Behavioral interventions targeting treatment adherence in chronic kidney disease: A systematic review and meta-analysis

Adherence to dialysis, medication regimens and dietary and fluid intake recommendations can improve quality of life and survival in chronic kidney disease, but non-adherence is prevalent. This review and meta-analysis investigated the effects of behavioral interventions on treatment adherence in chronic kidney disease and examined intervention characteristics (Behavior Change Techniques and delivery methods) associated with direct and indirect measures of adherence. Literature searches in five databases identified 149 eligible studies (255 study arms; 15878 patients). Random-effects meta-analyses revealed mostly small and statistically significant beneficial effects on outcomes, ranging from g = 0.27 (95% CI [0.03, 0.50]; p = 0.02) for dialysis adherence to g = 0.84 (95% CI [0.23, 1.45]; p = 0.01) for sodium. Moderator analyses revealed 16 Behavior Change Techniques and 12 delivery related moderators associated with improvements in adherence. These included intervention methods targeting behavioral regulation, health beliefs and knowledge, social support, and involving a dietitian or a nurse. The Behavior Change Techniques 'instructions on how to perform the behavior, 'information about antecedents', 'information about health consequences', 'social support (unspecified)', and 'goal setting (behavior)' were associated with beneficial changes in several adherence outcomes. These results can be used to inform the development of new interventions to improve chronic kidney disease treatment adherence.