Clinical and Experimental Nephrology

, Volume 22, Issue 4, pp 947–956 | Cite as

Patient knowledge and adherence to maintenance hemodialysis: an International comparison study

  • Kana N. MiyataEmail author
  • Jenny I. Shen
  • Yasuhide Nishio
  • Manabu Haneda
  • Kobena A. Dadzie
  • Nijal R. Sheth
  • Renjiro Kuriyama
  • Chika Matsuzawa
  • Ken Tachibana
  • Nikolas B. Harbord
  • James F. Winchester
Original article



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.


Adherence 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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10157_2017_1512_MOESM1_ESM.docx (72 kb)
Supplementary material 1 (DOCX 72 KB)


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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Kana N. Miyata
    • 1
    • 3
    Email author
  • Jenny I. Shen
    • 1
  • Yasuhide Nishio
    • 2
  • Manabu Haneda
    • 2
  • Kobena A. Dadzie
    • 3
  • Nijal R. Sheth
    • 3
  • Renjiro Kuriyama
    • 4
  • Chika Matsuzawa
    • 5
  • Ken Tachibana
    • 6
  • Nikolas B. Harbord
    • 3
  • James F. Winchester
    • 3
  1. 1.Division of Nephrology and HypertensionLos Angeles Biomedical Research Institute at Harbor–UCLA Medical CenterTorranceUSA
  2. 2.Division of Nephrology, Department of MedicineTokyo Metropolitan Tama Medical CenterTokyoJapan
  3. 3.Division of Nephrology and HypertensionMount Sinai Beth IsraelNew YorkUSA
  4. 4.Kokubunji Minamiguchi ClinicTokyoJapan
  5. 5.Kotobukichou Jin Naika ClinicTokyoJapan
  6. 6.Tachibana ClinicTokyoJapan

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