A multicenter study of noncompliance with continuous ambulatory peritonealdialysis exchanges in US and Canadian patients

Recent evidence suggested that noncompliance (NC) with continuous ambulator y peritoneal dialysis (CAPD) exchanges may be more common in US than in Can adian dialysis centers. This issue was investigated using a questionnaire-b ased method in 656 CAPD patients at 14 centers in the United States and Can ada. NC was defined as missing more than one exchange per week or more than two exchanges per month. Patients were ensured of the confidentiality of t heir individual results. Mean patient age was 56 +/- 16 years, 52% were wom en, and 39% had diabetes. The overall admitted rate of NC was 13%, with a r ate of 18% in the United States and 7% in Canada (P < 0.001). NC was more c ommon in younger patients (P < 0.0001), those without diabetes (P < 0.001), and employed patients (P < 0.05). It was also more common in black and His panic than in Asian and white patients (P < 0.001). NC was more common in p atients prescribed more than four exchanges daily (P < 0.0001) but was not affected by dwell volume. On multiple regression analysis, the independent predictors of NC, in order of importance, were being prescribed more than f our exchanges per day, black race, being employed, younger age, and not hav ing diabetes. Being treated in a US unit did not quite achieve significance as a multivariate independent predictor. These findings suggest that NC is not uncommon in CAPD patients and is more frequent in US than in Canadian patients. However, country of residence is less powerful as a predictor of NC than a variety of other demographic and prescription factors. (C) 2000 b y the National Kidney Foundation, Inc.