An analysis of the adequacy of preparation for end-stage renal disease care in Michigan. Michigan Renal Plan Task Force.

The Michigan Renal Plan Task Force has been charged with the development of a comprehensive plan to optimize the management of renal disease in Michigan. To assess the preparedness of new patients with end-stage renal disease (ESRD) patients in Michigan, surveys were sent to all outpatient ESRD facilities in the state concerning all new ESRD outpatients starting treatment during the first quarter of 1994. Responses were received from 69% of these facilities, covering 439 patients; 73% of patients were admitted to the hospital at the initiation of dialysis, and 69% required a temporary dialysis catheter. The median time to first outpatient dialysis was 10 days. Hospital admittance and use of temporary catheters were associated with a lower serum albumin at 1 month of follow-up. Temporary dialysis catheter usage was highest (85%) in rural areas, and lowest (59%) in suburban centers. Fifty-four percent of patients had a 1 month serum albumin of < or = 3.5 g/dl. At 1 month, nearly 60% of patients had a plasma hemoglobin of < or = 10.0 g/dl. These results suggest that better patient preparation for ESRD is needed to reduce the need for hospital admittance, to reduce the use of temporary catheters with their associated risks, and to improve the nutritional and psychosocial rehabilitation of these patients.