Obialo Chamberlain, Zager Phillip G, Myers Orrin B, Hunt William C
Morehouse School of Medicine, Atlanta, GA, USA,
J Nephrol. 2014 Aug;27(4):425-30. doi: 10.1007/s40620-013-0035-y. Epub 2014 Jan 21.
Significant international differences abound in the adherence of hemodialysis (HD) patients to prescribed treatments. Unfortunately, factors influencing adherence within the United States (US) are not well understood. This study explores the hypothesis that race/ethnicity, geographic region and clinic size are associated with differences in the frequency of missed/shortened treatments.
A retrospective analysis on all prevalent chronic HD patients treated at Dialysis Clinics Inc. facilities between January 2007 and June 2008. Logistic regression models were computed in which the outcome measures were the odds for missing or shortening treatments.
The cohort consisted of 15,340 HD patients of whom 48% were non-Hispanic whites (NHW), 41% African Americans (AA), 6% Hispanics, 2% Native Americans, 2% Asians, and 1% unknown. Patients were older in the Northeast than in the South (p < 0.001) or West (p = 0.0052). The frequency of missed and shortened treatments was lower in the Northeast than other regions, p < 0.0001. Hospitalization rates were lower in the West than the Northeast (p < 0.01) but mortality rates were similar across all regions. The odds ratio and 95% confidence interval for missed [1.31 (1.14-1.52)] and shortened treatments [1.86 (1.73-2.0)] were greater in clinics with >100 patients than in those with <50 patients. Compared to NHW, the frequencies of missed and shortened treatments were higher in AA, Hispanics and Native Americans (p < 0.001) but lower among Asians (p < 0.001).
The frequency of missed and shortened HD varies significantly by race/ethnicity, geographic region and clinic size. The relationship of clinic size to missed/shortened treatments may warrant consideration when planning new HD facilities.
血液透析（HD）患者对规定治疗的依从性在国际上存在显著差异。遗憾的是，美国国内影响依从性的因素尚未得到充分了解。本研究探讨种族/民族、地理区域和诊所规模与错过/缩短治疗频率差异相关这一假设。
对2007年1月至2008年6月期间在透析诊所公司设施接受治疗的所有慢性HD患者进行回顾性分析。计算逻辑回归模型，其中结局指标为错过或缩短治疗的几率。
该队列包括15340名HD患者，其中48%为非西班牙裔白人（NHW），41%为非裔美国人（AA），6%为西班牙裔，2%为美洲原住民，2%为亚洲人，1%信息不明。东北部患者的年龄高于南部（p < 0.001）或西部（p = 0.0052）。东北部错过和缩短治疗的频率低于其他地区，p < 0.0001。西部的住院率低于东北部（p < 0.01），但所有地区的死亡率相似。患者人数>100人的诊所错过治疗[1.31（1.14 - 1.52）]和缩短治疗[1.86（1.73 - 2.0）]的优势比和95%置信区间高于患者人数<50人的诊所。与NHW相比，AA、西班牙裔和美洲原住民错过和缩短治疗的频率更高（p < 0.001），而亚洲人则较低（p < 0.001）。
HD错过和缩短治疗的频率因种族/民族、地理区域和诊所规模而有显著差异。在规划新的HD设施时，诊所规模与错过/缩短治疗之间的关系可能值得考虑。
