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Numerous studies have also revealed that nonadherence is the cause of mortality, frequent hospitals visits, and hospital admissions [12, 13]. , missed and shortened dialysis treatment time resulted in physical problems such as hypotension, cramps, fatigue, and clots in access site.
Eleven percent (11 %) of the patients required extra treatment and 12 % had shortened their sessions.
Negative patient outcomes and increased health care expenses as well as workload of the hemodialysis unit are consequences of nonadherence behaviors in ESRD population .
The irreversible advanced CKD leads to End Stage Renal Disease (ESRD) where there is permanent loss of kidney function causing extreme mortality rates among this population .
The increasing prevalence of ESRD is similar to the increasing prevalence of type 2 diabetes mellitus which further complicates into ESRD as the total number of people with diabetes is expected to grow from 336 million in 2012 to 522 million in 2030 .
Moreover, there are limited studies in Rwanda about adherence to hemodialysis among ESRD.
Yet, the health profile of Rwanda 2014 (WHO update) reveals that renal diseases were the fourteenth leading cause of death among 50 top causes of death in Rwanda .Documented literature reveals that approximately 50% of individuals with ESRD undergoing hemodialysis (HD) were not adhering to their prescribed treatment regimen .This is also confirmed by Ibrahim and colleagues, who showed that nonadherence through skipping hemodialysis sessions ranged from 7 to 32% among ESRD patients .Similarly, a study conducted on Zimbabweans showed that more than 50% of patients were not adhering to the scheduled hemodialysis plan.In fact, 93% of the respondents had missed at least one session of HD with 61% missing most of the scheduled sessions.This makes it difficult for far away rural populations in other provinces to access hemodialysis services, forcing the majority of the patients with ESRD to go to urban dialysis centers.Nonadherence to hemodialysis on the other hand remains a major obstacle in the management of End Stage Renal Disease (ESRD) population.In Rwanda, like in most of other African countries, there is limited data on the prevalence of ESRD requiring hemodialysis.However, from clinical observations, the number of ESRD patients on hemodialysis was approximately 70 nationwide at the time of the study.Nevertheless, hemodialysis is also expensive but the preferred modality of treatment of ESRD patients in Rwanda .In 2015, Rwanda Demographic Health Survey data showed a projected total population of 11,274,221 people with approximately 84 percent of them living in rural area.