Context International differences in compliance of patients
undergoing hemodialysis are poorly characterized and could contribute
to international survival differences.
Objective To compare international differences in patient
compliance with hemodialysis treatments.
Design A prospective observational study of patients undergoing
hemodialysis in 1995 and a cross-sectional survey of health care
professionals caring for hemodialyzed patients in 1996.
Setting and Patients Four dialysis centers in the southeastern
United States with 415 patients undergoing hemodialysis, 1 center in
Sweden with 84 patients, and 4 centers in Japan with 194 patients
participated in the prospective observational study. In the
cross-sectional survey, nurses and nephrologists from the United States
(n=49), Japan (n=21), and Sweden
(n=16) responded to questions regarding the compliance
of their patients undergoing hemodialysis.
Main Outcome Measures Percentage of patients who miss a dialysis
treatment and number of missed dialysis treatments.
Results Of 415 US patients, 147 missed 699 treatments over a
6-month period (28.1 missed treatments per 100 patient-months or 2.3%
of all prescribed treatments). During a 3-month period, there were 0
missed treatments per 100 patient-months for patients from Japan and 0
missed treatments per 100 patient-months for patients from Sweden
(P<.001). In the cross-sectional survey, the mean (SD)
estimated percentage of patients missing a treatment per month was 4%
(3%) for the United States, 0% for Japan, and 0.1% (3%) for Sweden
Conclusions Noncompliance is much more common in US patients
undergoing hemodialysis than Swedish and Japanese patients. The
implications of these results for international differences in survival
deserve further study.