Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review

Figures & data

Figure 1 Flow diagram showing data sources and study-selection process.

Table 1 Descriptive Characteristics of Intervention Studies Assessing HD-Treatment Adherence in Populations with >25% Blacks

	Improving Dialysis Adherence for High-Risk Patients Using Automated Messaging: Proof of Concept	Improving Patient Experience and Treatment Adherence in the Adult Outpatient Hemodialysis Population	A Peer-to-Peer Mentoring Program for in-Center Hemodialysis: a Patient-Centered Quality Improvement Program
Authors	Som et al^Citation19	Saunders et al^Citation22	St Clair Russell et al^Citation20
Study design	Randomized control trial	Pre–post	Pre–post
Sample size	19	65	Mentors 23, mentees 23
% Black	84.2%	62%	Mentors 73.9%, mentees 91.3%
Age, years	50 (25–63)	65–74	Mentors 57, mentees 56
Setting	University-affiliated HD center in urban area	University-affiliated outpatient HD clinic	University-affiliated HD center in urban area
Dates of enrollment	February 2015	Not reported	March–June 2015
Inclusion criteria	aged >18 years, on chronic HD ≥12 weeks at participating centers 2–6 missed HD sessions over prior 12-week period planned HD for subsequent 16 weeks access to mobile or landline phone ability to provide informed consent	aged >18 years, on chronic HD for ≥3 months no altered mental status not living in skilled-nursing or assisted-living facilities and managing their own medications life expectancy ≥6 months	Mentees: aged >18 years with ESKD on HD at the facility, ability to provide informed consent comprehends English committed to duration of program no altered mental status no intellectual disability Mentors: on HD >1 year on ≥ 6-month in-center HD on home dialysis or former patients of the facility completing all training activities
Intervention type	Crossover design of SMS texts or voice-message reminders followed by a period of no intervention (or opposite)	Nurse-practitioner medication review	Mentor–mentee pairing
Dosing of intervention	3 times per week for 8 weeks	Once per month for 3 months	Weekly for 4 months
Period of baseline-data collection	12 weeks	Measurement before implementation	3 months
Postintervention data-collection period	8 weeks of intervention and 8 weeks of control	Measurement after stopping intervention	3 months
Theoretical basis	Not specified	Diffusion-of-innovation theory	Social cognitive theory
Adherence measure	Median number of missed dialysis sessions	End-Stage Renal Disease Adherence Questionnaire + medical records of dialysis attendance	Missed treatments and shortened treatments reported in the EHR
Prior to intervention	Median number of missed sessions: 4 treatments over prior 12 weeks	Dialysis attendance: 53.8% (n=35): number of patients coming to all HD treatments and completing the treatments	Mentees: Missed HD: 7.14, ie, sum of missed HD sessions per 2-month time period divided by total prescribed HD sessions per time period Shortened sessions: 11.54, ie, sum of HD treatments shortened by ≥30 minutes per individual per 2-month time period divided by total prescribed HD sessions per time period Mentors: Missed sessions: 0. Shortened sessions: 12
After intervention	Median number of missed sessions: 1 treatment during study period (8 weeks of intervention and 8 weeks of control)	Dialysis attendance: 71.9% (n=41): number of patients coming to all HD treatments and completing the treatments	Mentees: Missed sessions: 0 Shortened sessions: 13.46 Mentors: Missed sessions: 0, shortened sessions: 7.69

Abbreviation: HD, hemodialysis.

Table 2 Assessment of Risk of Bias

Pre–post	Experimental design	No Confounding	No Selection Bias	No Bias in Measurement of Outcome	No Bias Due to Deviation from Intended Interventions	No Bias Due to Selective Reporting of Results	No Bias Due to Missing Outcome Data	Score
St Clair Russell et al^Citation20	0	0	1	0	1	1	1	Medium risk
Saunders et al^Citation22	0	0	1	0	1	1	0	High risk
RCT	Experimental design	Random-sequence generation	Allocation concealment	Blinding	Level of completion of outcome data	Similarity of groups at baseline	No loss of data	Score
Som et al^Citation19	1	1	1	0	1	1	1	Low risk

Notes: Scoring: 6–7 — low risk, 4–5 — medium risk, 1–3 — high risk.

Som A, Groenendyk J, An T, et al. Improving dialysis adherence for high risk patients using automated messaging: proof of concept. Sci Rep. 2017;7(1):4177. doi:10.1038/s41598-017-03184-z

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Saunders J, Ahmadzadeh S, Bush M, Wright R, Granger B. Improving patient experience and treatment adherence in the adult, outpatient hemodialysis population. J Nurs Care Qual. 2019;34(4):330–336.

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St Clair Russell J, Southerland S, Huff ED, Thomson M, Meyer KB, Lynch JR. A peer-to-peer mentoring program for in-center hemodialysis: a patient-centered quality improvement program. Nephrol Nurs J. 2017;44(6):481–496.

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