Abstract
Adherence to medication is one of the essential determinants of outcomes in patients on maintenance hemodialysis, but there is considerable variability in the rates of medication adherence and the determinants of adherence in different studies. The objective of this review was to summarize the evidence on medication adherence in adult patients on hemodialysis and to identify the determinants that have been most consistently related to medication adherence behavior. A systematic literature search was conducted in PubMed, Scopus, Google Scholar, and Web of Science for studies published in English between January 2005 and January 2024, in accordance with PRISMA 2021 guidelines. Study quality was evaluated using the Newcastle–Ottawa Scale. Fourteen studies met the inclusion criteria, most of which were cross-sectional in design. Medication adherence rates varied widely, ranging from 10% to 94%, largely due to heterogeneity in assessment tools, study populations, and methodological quality. Across studies, psychosocial and cognitive factors emerged as the most consistent predictors of adherence. Motivation and perception of hemodialysis, as well as the level of medical knowledge, were significantly associated with adherence in all studies assessing these variables. Depression, forgetfulness, and economic status were also frequently significant, whereas demographic variables and clinical factors showed inconsistent or weak associations. This review highlights that medication adherence in hemodialysis patients is driven predominantly by psychosocial and knowledge-based determinants rather than by clinical characteristics alone. These findings support a biopsychosocial, patient-centered approach to care and underscore the need for standardized adherence measurement and targeted interventions addressing motivation, health literacy, and mental health to improve outcomes in this vulnerable population.
Keywords: Determinants, Hemodialysis, Medication Adherence, Psychosocial Factors.