[Approach to quality objectives in incidents of patients in peritoneal dialysis].
BACKGROUND
In 2007 the Scientific Quality-technical and Improvement of Quality in Peritoneal Dialysis was edited. It includes several quality indicators. As far as we know, only some groups of work had evaluated these indicators, with inconclusive results.


OBJECTIVE
To study the evolution and impact of guidelines in Peritoneal Dialysis.


METHODS
Prospective cohort study of each incident of patients in Peritoneal Dialysis, in a regional public health care system (2003-2006). We prospectively collected baseline clinical and analytical data, technical efficacy, cardiovascular risk, events and deaths, hospital admissions and also prescription data was collected every 6 months.


RESULTS
Over a period of 3 years, 490 patients (53.58 years of age; 61.6% males.) Causes of ERC: glomerular 25.5%, diabetes 16%, vascular 12.4%, and interstitial 13.3%. 26.48% were on the list for transplant. Dialysis efficacy: Of the first available results, the residual renal function was 6.37 ml/min, achieving 67.6% of all the objectives K/DOQI. 38.6% remained within the range during the entire first year. Anaemia: 79.3% received erythropoietic stimulating agents and maintained an average Hb of 12.1 g/dl. The percentage of patients in the range (Hb: 11-13 g/dl) improved after a year (58.4% vs 56.3% keeping in the range during this time of 25.6%). Evolution: it has been estimated that per patient-year the risk of: 1) mortality is 0.06 IC 95% [0.04-0.08]; 2) admissions 0.65 [0.58-0.72]; 3) peritoneal infections 0.5 [0.44-0.56].


CONCLUSIONS
Diabetes Mellitus patients had a higher cardiovascular risk and prevalence of events. The degrees of control during the follow-up in many topics of peritoneal dialysis improve each year; however they are far from the recommended guidelines, especially if they are evaluated throughout the whole study.
Portolés
J
J
Servicio de Nefrología, Hospital Universitario Fundación Alcorcón, (REDinREN Carlos III. Red 06/0016), Alcorcón, Madrid. jmportoles@fhalcorcon.es
Ocaña
J
J
López-Sánchez
P
P
Gómez
M
M
Rivera
M T
MT
Del Peso
G
G
Corchete
E
E
Bajo
M A
MA
Rodríguez-Palomares
J R
JR
Fernández-Perpen
A
A
López-Gómez
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D055815:Young Adult
D006397:Hematinics