Although patients with end-stage renal disease (ESRD) cannot survive without lifelong renal replacement treatment, such as dialysis and renal transplantation, these highly demanding treatments involve strict regimens of attendance to dialysis sessions and adherence to dietary and fluid restrictions, poly-medication protocols, and follow-up consults. Successful treatment largely depends on the patients’ adherence and self-management, in order to avoid treatment-related complications and early mortality. Nevertheless, poor adherence has been documented in this population, and social support has been consistently linked to better health outcomes in other chronic diseases.
For a paper published in Seminars in Dialysis, we and our colleagues conducted a systematic review on the relationship between social support and treatment adherence in patients with ESRD. Our team reviewed 17 studies including 2,362 patients.
Adherence to fluid restrictions was the adherence type with more significant associations with social support (63%). Mixed results were found for adherence to dialysis sessions (50%) and to medication (50%). Associations between adherence to diet restrictions and social support were found in 44% of the included studies. No significant associations were found between social support and adherence to follow-up consults. Our results suggest the protective role of health professionals, family members, and significant others on treatment adherence in patients with ESRD who are undergoing dialysis.
Supportive communication with healthcare professionals may enhance patient’s understanding about the disease and treatments, thus, improving adherence. Support from family or significant others could influence patients’ adherence by decreasing distress, depression, loneliness, and disease burden. Future interventions aimed at improving treatment adherence in patients with ESRD may benefit from the adoption of a broader perspective, as the inclusion of close family members may also protect against erosion of physician support to patients. Ultimately, a family-focused approach could provide long-term health cost savings, increase patients’ eligibility for transplantation, and prolong survival, but there is no objective evidence to sustain such hypotheses, making robust and well-designed studies urgently needed.