International differences in compliance of patients
undergoing hemodialysis are poorly characterized and could contribute
to international survival differences.
To compare international differences in patient
compliance with hemodialysis treatments.
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.
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
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.