Meeting KDOQI guideline goals at hemodialysis initiation and survival during the first year.
OBJECTIVE
To determine, in a national cohort of incident hemodialysis patients, whether meeting a greater number of National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guideline goals at dialysis initiation was independently associated, in a graded manner, with lower first-year mortality rates.


METHODS
Patients who initiated hemodialysis between June 1, 2005, and May 31, 2007, in the US were included in this retrospective cohort analysis. Guidelines examined were (1) use of arteriovenous fistula or graft at initiation; (2) hemoglobin > or = 11 g/dl; and (3) albumin at goal. The primary predictor variable was number of guideline goals (zero, one, two, or three) met at dialysis initiation. Cox regression analysis was used to compare time to death, adjusting for baseline characteristics.


RESULTS
At dialysis initiation, 59%, 31%, 9%, and 1.6% of patients met zero, one, two, or three guideline goals, respectively (total n = 192,307). After multivariate adjustment, mortality hazard ratios (95% confidence intervals) were 0.81 (0.80 to 0.83) for patients who met one, 0.53 (0.51 to 0.56) for patients who met two, and 0.34 (0.30 to 0.39) for patients who met three guideline goals, compared with patients who met none. Meeting each individual goal was also associated with lower mortality.


CONCLUSIONS
These findings suggest a graded association between meeting a greater number of evidence-based guideline goals at dialysis initiation and lower risk of death during the first year on dialysis.
VA Medical Center (111J), One Veteran's Drive, Minneapolis, MN 55417, USA. slini001@umn.edu
Yelena
Y
Slinin
Haifeng
H
Guo
David T
DT
Gilbertson
Lih-Wen
LW
Mau
Kristine
K
Ensrud
Thomas
T
Rector
Allan J
AJ
Collins
Areef
A
Ishani
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin