title: The "right" of passage: surviving the first year of dialysis.
abstract: Mortality risk for dialysis patients is highest in the first year. We previously showed a 41% mortality benefit associated with a pilot case management program for incident hemodialysis patients (n = 918). The RightStart Program (RSP) provided prompt medical management and self-management education and was recently expanded to more facilities. We conducted a matched cohort analysis to validate the expanded program's continued effectiveness. Death risk was reduced for RS patients (n = 4308) versus matched controls (C; n = 4308) by 34% (hazard ratio = 0.66, P < 0.0001) at 120 d and 22% at 1 yr (hazard ratio = 0.78, P < 0.0001). RS patients had lower hospitalization during the first year (RS = 15.5 days per patient year versus C = 16.9, P < 0.01). At 120 d, more RS patients achieved hemoglobin 11 to 12 g/dl (RS = 22.4% versus C = 19.7%, P < 0.01), eKt/V > or = 1.2 (RS = 66% versus C = 53.5%, P < 0.01), albumin > or = 4.0 g/dl (RS = 26% versus C = 22%, P < 0.01), and phosphorus 3.5 to 5.5 mg/dl (RS = 52.4% versus C = 45.4%). At 120 d, RS patients had a greater reduction in catheter use (RS = 32% versus C = 25%, P < 0.01) and more vitamin D orders (RS = 60% versus C = 55%, P < 0.01). Expansion of RS to a larger incident patient population results in significant reduction of morbidity and mortality associated with improvement of intermediate outcomes.
authors.affiliation: Medical Department, Fresenius Medical Care North America, 750 Old Hickory Blvd, Suite 230, Brentwood, TN 37027, USA. rebecca.wingard@fmc-na.com
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Wingard
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Chan
authors.forename: J Michael
authors.initials: JM
authors.lastname: Lazarus
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Hakim
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010758:Phosphorus / Q000097:blood; D015397:Program Evaluation; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin; D014807:Vitamin D; D010758:Phosphorus