title: Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995.
abstract: The objective of this review is to describe the adequacy of delivered dialysis provided to in-center hemodialysis patients in the United States and to compare the findings with published guidelines. The medical records of random samples of 6,138, 6,919, and 6,861 patients in hemodialysis facilities were studied from all Medicare-eligible adult in-center hemodialysis patients alive on December 31, 1993, 1994, and 1995, respectively. The main clinical measure used was the urea reduction ratio (URR), the mean of which was 0.63 in 1993, 0.64 in 1994, and 0.66 in 1995. The proportion of patients with URR > or = 0.65, as recommended by the Renal Physicians Association and a National Institutes of Health Consensus Development Conference Statement, increased from 43% in 1993 to 49% in 1994 and 59% in 1995. In each of these 3 years, women were more likely than men to have a URR > or = 0.65 (1993: 54% v 31%, odds ratio 2.6; 1994: 61% v 38%, odds ratio 2.5; and 1995: 70% v 50%, odds ratio 24), as were older patients (65+ years) compared with younger patients (18 to 44 years) (1993: 47% v 37%, odds ratio 1.4; 1994: 54% v 45%, odds ratio 1.5; and 1995: 65% v 53%, odds ratio 1.6) and white patients compared with black patients (1993: 46% v 36%, odds ratio 1.5; 1994: 53% v 43%, odds ratio 1.5; and 1995: 63% v 54%, odds ratio 1.4). There was also substantial geographic variation in the proportion of patients receiving hemodialysis with a URR > or = 0.65. In conclusion, marked differences existed in 1993, 1994, and 1995 between observed practice and consensus guidelines for the delivery of adequate dialysis. Nevertheless, notable improvement occurred during this time period. A system to monitor further improvements in hemodialysis care in the United States is in place.
authors.affiliation: Health Care Financing Administration, Region X, Seattle, WA 98121-1850, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Helgerson
authors.forename: W M
authors.initials: WM
authors.lastname: McClellan
authors.forename: P R
authors.initials: PR
authors.lastname: Frederick
authors.forename: S K
authors.initials: SK
authors.lastname: Beaver
authors.forename: D L
authors.initials: DL
authors.lastname: Frankenfield
authors.forename: M
authors.initials: M
authors.lastname: McMullan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000208:ethnology / Q000628:therapy*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D006435:Renal Dialysis / Q000592:standards*; D014481:United States; D014508:Urea / Q000097:blood
chemical_list: D014508:Urea