Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 45, Issue 1, Pages 127-135Publisher
W B SAUNDERS CO
DOI: 10.1053/j.ajkd.2004.09.023
Keywords
end-stage renal disease (ESRD); quality improvement; dose of dialysis; anemia management; standardized mortality ratio (SMR); hemodialysis (HD) survival
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Background Benefits in terms of reductions in mortality corresponding to improvements in Kidney Disease Outcomes Quality Initiative (K/DOQI) compliance for adequacy of dialysis dose and anemia control have not been documented in the literature. We studied changes in achieving K/DOQI guidelines at the facility level to determine whether those changes are associated with corresponding changes in mortality. Methods Adjusted mortality and fractions of patients achieving K/DOQI guidelines for urea reduction ratios (URRs: 65 %) and hematocrit levels (greater than or equal to 33 %) were computed for 2,858 dialysis facilities from 1999 to 2002 using national data for patients with end-stage renal disease. Linear and Poisson regression were used to study the relationship between K/DOQI compliance and mortality and between changes in compliance and changes in mortality. Results: In 2002. facilities in the lowest quintile of K/DOQI compliance for URR and hematocrit guidelines had 22 % and 14 % greater mortality rates (P < 0.0001) than facilities in the highest quintile, respectively. A 10-percentage point increase in traction of patients with a URR of 65 % or greater was associated with a 2.2 % decrease in mortality (P = 0.0006), and a 10-percentage point increase in percentage of patients with a hematocrit of 33 % or greater was associated with a 1.5 % decrease in mortality (P = 0.003). Facilities in the highest tertiles of improvement for URR and hematocrit had a change in mortality rates that was 15 % better than those observed for facilities in the lowest tertiles (P < 0.0001). Conclusion: Both current practice and changes in practices with regard to achieving anemia and dialysis-dose guidelines are associated significantly with mortality outcomes at the dialysis-facility level. (C) 2004 by the National Kidney Foundation, Inc.
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