Americans Skip Dialysis; Swedes and Japanese Don't

Embargoed for Release at 4 p.m. EST on April 6, 1999 Release time set by the Journal of the American Medical Association

Americans Skip Dialysis; Swedes and Japanese Don't, Wake Forest Study Shows

WINSTON-SALEM, N.C. -- American dialysis patients are far more likely to skip kidney dialysis treatments than patients in either Sweden or Japan, a Wake Forest University Baptist Medical Center physician reports in the April 7 issue of the Journal of the American Medical Association.

Anthony J. Bleyer, M.D., assistant professor of internal medicine (nephrology) said that Swedes and Japanese almost never miss a dialysis treatment. That's not true in the United States, despite specific physician instructions.

"Even an occasional missed treatment places the patient as a much higher risk of life-threatening conditions," Bleyer said. "We have long seen a big difference in survival between the United States and other countries. A difference in compliance could contribute to this.

"There is a high rate of noncompliance for U.S. patients in general. We decided to study noncompliance in dialysis patients because it is likely to affect patient survival and could explain inferior U.S. dialysis patient survival compared to other countries."

In the first half of 1996, Bleyer and colleagues in Sweden and Japan compared a total of 415 patients at four southeastern United States dialysis centers with 84 patients at one Swedish center and 194 patients at four dialysis centers in Japan. Not one Swede or Japanese patient missed a single dialysis session, while 147 American patients missed at least one treatment, and seven missed at least 25 treatments. (All patients underwent a type of dialysis called hemodialysis.)

The difference in the initial observational study was so large that the investigators decided to conduct a cross-sectional survey of compliance, asking nurses and nephrologists in every state, as well as at 21 centers in Japan and 16 centers in Sweden.

In the United States, an average of 4 percent of patients in the cross-sectional study missed at least one treatment each month, compared with 0.1 percent in Sweden and 0 in Japan.

"The results of this study demonstrate a markedly increased incidence of skipping dialysis treatments in United States patients compared to patients from Sweden and Japan," Bleyer said.

While data collection and health care delivery might vary among the countries, "the consistency of this finding, as well as the large magnitude of this difference, suggest there is a true international variation in patient compliance."

Why?

Bleyer and his colleagues suggested several reasons: