Discordance between hemodialysis patients' reports and their physicians' estimates of adherence to dietary restrictions in Japan.

ABSTRACT

INTRODUCTION: This study examined the discordance between hemodialysis patients' reports and their physicians' estimates of dietary restriction adherence and related factors in Japan. METHODS: In a cross-sectional survey of 6644 outpatients, physicians who estimated higher and lower adherence than their patients' self-reported were categorized as overestimation and underestimation in terms of discordance, respectively. Possible factors included clinical indicators, patient characteristics related to negative stereotypes, and health beliefs related to statistical discrimination. RESULTS: The concordance rate was 0.069 based on the weighted kappa coefficient. The coefficients of acceptable serum potassium, prevalence of diabetes, and self-efficacy on overestimates were 0.663, -0.126, and -0.132, respectively. The coefficients of these factors on underestimates were -0.589, 0.338, and 0.145, respectively. All these coefficients were significant. CONCLUSIONS: The discordance may be high and is related to physicians' clinical data reliance, negative stereotypes about patient characteristics, and a lack of understanding of patients' health beliefs.