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

Area of Science:

• Nephrology
• Public Health
• Cross-cultural Health Studies

Background:

• Non-adherence to hemodialysis (HD) is linked to increased patient morbidity and mortality.
• International variations in adherence rates suggest potential contributing factors like patient knowledge.
• Understanding these differences is crucial for improving patient outcomes globally.

Purpose of the Study:

• To compare the rates and correlates of non-adherence to hemodialysis between the US and Japan.
• To investigate if differences in patient knowledge about hemodialysis explain international variations in adherence.
• To identify factors associated with non-adherence in US hemodialysis patients.

Main Methods:

• A cross-sectional study evaluated 100 US and 116 Japanese patients undergoing maintenance hemodialysis.
• Patient knowledge was assessed on vascular access, dry weight, kidney disease cause, and dietary restrictions (phosphorus, potassium).
• Non-adherence was defined as missing >3% of hemodialysis sessions within a 3-month period.

Main Results:

• 23% of US patients were non-adherent, while 0% of Japanese patients were non-adherent.
• In the US, non-adherence was higher in Black patients and lower in high school graduates and those on the transplant waiting list.
• Japanese patients demonstrated significantly higher hemodialysis knowledge than US patients, even after adjusting for age.

Conclusions:

• Age-adjusted hemodialysis knowledge was higher in Japan, with lower non-adherence rates compared to the US.
• The study could not formally test the association between knowledge and adherence due to 100% adherence in Japan.
• Further research is necessary to elucidate the underlying reasons for higher non-adherence rates observed in the US.