The Worldwide Prevalence of Nonadherence to Diet and Fluid Restrictions Among Hemodialysis Patients: A Systematic Review and Meta-analysis

Published:December 16, 2021DOI:


      Nonadherence to diet and fluid restrictions in hemodialysis (HD) patients can lead to undesired health outcomes. This systematic review and meta-analysis aim to estimate the pooled prevalence of nonadherence to diet and fluid restrictions in HD patients.


      Research articles from PubMed, CINAHL, and Google Scholar on nonadherence to diet and fluid restrictions in HD patients published between 2000 and 2020 were selected for this study. The methodological quality of each study was graded, and the estimates were pooled using the random-effects model of meta-analysis. Analyses of subgroups and meta-regression were carried out. Egger's test and visual analysis of the symmetry of funnel plots were used to assess the publication bias.


      Eight hundred sixty-eight potential records were identified during the search. Twenty-three studies that met inclusion criteria were considered for meta-analysis and comprised 11,209 HD patients (mean age 55.85 years ± SD 6.86, men 57.74%). The estimated worldwide prevalence of nonadherence to diet and fluid restrictions was 60.2% (95% CI: 47.3-72.5) and 60.6% (95% CI: 50-70.7), respectively. The meta-regression found that the income category was negatively associated and the risk of bias score was positively associated with the prevalence of nonadherence to fluid restrictions (P < .05). The funnel plot of nonadherence to fluid restrictions revealed asymmetry, and a significant publication bias was also noted as assessed by Egger's test (P = .004). However, the pooled estimate should be interpreted with caution because the prevalence of individual studies varies considerably because of methodological or measurement discrepancies.


      The pooled prevalence of nonadherence to diet (47.3-72.5%) and fluid (50-70.7%) restrictions was substantially high. The health care team must recognize the factors and barriers influencing adherence behavior and develop holistic interventions to improve it.


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