Improving compliance in dialysis patients: Does anything work?

Noncompliance with prescribed therapy significantly impacts dialysis patien t care and outcome. At least one-half of hemodialysis (HD) patients are lik ely to be noncompliant with some part of their treatment regimen, and one-t hird of peritoneal dialysis (PD) patients are believed to miss prescribed e xchanges. Psychosocial issues, younger age, and smoking behavior have been linked with compliance problems in multiple studies. Few interventions have been rigorously tested, but patient education and/or individualized attent ion, supervision, encouragement, and support are widely advocated strategie s to improve patient compliance. Areas in need of continued study include p sychosocial determinants of compliance in PD as well as HD patients, compli ance behavior patterns over time, and the parameters within which dialysis compliance can vary and still achieve specified treatment goals.