US Kidney Patients Skip Dialysis



NEW YORK, Apr 16 (Reuters Health) -- US kidney dialysis patients are much more likely than patients in other countries to skip hemodialysis treatments, according to researchers.

"Even an occasional missed treatment places the patient at a much higher risk of life-threatening conditions," warned study lead author Dr. Anthony Bleyer of Wake Forest University School of Medicine in Winston-Salem, North Carolina. The findings were published in a recent issue of The Journal of the American Medical Association.

"We have long seen a big difference in survival (of dialysis patients) between the United States and other countries. A difference in compliance (with dialysis treatment) could contribute to this," Bleyer said in a Wake Forest University statement.

Patients with advanced kidney disease require regular hemodialysis to rid their blood of various toxins, a job normally performed by the kidneys.

Bleyer's team sought to compare the dialysis attendance rates of 415 American kidney patients with that of 278 patients treated in either Japan or Sweden.

Among the US patients, "147 missed 699 treatments over a 6-month period," according to the researchers. None of these absences were due to either a lack of transportation or hospitalization, the researchers note.

In contrast, not one Japanese or Swedish patient missed a dialysis session over a period of 12 weeks.

Why might American patients be more likely to skip hemodialysis than their counterparts elsewhere? The authors speculate that dialysis may be more a difficult procedure in the US. "US patients receive a shorter treatment with higher blood flows, which may lead to increased incidences of cramping and hypotension (low blood pressure)," they explain.

The US healthcare system may also cover a wider range of 'problem' patients for hemodialysis, including drug-addicted individuals with long-term histories of medical noncompliance.

Bleyer's team also speculates that US patients have become increasingly independent over the past few decades. "Patient autonomy has become increasingly emphasized in the healthcare profession," they write, "in lay publications, and most importantly on television."

In a University statement, Bleyer said he believes that "Americans by nature are very independent and this may make them less likely to follow doctors' instructions," even when a missed dialysis session puts them at increased risk for serious health problems.

SOURCE: The Journal of the American Medical Association 1999;281:1211-1213.

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