Impact of predialysis therapeutic practices on patient outcomes during the first year of dialysis: the Pharmacoepidemiologic AVENIR study.
BACKGROUND
Studies evaluating patient outcomes in dialysis as a function of quality of predialysis therapeutic care are lacking.


OBJECTIVE
To evaluate the association of quality of predialysis therapeutic practices with survival and hospitalization during the first year of dialysis.


METHODS
The AVantagE de la Néphroprotection dans l'Insuffisance Rénale study was an observational cohort study. Cox models explored the association between quality of therapeutic practices and survival over the first year whereas logistic regression measured the association with total duration of hospitalization (0 to 6 d, ≥7 d) among surviving patients at 1 year.


METHODS
All adult patients with chronic kidney disease starting dialysis in Lorraine (France) between 2005 and 2006.


METHODS
The appropriateness of therapeutic practices was evaluated with reference to current guidelines covering 5 aspects of chronic kidney disease: hypertension/proteinuria, anemia, bone disease, metabolic acidosis, and dyslipidemia. Each patient was then assigned a quality of therapeutic practices rating (high, moderate, or poor) depending on the number of aspects appropriately managed.


RESULTS
Quality of predialysis therapeutic practices was high in 18.2% of the 566 included patients, moderate in 62.5%, and poor in 19.3%. In multivariate analysis, the higher the quality of practices, the better the survival rate during the first year of dialysis [High: hazard ratio (HR) 1; moderate: HR 1.56, P=0.09; poor: HR 1.95, P=0.02]. Conversely, quality of therapeutic practices was not associated with duration of hospitalization among the 390 surviving patients at 1 year.


CONCLUSIONS
This study suggests that quality of predialysis therapeutic practices is positively associated with survival during the first year of dialysis.
Thilly
Nathalie
N
Nancy University, Paul Verlaine Metz University, Paris Descartes University EA 4360 Apemac, Nancy, France. n.thilly@chu-nancy.fr
Boini
Stéphanie
S
Loos-Ayav
Carole
C
Kessler
Michéle
M
Briançon
Serge
S
Frimat
Luc
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000401:mortality*; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis