An International Study of Patient Compliance With Hemodialysis

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International differences in compliance of patients undergoing hemodialysis are poorly characterized and could contribute to international survival differences.


To compare international differences in patient compliance with hemodialysis treatments.


A prospective observational study of patients undergoing hemodialysis in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996.

Setting and Patients

Four dialysis centers in the southeastern United States with 415 patients undergoing hemodialysis, 1 center in Sweden with 84 patients, and 4 centers in Japan with 194 patients participated in the prospective observational study. In the cross-sectional survey, nurses and nephrologists from the United States (n=49), Japan (n=21), and Sweden (n=16) responded to questions regarding the compliance of their patients undergoing hemodialysis.

Main Outcome Measures

Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments.


Of 415 US patients, 147 missed 699 treatments over a 6-month period (28.1 missed treatments per 100 patient-months or 2.3% of all prescribed treatments). During a 3-month period, there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 patient-months for patients from Sweden (P<.001). In the cross-sectional survey, the mean (SD) estimated percentage of patients missing a treatment per month was 4% (3%) for the United States, 0% for Japan, and 0.1% (3%) for Sweden (P<.001).


Noncompliance is much more common in US patients undergoing hemodialysis than Swedish and Japanese patients. The implications of these results for international differences in survival deserve further study.

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