Factors Affecting Non-Adherence to Treatment in End Stage Renal Disease (ESRD) Patients Undergoing Hemodialysis in Indonesia

Kustimah Kustimah1, *, Ahmad Gimmy Prathama Siswadi1, Achmad Djunaidi1, Aulia Iskandarsyah1
1 Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Indonesia

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© 2019 Usri et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Kampus Jatinangor Jl. Raya Bandung Suemdang Km. 21 Sumedang, Jawa Barat, Indonesia; Tel: 022.7794126;



Non-adherence to treatment regimens is a widespread problem of great clinical relevance among hemodialysis patients. However, only few studies have addressed the factors of non-adherence in End Stage Renal Disease (ESRD) patients, and none conducted in the Indonesia.


The present study explores the reasons of non-adherence in end stage renal disease patients undergoing hemodialysis in Indonesia seen from perspectives of patients, caregivers and health professionals.


The study is conducted using qualitative methods and is set in the hemodialysis unit in a private hospital in Bandung. A total of 23 respondents were recruited in this study. All participants were selected through purposive sampling and invited to participate in semi-structured interviews with open-ended questions. The data obtained were written in verbatim and analyzed using thematic analysis.


The six main themes related to non-adherence emerged. These themes were categorized into two clusters namely: (1) factors related to patient (patient related factors) (negative perception and treatment belief, denial, lack of awareness and knowledge and negative feelings) and (2) factors related to the treatment (treatment burden and financial problems).


The findings showed determinants of non-adherence in ESRD patients from perspective of patients, caregivers and health professional. The finding from this study can be used as a base for designing an intervention, aimed to increase the adherence to treatment in ESRD patients who are undergoing hemodialysis.

Keywords: End stage renal disease, Non-adherence, Hemodialysis, Dialysis, CKD, Factors.