title: Improvements in dialysis patient mortality are associated with improvements in urea reduction ratio and hematocrit, 1999 to 2002.
abstract: 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.
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI 48103, USA. bobwolfe@umich.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: Tempie E
authors.initials: TE
authors.lastname: Hulbert-Shearon
authors.forename: Valarie B
authors.initials: VB
authors.lastname: Ashby
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Mahadevan
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
mesh_terms: 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*
chemical_list: D014508:Urea