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OBJECTIVE: To measure compliance with prescribed exchanges in continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) patients using inventories of home dialysis supplies; to determine the reliability of the ratio of measured to predicted creatinine (M/P) in predicting compliance with prescribed exchanges; to determine the effects of the ingestion of performed creatine on the excretion of creatinine. DESIGN: A prospective analysis. SETTING: A university dialysis center. PATIENTS: Twenty patients on home peritoneal dialysis (PD). MEASUREMENTS: An inventory of supplies during two home visits over a 4-8 week interval determined the number of PD exchanges performed. This number was divided by the number of exchanges prescribed for the period to determine the percent compliance. Three consecutive days of the dialysate and urine were measured with all food consumed recorded during those days. M/P creatinine ratios and dietary protein intake (DPI) for each day were calculated. RESULTS: Of the patients tested, 8/20 (4%) were found to be noncompliant with the prescribed number of exchanges based on the home visits inventories, performing a mean of 75% of their exchanges. There was no significant difference in the M/P creatinine ratios of compliant and noncompliant patients, nor were the M/P ratios distributed differently for compliant and noncompliant patients. The M/P ratios did not vary significantly over the past 3 days. There was no correlation between the measured creatinine on a given day and the DPI for the same day. CONCLUSION: Based on assessment of the patient's inventory, 40% of the patients studied were noncompliant with their prescribed exchanges, indicating this is a serious and common problem in PD patients. The M/P creatinine ratio is not a predictor of compliance in PD. We suggest that use of home visit inventories to assess compliance in PD patients.