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; > or =65%) and hematocrit levels (> or =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 fraction 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.
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; > or =65%) and hematocrit levels (> or =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 fraction 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.
Authors: William M McClellan; Haimanot Wasse; Ann C McClellan; James Holt; Jenna Krisher; Lance A Waller Journal: J Am Soc Nephrol Date: 2010-08-05 Impact factor: 10.121
Authors: Erika B Rangel; Maria Claudia Andreoli; Ana Cristina C Matos; Nadia K Guimarães-Souza; Ana Cláudia Mallet; Fabiana D Carneiro; Bento C Santos Journal: J Artif Organs Date: 2010-02-19 Impact factor: 1.731
Authors: Mahesh Krishnan; Steven M Brunelli; Franklin W Maddux; Thomas F Parker; Douglas Johnson; Allen R Nissenson; Allan Collins; Eduardo Lacson Journal: Clin J Am Soc Nephrol Date: 2014-02-20 Impact factor: 8.237
Authors: David Van Wyck; John Robertson; Allen Nissenson; Robert Provenzano; Dennis Kogod Journal: Clin J Am Soc Nephrol Date: 2009-12-10 Impact factor: 8.237
Authors: William M McClellan; Haimanot Wasse; Ann C McClellan; Adam Kipp; Lance A Waller; Michael V Rocco Journal: J Am Soc Nephrol Date: 2009-03-25 Impact factor: 10.121