factors of medication adherence behavior in patients with end-stage renal disease (ESRD), with a special interest in patient-related factors based on the World Health Organization adherence model.

Materials and methods: 

Primary electronic databases comprising PubMed, Scopus, Web of Science, Embase and Cochrane Library, as well as ProQuest (Health and Medical), ProQuest (Psychology), and EBSCOHost (APA PsychARTICLES) were used to search for literature on patient-related factors in medication adherence, from inception till August 31, 2021.

Results: 

479 articles were identified and six articles meeting eligibility criteria were reviewed and remained in this systematic review. The present review found that despite different tools being used to measure ESRD's perception of medication's necessity and beliefs, there was a profound association between perception and beliefs with medication adherence behavior. There is a positive relationship between knowledge, belief, educational level, ethnicity, female, and medication adherence behavior. Mixed finding was reported between perception, age, and medication adherence behavior. However, there were no studies on patients' attitudes and medication adherence behavior as suggested in the WHO adherence model.

Conclusion: 

Only a limited number of patient-related factors were available for evaluation in the current systematic review. Additional research is needed to advance the understanding of medication adherence behavior affected by patient-related factors on the medication and illness. However, the findings must be taken with caution because of the limited studies included in this review.

1. Bikbov, B., Perico, N., & Remuzzi, G. (2018). Disparities in chronic kidney disease prevalence among males and females in 195 countries: Analysis of the Global Burden of Disease 2016 study. Nephron, 139(4), 313–318. https://doi.org/10.1159/000490896
2. James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., ... & Murray, C. J. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7
3. Tonelli, M., Wiebe, N., Guthrie, B., James, M. T., Quan, H., Fortin, M., ... & Alberta Kidney Disease Network. (2015). Comorbidity as a driver of adverse outcomes in people with chronic kidney disease. Kidney International, 88(4), 859–866. https://doi.org/10.1038/ki.2015.228
4. Fraser, S. D., Roderick, P. J., May, C. R., McIntyre, N., McIntyre, C., Fluck, R. J., ... & Taal, M. W. (2015). The burden of comorbidity in people with chronic kidney disease stage 3: A cohort study. BMC Nephrology, 16, Article 193. https://doi.org/10.1186/s12882-015-0189-z
5. Moreira, J. M., Bouissou Morais Soares, C. M., Teixeira, A. L., Simões e Silva, A. C., & Kummer, A. M. (2015). Anxiety, depression, resilience and quality of life in children and adolescents with pre-dialysis chronic kidney disease. Pediatric Nephrology, 30(12), 2153–2162. https://doi.org/10.1007/s00467-015-3159-6
6. Ozcan, H., Yucel, A., Avşar, U. Z., Cankaya, E., Yucel, N., Gözübüyük, H., ... & Keles, M. (2015). Kidney transplantation is superior to hemodialysis and peritoneal dialysis in terms of cognitive function, anxiety, and depression symptoms in chronic kidney disease. Transplantation Proceedings, 47(5), 1348–1351. https://doi.org/10.1016/j.transproceed.2015.04.049
7. St. Peter, W. L. (Ed.). (2015). Management of polypharmacy in dialysis patients. Seminars in Dialysis, 28(4), 427–432. https://doi.org/10.1111/sdi.12379
8. World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization.
9. Tangkiatkumjai, M., Walker, D. M., Praditpornsilpa, K., & Boardman, H. (2017). Association between medication adherence and clinical outcomes in patients with chronic kidney disease: A prospective cohort study. Clinical and Experimental Nephrology, 21(3), 504–512. https://doi.org/10.1007/s10157-016-1312-6
10. Simpson, S. H., Eurich, D. T., Majumdar, S. R., Padwal, R. S., Tsuyuki, R. T., Varney, J., ... & Johnson, J. A. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. BMJ, 333(7557), Article 15. https://doi.org/10.1136/bmj.333.7557.15
11. Adams, A. S., Uratsu, C., Dyer, W., Magid, D., O'Connor, P., Beck, A., ... & Schmittdiel, J. A. (2013). Health system factors and antihypertensive adherence in a racially and ethnically diverse cohort of new users. JAMA Internal Medicine, 173(1), 54–61. https://doi.org/10.1001/2013.jamainternmed.504
12. Sarkar, U., Lyles, C. R., Parker, M. M., Allen, J., Nguyen, R., Moffet, H. H., ... & Karter, A. J. (2014). Use of the refill function through an online patient portal is associated with improved adherence to statins in an integrated health system. Medical Care, 52(3), 194–201. https://doi.org/10.1097/MLR.0000000000000069
13. Demian, M. N., Shapiro, R. J., & Thornton, W. L. (2016). An observational study of health literacy and medication adherence in adult kidney transplant recipients. Clinical Kidney Journal, 9(6), 858–865. https://doi.org/10.1093/ckj/sfw074
14. Adefolalu, A. O., & Nkosi, Z. Z. (2013). The complex nature of adherence in the management of HIV/AIDS as a chronic medical condition. Diseases, 1(1), 18–35. https://doi.org/10.3390/diseases1010018
15. Saadat, Z., Nikdoust, F., Aerab-Sheibani, H., Bahremand, M., Shobeiri, E., Saadat, H., ... & Sabet, B. (2015). Adherence to antihypertensives in patients with comorbid condition. Nephro-Urology Monthly, 7(4), Article e29863. https://doi.org/10.5812/numonthly.29863
16. Phillips, L. A., Leventhal, H., & Leventhal, E. A. (2012). Physicians' communication of the common-sense self-regulation model results in greater reported adherence than physicians' use of interpersonal skills. British Journal of Health Psychology, 17(2), 244–257. https://doi.org/10.1111/j.2044-8287.2011.02035.x
17. Xie, L., Frech-Tamas, F., Marrett, E., & Baser, O. (2014). A medication adherence and persistence comparison of hypertensive patients treated with single-, double- and triple-pill combination therapy. Current Medical Research and Opinion, 30(12), 2415–2422. https://doi.org/10.1185/03007995.2014.953147
18. Carbone, L., Zebrack, B., Plegue, M., Joshi, S., & Shellhaas, R. (2013). Treatment adherence among adolescents with epilepsy: What really matters? Epilepsy & Behavior, 27(1), 59–63. https://doi.org/10.1016/j.yebeh.2012.12.023
19. Sontakke, S., Budania, R., Bajait, C., Jaiswal, K., & Pimpalkhute, S. (2015). Evaluation of adherence to therapy in patients of chronic kidney disease. Indian Journal of Pharmacology, 47(6), 668–671. https://doi.org/10.4103/0253-7613.169578
20. Peltzer, K., & Pengpid, S. (2013). Socioeconomic factors in adherence to HIV therapy in low- and middle-income countries. Journal of Health, Population, and Nutrition, 31(2), 150–170. https://doi.org/10.3329/jhpn.v31i2.16378
21. Hodeib, M., Chang, J., Liu, F., Ziogas, A., Dilley, S., Randall, L. M., ... & Bristow, R. E. (2015). Socioeconomic status as a predictor of adherence to treatment guidelines for early-stage ovarian cancer. Gynecologic Oncology, 138(1), 121–127. https://doi.org/10.1016/j.ygyno.2015.04.025
22. Kim, T. H., Lee, M. J., Yoo, K. B., Han, E., & Choi, J. W. (2015). Association of demographic and socioeconomic factors with risk factors for chronic kidney disease. Journal of Preventive Medicine and Public Health, 48(3), 170–177. https://doi.org/10.3961/jpmph.15.011
23. Pagès-Puigdemont, N., Mangues, M. A., Masip, M., Gabriele, G., Fernández-Maldonado, L., Blancafort, S., ... & Doñate-Martínez, A. (2016). Patients' perspective of medication adherence in chronic conditions: A qualitative study. Advances in Therapy, 33(10), 1740–1754. https://doi.org/10.1007/s12325-016-0394-6
24. Ghimire, S., Castelino, R. L., Jose, M. D., & Zaidi, S. T. (2017). Medication adherence perspectives in haemodialysis patients: A qualitative study. BMC Nephrology, 18, Article 167. https://doi.org/10.1186/s12882-017-0583-9
25. Ahlawat, R., Tiwari, P., & D'Cruz, S. (2016). Prevalence and predictors of medication non-adherence in patients of chronic kidney disease: Evidence from a cross sectional study. Journal of Pharma Care & Health Systems, 3(1), Article 1000152. https://doi.org/10.4172/2376-0419.1000152
26. Al-Ramahi, R. (2015). Adherence to medications and associated factors: A cross-sectional study among Palestinian hypertensive patients. Journal of Epidemiology and Global Health, 5(2), 125–132. https://doi.org/10.1016/j.jegh.2014.05.005
27. Ramli, A., Ahmad, N. S., & Paraidathathu, T. (2012). Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Preference and Adherence, 6, 613–622. https://doi.org/10.2147/PPA.S34734
28. Ahmad, N. S., Ramli, A., Islahudin, F., & Paraidathathu, T. (2013). Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Preference and Adherence, 7, 525–530. https://doi.org/10.2147/PPA.S44698
29. Eindhoven, D. C., Hilt, A. D., Zwaan, T. C., Schalij, M. J., & Borleffs, C. J. (2018). Age and gender differences in medical adherence after myocardial infarction: Women do not receive optimal treatment – The Netherlands claims database. European Journal of Preventive Cardiology, 25(2), 181–189. https://doi.org/10.1177/2047487317744363
30. Billimek, J., Malik, S., Sorkin, D. H., Schmalbach, P., Ngo-Metzger, Q., Greenfield, S., ... & Kaplan, S. H. (2015). Understanding disparities in lipid management among patients with type 2 diabetes: Gender differences in medication nonadherence after treatment intensification. Women's Health Issues, 25(1), 6–12. https://doi.org/10.1016/j.whi.2014.10.003
31. Bajorek, B., Lemay, K., Magin, P., Roberts, C., Krass, I., & Armour, C. (2017). Patients' attitudes and approaches to the self-management of hypertension: Perspectives from an Australian qualitative study in community pharmacy. High Blood Pressure & Cardiovascular Prevention, 24(2), 149–155. https://doi.org/10.1007/s40292-017-0186-0
32. Vanhaudenhuyse, A., Gillet, A., Malaise, N., Salamun, I., Grosdent, S., Maquet, D., ... & Faymonville, M. E. (2018). Psychological interventions influence patients' attitudes and beliefs about their chronic pain. Journal of Traditional and Complementary Medicine, 8(2), 296–302. https://doi.org/10.1016/j.jtcme.2017.06.004
33. Rebafka, A. (2016). Medication adherence after renal transplantation – A review of the literature. Journal of Renal Care, 42(4), 239–256. https://doi.org/10.1111/jorc.12181
34. Jin, J., Sklar, G. E., Min Sen Oh, V., & Chuen Li, S. (2008). Factors affecting therapeutic compliance: A review from the patient's perspective. Therapeutics and Clinical Risk Management, 4(1), 269–286. https://doi.org/10.2147/tcrm.s1458
35. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Physical Therapy, 89(9), 873–880. https://doi.org/10.2522/ptj.2009.89.9.873
36. Joanna Briggs Institute. (2014). Joanna Briggs Institute reviewers' manual: 2014 edition/supplement. The University of Adelaide. http://joannabriggs.org/sumari.html
37. Abd Kadir, T., Islahudin, F., Abdullah, M. Z., Ibrahim, N., & Bing, P. K. (2019). Assessing individual medication adherence among chronic kidney disease patients: A multi-centered study. Journal of Pharmaceutical Research International, 31(3), 1–11. https://doi.org/10.9734/jpri/2019/v31i330304
38. Aleidi, A. M., Alayed, N. J., Alduraibi, H. M., Alqassimi, N. S., & Ismail, A. A. (2020). Phosphate binders usage, patients knowledge, and adherence: A cross-sectional study in 4 centers at Qassim, Saudi Arabia. Saudi Medical Journal, 41(10), 1076–1082. https://doi.org/10.15537/smj.2020.10.25413
39. Chater, A. M., Parham, R., Riley, S., Hutchison, A. J., & Horne, R. (2014). Profiling patient attitudes to phosphate binding medication: A route to personalising treatment and adherence support. Psychology & Health, 29(12), 1407–1420. https://doi.org/10.1080/08870446.2014.943568
40. Horne, R., & Weinman, J. (1999). Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47(6), 555–567. https://doi.org/10.1016/s0022-3999(99)00036-9
41. Kim, Y., & Evangelista, L. S. (2010). Relationship between illness perceptions, treatment adherence, and clinical outcomes in patients on maintenance hemodialysis. Nephrology Nursing Journal, 37(3), 271–280.
42. Neri, L., Martini, A., Andreucci, V. E., Gallieni, M., Rey, L. A., Brancaccio, D., ... & GARR Study Group. (2011). Regimen complexity and prescription adherence in dialysis patients. American Journal of Nephrology, 34(1), 71–76. https://doi.org/10.1159/000329307
43. Leventhal, H., Nerenz, D. R., & Steele, D. J. (2020). Illness representations and coping with health threats. In Handbook of Psychology and Health (Vol. 4, pp. 219–252). Routledge.
44. Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The Brief Illness Perception Questionnaire. Journal of Psychosomatic Research, 60(6), 631–637. https://doi.org/10.1016/j.jpsychores.2005.10.020
45. Arpey, N. C., Gaglioti, H. A., & Rosenbaum, M. E. (2017). How socioeconomic status affects patient perceptions of health care: A qualitative study. Journal of Primary Care & Community Health, 8(3), 169–175. https://doi.org/10.1177/2150131917700299
46. Aflakseir, A. (2012). Role of illness and medication perceptions on adherence to medication in a group of Iranian patients with type 2 diabetes. Journal of Diabetes, 4(3), 243–247. https://doi.org/10.1111/j.1753-0407.2012.00192.x
47. Awodele, O., & Osuolale, J. A. (2015). Medication adherence in type 2 diabetes patients: Study of patients in Alimosho General Hospital, Igando, Lagos, Nigeria. African Health Sciences, 15(2), 513–522. https://doi.org/10.4314/ahs.v15i2.26
48. Cohen, M. J., Shaykevich, S., Cawthon, C., Kripalani, S., Paasche-Orlow, M. K., & Schnipper, J. L. (2012). Predictors of medication adherence postdischarge: The impact of patient age, insurance status, and prior adherence. Journal of Hospital Medicine, 7(6), 470–475. https://doi.org/10.1002/jhm.1935
49. Kang, C. D., Tsang, P. P., Li, W. T., Wang, H. H., Liu, K. Q., Griffiths, S. M., ... & Wong, M. C. (2015). Determinants of medication adherence and blood pressure control among hypertensive patients in Hong Kong: A cross-sectional study. International Journal of Cardiology, 182, 250–257. https://doi.org/10.1016/j.ijcard.2015.01.006
50. Lo, S. H., Chau, J. P., Woo, J., Thompson, D. R., & Choi, K. C. (2016). Adherence to antihypertensive medication in older adults with hypertension. Journal of Cardiovascular Nursing, 31(4), 296–303. https://doi.org/10.1097/JCN.0000000000000251
51. Siegel, D., Lopez, J., & Meier, J. (2007). Antihypertensive medication adherence in the Department of Veterans Affairs. The American Journal of Medicine, 120(1), 26–32. https://doi.org/10.1016/j.amjmed.2006.06.031
52. Park, J. H., Shin, Y., Lee, S. Y., & Lee, S. I. (2008). Antihypertensive drug medication adherence and its affecting factors in South Korea. International Journal of Cardiology, 128(3), 392–398. https://doi.org/10.1016/j.ijcard.2007.06.062
53. Pasina, L., Brucato, A. L., Falcone, C., Cucchi, E., Bresciani, A., Sottocorno, M., ... & Nobili, A. (2014). Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs & Aging, 31(4), 283–289. https://doi.org/10.1007/s40266-014-0163-7
54. Castellucci, L. A., Shaw, J., van der Salm, K., Erkens, P., Le Gal, G., Petrcich, W., ... & Rodger, M. (2015). Self-reported adherence to anticoagulation and its determinants using the Morisky Medication Adherence Scale. Thrombosis Research, 136(4), 727–731. https://doi.org/10.1016/j.thromres.2015.07.007
55. Constantiner, M., Rosenthal-Asher, D., Tedla, F., Salifu, M., Cukor, J., Wyka, K., ... & Sadowski, A. (2018). Differences in attitudes toward immunosuppressant therapy in a multi-ethnic sample of kidney transplant recipients. Journal of Clinical Psychology in Medical Settings, 25(1), 11–19. https://doi.org/10.1007/s10880-018-9538-4
56. Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Stathoulis, J., Babatsikou, F., ... & Zyga, S. (2019). The impact of education on knowledge, adherence and quality of life among patients on haemodialysis. Quality of Life Research, 28(1), 73–83. https://doi.org/10.1007/s11136-018-2011-x
57. Jin, H., Kim, Y., & Rhie, S. J. (2016). Factors affecting medication adherence in elderly people. Patient Preference and Adherence, 10, 2117–2125. https://doi.org/10.2147/PPA.S118121
58. Lemay, J., Waheedi, M., Al-Sharqawi, S., & Bayoud, T. (2018). Medication adherence in chronic illness: Do beliefs about medications play a role? Patient Preference and Adherence, 12, 1687–1698. https://doi.org/10.2147/PPA.S169236
59. Abdul-Sattar, A. B., & Abou El Magd, S. A. (2015). Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate. Rheumatology International, 35(6), 1045–1051. https://doi.org/10.1007/s00296-014-3195-2
60. Uchmanowicz, B., Chudiak, A., Uchmanowicz, I., Rosińczuk, J., & Froelicher, E. S. (2018). Factors influencing adherence to treatment in older adults with hypertension. Clinical Interventions in Aging, 13, 2425–2441. https://doi.org/10.2147/CIA.S182881
61. Dobbels, F., Berben, L., De Geest, S., Drent, G., Lennerling, A., Whittaker, C., ... & EuroSOC Study Group. (2010). The psychometric properties and practicability of self-report instruments to identify medication nonadherence in adult transplant patients: A systematic review. Transplantation, 90(2), 205–219. https://doi.org/10.1097/TP.0b013e3181e346cd
62. Lam, W. Y., & Fresco, P. (2015). Medication adherence measures: An overview. BioMed Research International, 2015, Article 217047. https://doi.org/10.1155/2015/217047