The liaison psychiatrist and the outpatient hemodialysis unit. Part II: Clinical psychiatric-liaison issues

Noncompliant hemodialysis patients. A biopsychosocial approach

Noncompliance to fluid restrictions is remarkably common and difficult to treat in hemodialysis patients. Psychosocial variables have not been convincingly demonstrated to correlate with fluid noncompliance. Fluid overloading tends to begin early in the course of dialysis treatments and remains remarkably stable over time. This maladaptive behavior on the part of so many dialysis patients could be promoted by abnormalities in the renin-aldosterone-angiotensin system or other abnormalities in the homeostatic mechanisms that regulate water metabolism. Hypotheses related to addictive behavior and milieu variables are also discussed. Recommendations include using a nonmoralistic approach, flexibility in dialysis schedules, and psychological intervention at the onset of dialysis.