Haemodialysis prescription, adherence and nutritional indicators in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).
BACKGROUND
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study designed to evaluate practice patterns in random samples of haemodialysis facilities and patients across three continents. Participating countries include France, Germany, Italy, Spain and the UK (Euro-DOPPS), Japan and the USA. DOPPS data collection has used the same questionnaires and protocols across all participating countries to assess components of dialysis therapy and outcomes. This study focuses on dialysis prescription, adherence and nutrition among the Euro-DOPPS countries.


METHODS
In each Euro-DOPPS country, patients were selected randomly from 20-21 representative facilities. Simple means and frequencies were calculated to compare relevant data elements to gain insights into differences in therapeutic aspects among nationally representative patients. Participants entering the study within 90 days of beginning dialysis therapy were excluded from these analyses.


RESULTS
Among the five countries, mean delivered dose as measured by normalized urea clearance (Kt/V) varied from 1.28 to 1.50 and was accompanied by differences in dialysis prescription components, including blood flow rates, treatment times, and dialyser membrane and flux characteristics. By country, a nearly 2-fold difference was observed in indicators of patient adherence and management (skipping and shortening dialysis, hyperkalaemia, hyperphosphataemia and high interdialytic weight gain). Indicators of malnutrition varied substantially.


CONCLUSIONS
This study demonstrates differences in the management of haemodialysis patients across Euro-DOPPS and offers opportunities for improving dialysis dose, adherence and nutrition. Correlation of differences in practice patterns at the dialysis unit level with patient outcomes will offer new insights into improving dialysis therapy.
Hecking
Erwin
E
Clinic for Nephrology, Hypertension and Dialysis, Augusta-Kranken-Anstalt, Ruhr University, Bochum, Germany.
Bragg-Gresham
Jennifer L
JL
Rayner
Hugh C
HC
Pisoni
Ronald L
RL
Andreucci
Vittorio E
VE
Combe
Christian
C
Greenwood
Roger
R
McCullough
Keith
K
Feldman
Harold I
HI
Young
Eric W
EW
Held
Philip J
PJ
Port
Friedrich K
FK
D003695:Delivery of Health Care / Q000592:standards*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome