Bernardini
Predicting compliance in home peritoneal dialysis
patients
42nd Annual Conference of the ASAIO
ASAIO J
(May) 42:(2):102 1996
One very important problem with any home dialysis regimen is compliance with
the treatment. There
has been much discussion of this pertaining to
predicted/measured creatinine ratios. In this study, Bernardini
use supply inventory at
two visits 4-8 weeks apart as a gold standard of compliance with a PD regimen
in 10 patients. Based
on the inventory, 50% of patients were non-compliant! The M/P creatinine
ratio, in agreement with
recent published results by
Burkart et al and Blake et al
failed to predict non-compliance. One thing which did predict non-
compliance with very
high accuracy was the DABS, a multidimensional psychological test
(questionnaire) which used 40
adjectives to measure positive and negative affects. This test had an 80%
sensitivity and 100%
specificity.
Comment: Of course, given an n of 10 patients, one needs to be bit
careful, but as this DABS
questionnaire takes only 5 minutes to complete, it certainly deserves further
evaluation in this
very important area.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
Additonal comments by Peter B. DeOreo MD, Case Western Reserve
University, Cleveland OH
This is a limited study done in
patients with a high prevalance of non compliance. Compliance was
verified by supply inventory evaluated on home visit. A low (negative)
affect score on a self rank correlated with poor compliance. A low
affect score was better than biochemical, dialysate creatinine, and
staff evaluations.
A low score probably points to depression. Others (Kimmel, More,
Hays) have shown depression to be a risk factor for non compliance in
both ESRD and in general medical settings. It is no surprise that
neither patient self report of compliance nor staff predictions were
either sensitive or specific. Health care workers and patients are
likely to have differing opinions on a patient's health status, with
the health care worker underestimating the extent of physical and
psychosocial disability. This study may be pointing to the under
diagnosis of depression. It will be interesting if, in their larger
series, the authors develop intervention strategies.
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42nd Annual Conference of the ASAIO
Basic hemodialysis :
Home hemodialysis
Basic peritoneal dialysis :
Chronic PD regimens, adequacy, modeling