Improvements in dialysis patient mortality are associated with improvements in urea reduction ratio and hematocrit, 1999 to 2002.
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).


CONCLUSIONS
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.
Wolfe
Robert A
RA
Department of Biostatistics, University of Michigan, Ann Arbor, MI 48103, USA. bobwolfe@umich.edu
Hulbert-Shearon
Tempie E
TE
Ashby
Valarie B
VB
Mahadevan
Sangeetha
S
Port
Friedrich K
FK
D000740:Anemia / Q000517:prevention & control*; D019983:Guideline Adherence; D006400:Hematocrit / Q000592:standards / Q000706:statistics & numerical data; D006436:Hemodialysis Units, Hospital / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D017410:Practice Guidelines as Topic / Q000592:standards; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care / Q000379:methods / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000401:mortality* / Q000592:standards; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014508:Urea / Q000097:blood*
D014508:Urea