The difference in the initial observational study was so large that the investigators decided to conduct a cross-sectional survey of compliance, asking nurses and nephrologists in every state, as well as at 21 centers in Japan and 16 centers in Sweden. In the United States, an average of 4 percent of patients in the cross-sectional study missed at least one treatment each month, compared with 0.1 percent in Sweden and 0 in Japan. For instance, treatments are shorter, with higher blood flow, which may lead to cramping and very low blood pressure. U.S. dialysis patients are likely to be sicker than patients in other countries. Such sicknes leads to weakness and depression, which may increase noncompliance.
Large differences exist between medical systems about who is eligible for dialysis.
For example, a noncompliant patient addicted to illicit drugs may be more likely to be accepted on dialysis treatment in the United States than in other countries. Compliance for U.S. patients in general is likely to be low, due to increased independence, increased patient autonomy and increased suspicion of health care providers. These international differences in compliance could be responsible for international differences in infant morality and low vaccination rates. Any question regarding a medical diagnosis, treatment, referral, drug availability or pricing should be directed to either a licensed physician or to the product's manufacturer. All rights reserved.