BEHAVIORAL COMPLIANCE WITH DIALYSIS PRESCRIPTION IN HEMODIALYSIS-PATIENTS

The relationship between compliance and outcome is poorly understood, partially because there has been no gold standard for measuring compli ance in hemodialysis patients. To investigate interrelationships betwe en psychological, medical, and compliance factors, hemodialysis (HD) p atients were studied with the Beck Depression Inventory, and a subset, the Cognitive Depression Index, the Perception of Illness Effects sca le, and the Multidimensional Scale of Perceived Social Support. Behavi oral compliance was measured in three ways: (1) percent time complianc e (signifying ''shortening behavior''); (2) percent attendance (signif ying ''skipping behavior) (3) percent total time compliance, assessing patients' time on dialysis normalized for prescribed time, including all shortenings and absences. Standard compliance indicators (predialy sis serum potassium and phosphorus concentrations and interdialytic we ight gain) were also analyzed. The patients' mean Beck Depression Inve ntory was in the range of mild depression. The prevalence of depressio n was 25.5%. Both depression indices correlated with Perception of Ill ness Effects scale scores. In general, social support was related to b oth measures of depression and perception of illness effects, Total ti me compliance was 95.8 +/- 5.0%. Younger patients were more likely to skip treatments compared with older patients. Time compliance comprise d a wide spectrum, with most patients relatively compliant, whereas a small proportion received far less than their prescribed dialysis. Ski pping and shortening behaviors did not correlate, suggesting that thes e constitute two separate types of noncompliant behaviors. Time compli ance parameters did not correlate with potassium levels or interdialyt ic weight gain, but did correlate with phosphorus levels, Interrelatio nships between behavioral compliance measures and other parameters var ied between units and patients of different gender. Finally, behaviora l compliance patterns were stable over months in patients. It was conc luded that behavioral time compliance parameters are quantifiable and are only partially related to standard compliance measures, If adheren ce to prescription is important for patient survival, strategies to ad dress different behavioral compliance styles will be necessary to ensu re adequate delivery of dialysis.