Factors Contributing to Non-Adherence to Treatment Among Adult Patients with Long-Term Haemodialysis: An Integrative Review.

Abstract

Background: Adherence of renal patients to a prescribed therapeutic regimen is crucial for the success of haemodialysis and the decreased mortality rates of patients; however, 60% are non-adherent to dialysis, fluid, and dietary allowances. To identify promising interventions aimed at improving treatment adherence, this review aimed to collate research evidence on the prevalence of non-adherence to treatment (fluid, diet, and routine haemodialysis) and to synthesise the factors contributing to non-adherence in long-term haemodialysis patients. Methods: An integrative review was conducted using Whittemore and Knafl's five-stage framework (2005). ProQuest, CINAHL, PubMed, and Web of Science were searched, using the keywords 'haemodialysis' and 'non-adherence'. The review included peer-reviewed quantitative studies published in English from 1 August 2018 to 30 June 2025, focusing on adults over 18 undergoing haemodialysis. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess the quality of the studies. Results: Twenty-nine studies were included, identifying factors across four treatment groups: non-adherence to fluid allowance, dietary allowance, haemodialysis session, and fluid/diet/haemodialysis. These factors were grouped into three themes: social demographics, clinical factors, self-management, and perceptions. Commonly cited factors included age, gender, educational status, health literacy, and perception. Conclusions: This review highlights the complex factors influencing treatment non-adherence, which may vary based on the variables and measurement tools used in each study. Low-level health literacy is the most frequently cited modifiable factor. Therefore, prioritising effective patient education that enhances knowledge and understanding of the importance of adhering to treatment is key to improving compliance in long-term haemodialysis patients.