Factors influencing erythropoietin compliance in peritoneal dialysis patients

Peritoneal dialysis patients who manage their own therapy with subcutaneous erythropoietin (EPO) may be at risk for noncompliance. The objectives of this study were to examine the rate of noncompliance and to investigate the factors that are associated with patient noncompliance with the prescribed EPO regimen.

A multiple-choice questionnaire was mailed to eligible patients, and a review of pharmacy records was conducted for EPO dates of refill. Noncompliance was defined as less than 90% use of the prescribed dose either by pharmacy record review or missed injections on the questionnaire.

Of 55 eligible patients, 54 completed the questionnaire. The overall rate of noncompliance was 35%. Patients who were noncompliant were younger (P = 0.005), had fewer comorbidities (P = 0.050), had been on EPO therapy longer (P = 0.011), were more likely to have completed postsecondary education (P = 0.011), and were more likely to admit to missed peritoneal dialysis exchanges (P = 0.011). On multiple regression analysis, the independent predictors of noncompliance, in order of importance, were missing dialysis exchanges, completion of postsecondary education, and younger age.

These findings suggest that noncompliance with EPO injections is relatively common among peritoneal dialysis patients. The independent predictors of noncompliance were missing dialysis exchanges, completion of postsecondary education, and younger age. Further studies are needed to determine if specific interventions targeting this group of patients can affect compliance.