Bernardini J, Piraino B
Compliance in CAPD and CCPD patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1506 1996
In this very important study the authors investigated compliance in their
population of 28 PD
patients by examining home inventory at intervals of 4-9 weeks. Non-
compliance was defined as the
performance of less than 90% of prescribed exchanges, as judged by change in
inventory. By this
definition a surprising 50% of patients were non-compliant, performing a mean
of only 73% of
prescribed exchanges. Only two of the 14 patients admitted non-compliance on
the questionnaire.
Non-compliance was more common in CAPD than in APD, and in patients who
showed evidence of low
affect on a multi-dimensional affect measurment test done in advance of the
study. The authors also
confirmed the previous finding that creatinine excretion ratios were not
useful in detecting
non-compliance.
Comment: This study, using what must be considered to be the gold
standard for compliance
assessment, finds that non-compliance is exceedingly common in US PD
patients. It remains to be
seen whether other centres in the US have similar problems and whether this
is seen in patients in
other countries too. Preliminary studies have suggested that non-compliance
may be less common in
Canadian than in American patients and that this may explain some of the
recognized excess mortality
in PD patients in the US. This study needs to be repeated at other centres
and in other countries.
(Peter G. Blake, M.D., Victoria Hospital, London, Ontario)
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Am Soc Nephrol
Basic peritoneal dialysis :
Chronic PD regimens, adequacy, modeling