Relationships of clinic size, geographic region, and race/ethnicity to the frequency of missed/shortened dialysis treatments.
BACKGROUND
Significant international differences abound in the adherence of hemodialysis (HD) patients to prescribed treatments. Unfortunately, factors influencing adherence within the United States (US) are not well understood. This study explores the hypothesis that race/ethnicity, geographic region and clinic size are associated with differences in the frequency of missed/shortened treatments.


METHODS
A retrospective analysis on all prevalent chronic HD patients treated at Dialysis Clinics Inc. facilities between January 2007 and June 2008. Logistic regression models were computed in which the outcome measures were the odds for missing or shortening treatments.


RESULTS
The cohort consisted of 15,340 HD patients of whom 48% were non-Hispanic whites (NHW), 41% African Americans (AA), 6% Hispanics, 2% Native Americans, 2% Asians, and 1% unknown. Patients were older in the Northeast than in the South (p < 0.001) or West (p = 0.0052). The frequency of missed and shortened treatments was lower in the Northeast than other regions, p < 0.0001. Hospitalization rates were lower in the West than the Northeast (p < 0.01) but mortality rates were similar across all regions. The odds ratio and 95% confidence interval for missed [1.31 (1.14-1.52)] and shortened treatments [1.86 (1.73-2.0)] were greater in clinics with >100 patients than in those with <50 patients. Compared to NHW, the frequencies of missed and shortened treatments were higher in AA, Hispanics and Native Americans (p < 0.001) but lower among Asians (p < 0.001).


CONCLUSIONS
The frequency of missed and shortened HD varies significantly by race/ethnicity, geographic region and clinic size. The relationship of clinic size to missed/shortened treatments may warrant consideration when planning new HD facilities.
Morehouse School of Medicine, Atlanta, GA, USA, cobialo@msm.edu.
Chamberlain
C
Obialo
Phillip G
PG
Zager
Orrin B
OB
Myers
William C
WC
Hunt
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D001213:Asian / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D044382:Population Groups / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data