Kee Chan|Ravi Thadhani|Franklin W. Maddux
Adherence Barriers to Chronic Dialysis in the United States
Massachusetts General Hospital|Fresenius Medical Care (United States)|Massachusetts General Hospital|Fresenius Medical Care (United States)
hemodialysis patients often attend scheduled treatment session investigated factors associated missed appointments whether nonadherence poses significant harm patients increases overall health care utilization observational analysis 44 million hemodialysis treatments 182536 patients esrd united states assessed risk hospitalization emergency room visit intensivecoronary care unit icuccu admission 2 days missed treatment relative risk patients received hemodialysis 5year study period average missed treatment rate 71 days per patientyear covariate adjusted logistic regression risk hospitalization odds ratio 398 95 confidence interval 95 ci 393 404 emergency room visit 200 95 ci 187 214 icuccu admission 389 95 ci 381 396 increased significantly missed treatment overall 09 missed treatment days per year associated suboptimal transportation dialysis inclement weather holidays psychiatric illness pain gastrointestinal upset barriers also associated excess hospitalization 56 events per patientyear emergency room visits 11 visits icuccu admissions 08 admissions conclusion poor adherence hemodialysis treatments may substantial roadblock achieving better patient outcomes addressing systemic patient barriers impede access hemodialysis care may decrease missed appointments reduce patient morbidity