A systematic review of psychological interventions for the treatment of nonadherence to fluid-intake restrictions in people receiving hemodialysis.

BACKGROUND: Psychological interventions aimed at improving adherence to fluid-intake restrictions in patients receiving hemodialysis have become increasingly common. To the authors' knowledge, this is the first systematic review of the literature examining the impact of these interventions associated with patient interdialytic weight gain (IWG).
METHODS: A systematic search of the literature was performed on EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PsychINFO. The search was augmented by manually examining reference lists of reviews and retrieved reports. Study quality was graded according to criteria developed by the authors. Two additional independent researchers separately coded a random sample of studies to avoid bias of rating.
RESULTS: Sixteen studies were identified as eligible for inclusion. Relevant information from each included study was extracted and entered into a standardized table. Nearly all studies showed a postintervention decrease in IWG. A number of method weaknesses in the existing literature were identified.
CONCLUSION: Studies investigating psychological interventions aimed at improving adherence to fluid-intake restrictions appear to indicate some success in decreasing IWG. However, confidence regarding the validity of this finding is circumscribed by the prevalent use of investigative designs with inherently high susceptibility to bias. Future studies would benefit from using larger numbers of participants within controlled designs. Clearer description of intervention protocols would foster greater understanding of the contextual appropriateness of different approaches and which treatment components are key to improving adherence to fluid-intake restrictions in patients receiving hemodialysis.