Patient knowledge and adherence to maintenance hemodialysis: an International comparison study
Non-adherence to hemodialysis (HD) is associated with increased morbidity and mortality. In this cross-sectional study, we compared correlates and rates of non-adherence between the US and Japan to determine if differences in patient knowledge about HD might account for international variation in adherence.
We evaluated 100 US and 116 Japanese patients on maintenance HD. Patient knowledge was scored based on the identification of their vascular access, dry weight, cause of kidney disease, and ≥ 3 phosphorus- and potassium-rich foods. Patients were considered non-adherent if they missed > 3% of HD sessions in 3 months.
23% of the US and none of the Japanese patients were non-adherent. Using logistic regression, we found that in the US non-adherence was more common in black patients [Odds ratio (OR) 3.98; 95% confidence interval (CI) 1.42–11.22], while high school graduates (OR 0.20; 95% CI 0.05–0.81) and those on the transplant waiting list (OR 0.25; 95% CI 0.083–0.72) were less likely to miss their treatments. There was no significant association between knowledge and non-adherence in the US. However, Japanese patients had significantly higher levels of HD knowledge than US patients after adjusting for age (p < 0.001).
Age-adjusted HD knowledge was higher and non-adherence rates were lower in Japan vs. the US. However, because of the unexpected finding of 100% adherence in Japan, we were unable to formally test whether knowledge was significantly associated with adherence across both countries. Further research is needed to understand the reasons behind the higher non-adherence rates in the US.
KeywordsAdherence Hemodialysis Patient knowledge International
JIS is supported by Grant K23DK103972 from the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK, Bethesda, MA, USA). KNM and JIS are supported by a generous gift honoring the life and work of nephrologist Henry Shavelle, MD. We thank Shin Miyata and Erik Lum for reviewing earlier drafts of this manuscript.
Compliance with ethical standards
Conflict of interest
The authors have declared that no conflict of interest exists.
This study was approved by the Mount Sinai Beth Israel Institutional Review Board (Approval #222-12) and the Tama Medical Center Research Ethics Committee (Approval #42) and was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki).
Informed consent was obtained from all individual participants included in the study.
- 1.Saran R, Bragg-Gresham JL, Rayner HC, Goodkin DA, Keen ML, Van Dijk PC, Kurokawa K, Piera L, Saito A, Fukuhara S, Young EW, Held PJ, Port FK. Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int. 2003;64:254–62.Google Scholar
- 4.Jangi S. Facing uncertainty—dispatch from Beth Israel Medical Center, Manhattan. N Engl J Med. 2012;367:2267–9.Google Scholar
- 6.Robinson BM, Akizawa T, Jager KJ, Kerr PG, Saran R, Pisoni RL. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet. 2016;388:294–306.Google Scholar
- 7.Foley RN, Hakim RM. Why is the mortality of dialysis patients in the United States much higher than the rest of the world? J Am Soc Nephrol. 2009;20:1432–5.Google Scholar
- 14.Salter ML, Kumar K, Law AH, Gupta N, Marks K, Balhara K, McAdams-DeMarco MA, Taylor LA, Segev DL. Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups. BMC Nephrol. 2015;16:49.CrossRefPubMedPubMedCentralGoogle Scholar