Factors Affecting Adherence To Anti-Hypertensive Medication Regimen Among Hemodialysis Patients Attending Pandya Memorial Hospital, Mombasa, Kenya

ABSTRACT

Patients with chronic kidney disease undergoing hemodialysis are usually co-morbid with

hypertension that contributes to increased cardiovascular morbidity and mortality if not

controlled. A number of factors are targeted as influencing agents to uncontrolled

hypertension but adherence to treatment is counted as a major factor contributing to poor

control of hypertension. In Kenya studies done among chronic kidney disease patients

have found high uncontrolled rate of blood pressure in this population, a study done at

Kenyatta national hospital found 84.4% uncontrolled blood pressure and another done in

Nephrology clinics in Nairobi found uncontrolled rate of 64.7% and adherence rate of

31.8% to antihypertensive medication. There are no studies done neither in other parts of

the country nor in private hospitals to compare with these studies. Therefore the current

study investigated factors influencing adherence to antihypertensive medication regimen

among hemodialysis patients attending Pandya Hospital in Mombasa. Specifically the

study assessed patient’s adherence to treatment; described the socio-demographic factors

affecting patients adherence to antihypertensive medications; established the patient’s

knowledge about antihypertensive medications; and determined the patient’s perception

of antihypertensive medications. A cross-sectional study was conducted at the renal unit

of Pandya Memorial Hospital amongst a sample size of 144 hypertensive patients aged

18 years and above, respondents were identified using simple random sampling. Data was

collected using semi structured questionnaires. Data analysis using Chi square test was

applied to establish significant relationships between the dependent variable (adherence)

and independent variables (socio-demographic factors, knowledge, perception), logistic

regression was used to predict independent variables that influence adherence, and results

with p values ≤ 0.05 were considered statistically significant. Adherence was determined

using Morisky’s Medication Adherence Scale (MMAS-8).Overall, 83(57.6%) of the

patients were found to be fully adherent to their antihypertensive medication. Factors that

influenced adherence to antihypertensive medication were; age p = 0.23

(OR=1.02,CI=0.98-1.07), female gender had better adherence than males p= 0.98 (OR=

2.58, CI=1.09-6.16), patients with health insurance p = 0.92(OR=0.35, CI=0.15-0.84),

knowledge of side effects of medication p=0.58(OR=2.02,CI=0.44-9.27), perception of

severity p = 0.69(OR=3.61,CI=1.02-12.78), perception of benefit

p=0.30(OR=3.22,CI=1.06-9.79), and perception of barriers p=0.75(OR=0.23, CI= 0.08-

0.64). The study showed male patients, older patients and patients with no health

insurance were associated with adherence to antihypertensive medication to avert

morbidities and mortalities healthcare workers should formulate interventions tailored

towards scaling up adherence in those subgroups of hypertensive patients. Interventions

to increase patient’s knowledge on the medications and patient’s perception on

antihypertensive are critical aspects to ensure an improved adherence level thus

controlling blood pressure levels and consequently reduce morbidities and mortalities

associated with hypertension in patients with chronic kidney disease undergoing

hemodialysis.