Time trends in initiation and dose of dialysis in end-stage renal disease patients in The Netherlands.
BACKGROUND
The guidelines published by the NKF-Dialysis Outcomes Quality Initiative (DOQI) in 1997 advocate an earlier start of dialysis in ESRD patients and a higher dialysis dose than usual. We studied the possible influence of the increasing emphasis on adequate dialysis on the management of ESRD patients in The Netherlands in 1993-2000.


METHODS
The NECOSAD study on the adequacy of dialysis started in 1993. This prospective multi-centre study included ESRD patients older than 18 years who started HD or PD as the first RRT. We analysed the distribution of age, gender, primary renal disease and co-morbidity, the mean residual renal function and the mean dialysis-Kt/V(urea) at 3 months in 1569 consecutive patients by calendar year of initiation dialysis.


RESULTS
Age, gender, primary renal disease and number of co-morbid conditions at the start of dialysis remained stable over time between 1993 and 2000. The mean renal Kt/V(urea) at 3 months increased from 0.5 in 1993 to 0.8 per week in 2000 (P<0.01). An upward trend remained after adjustment for patient characteristics and dialysis centre. The total Kt/V(urea) at 3 months increased from 3.3 in 1993 to 3.7 per week in 2000 in HD (P<0.01) and from 2.0 in 1993 to 2.3 per week in 1999 in PD patients (P<0.01). An upward trend in the dialysis-Kt/V(urea) was found after adjustment for renal Kt/V(urea) (HD: +0.3 per week, P=0.06; PD, +0.2 per week, P<0.05).


CONCLUSIONS
These results indicate a tendency towards earlier introduction of RRT and higher doses of dialysis in The Netherlands. Possible effects of this development on mortality, morbidity, quality of life and the balance between costs and benefits need further investigation.
Termorshuizen
Fabian
F
Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. f.termorshuizen@amc.uva.nl
Korevaar
Johanna C
JC
Dekker
Friedo W
FW
Jager
Kitty J
KJ
van Manen
Jeannette G
JG
Boeschoten
Elisabeth W
EW
Krediet
Raymond T
RT
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands; D010530:Peritoneal Dialysis / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000639:trends*; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors