Adherence with dialysis: a focus on mortality risk

Noncompliance in the dialysis patient is a frustrating issue for nephrologists and dialysis staff. Given the multidimensional nature of end-stage renal disease therapy, there are several potential definitions of noncompliance. This review identifies some of these definitions. These range from objective, such as skipping dialysis or serum phosphate concentration, to subjective, such as staff assessment. This article then reviews mortality risk based on several of these behaviors. Some, but not all of the behaviors are associated with an increased mortality risk. One measure of noncompliance, in fact, identifies patients at decreased mortality risk. The review concludes with caveats about interpreting noncompliant behavior and with a suggestion for a change in our language regarding compliance.