BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
BACKGROUND: 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. METHODS: A retrospective analysis on all prevalent chronic HDpatients 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. RESULTS: The cohort consisted of 15,340 HDpatients 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). CONCLUSION: 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.
Authors: Ira S Ockene; Laura L Hayman; Richard C Pasternak; Eleanor Schron; Jacqueline Dunbar-Jacob Journal: J Am Coll Cardiol Date: 2002-08-21 Impact factor: 24.094
Authors: Myles Wolf; Joseph Betancourt; Yuchiao Chang; Anand Shah; Ming Teng; Hector Tamez; Orlando Gutierrez; Carlos A Camargo; Michal Melamed; Keith Norris; Meir J Stampfer; Neil R Powe; Ravi Thadhani Journal: J Am Soc Nephrol Date: 2008-04-09 Impact factor: 10.121
Authors: Mihály Tapolyai; Tibor Fülöp; Aşkin Uysal; Zsolt Lengvárszky; Tibor Szarvas; Kathleen Ballard; Neville R Dossabhoy Journal: Am J Med Sci Date: 2010-06 Impact factor: 2.378
Authors: Rajiv Saran; Jennifer L Bragg-Gresham; Hugh C Rayner; David A Goodkin; Marcia L Keen; Paul C Van Dijk; Kiyoshi Kurokawa; Luis Piera; Akira Saito; Shunichi Fukuhara; Eric W Young; Philip J Held; Friedrich K Port Journal: Kidney Int Date: 2003-07 Impact factor: 10.612
Authors: Mihály B Tapolyai; Mária Faludi; Klára Berta; Tibor Szarvas; Zsolt Lengvárszky; Miklos Z Molnar; Neville R Dossabhoy; Tibor Fülöp Journal: Int Urol Nephrol Date: 2016-04-28 Impact factor: 2.370
Authors: Amber O Molnar; Louise Moist; Scott Klarenbach; Jean-Philippe Lafrance; S Joseph Kim; Karthik Tennankore; Jeffrey Perl; Joanne Kappel; Michael Terner; Jagbir Gill; Manish M Sood Journal: Can J Kidney Health Dis Date: 2018-06-01