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Anthony J. Bleyer, MD; Britta Hylander, MD; Hiroshi Sudo, MD; Yasuo Nomoto, MD; Ernesto de la Torre, MD; Randolph A. Chen, BS; John M. Burkart, MD

JAMA. 1999;281:1211-1213.

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 (P<.001).

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.

Author Affiliations: Sections on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Bleyer, de la Torre, and Burkart and Mr Chen), and Karolinska Hospital, Stockholm, Sweden (Dr Hylander); and Tokai University School of Medicine, Isehara City, Japan (Drs Sudo and Nomoto).

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