Regional differences in nonadherence to dialysis among southern dialysis patients: a comparative cross-sectional study to the dialysis outcomes and practice patterns study.

INTRODUCTION

Treatment outcomes of end-stage renal disease (ESRD) vary significantly between European, Japanese, and American populations. The Dialysis Outcomes and Practice Patterns Study (DOPPS) described multiple differences between these cohorts; however, remarkable outcome differences exist among regions within the American population. Southern networks continue to have higher degrees of adverse outcomes despite improvements in healthcare delivery.

METHODS

We examined the demographic indices and the degree of nonadherence to dialysis prescription among a sample of 97 patients with ESRD from the Northwestern Louisiana, Southern Arkansas and Northeast Texas area through face-to-face interviews and chart review and compared them with the published DOPPS results.

RESULTS

We found a significant difference between this Southern ESRD population and the overall American DOPPS cohort in demographics and dialysis adherence. Most (95.8%) patients were of African American ancestry and had a longer vintage on dialysis. Most patients were nonadherent as assessed by 2 of 4 measures of dialysis adherence: 29.2% of patients did not attend at least 1 dialysis session per month, and 86.4% shortened their dialysis session by 10 minutes or more at least 1 per month. These parameters were identified as major risk factors for adverse outcome in the DOPPS study.

CONCLUSION

This Southern patient cohort is different from the rest of the American ESRD population in terms of important measures of dialysis adherence. Such differences might contribute to our understanding of regional disparity in outcomes.