Patient adherence in renal replacement therapy: whose problem is it? The physician's perspective.

Patient compliance is an issue sadly neglected in the literature. Out of 470 scientific papers concerning dialysis published in 1996 only 4 (< 1%) addressed the subject. Doctors have an important role in the process leading to patient adherence, as they often see the patient on an outpatient basis for years before the start of dialysis and have an opportunity to prepare the patients for the forthcoming demands. Studies have shown that patients not seeing a Nephrologist before start of dialysis have a higher mortality and morbidity rate. The doctor has also an important role when informing the patient about the consequences of non-compliance. The aim should be to make the patient feel that he or she is a valuable member of the caring team.