title: Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients.
abstract: OBJECTIVE
  The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome.
  
  
  METHODS
  A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V>1.2), hemoglobin (>110g/L), serum phosphorus (1.1-1.8mmol/L), calcium (2.1-2.4mmol/L) and iPTH (150-300pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death.
  
  
  RESULTS
  The patients were on regular HD for 5.3±5.3 years, dialyzed 11.8±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death.
  
  
  CONCLUSIONS
  Substantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for Kt/V, hemoglobin and iPTH.
authors: School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: ljubicadjukanovic@yahoo.com.
authors: Ljubica
authors: L
authors: Djukanović
authors: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Nada
authors: N
authors: Dimković
authors: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Jelena
authors: J
authors: Marinković
authors: Nephrology Ward, General Hospital Krusevac, Krusevac, Serbia.
authors: Branislav
authors: B
authors: Andrić
authors: Nephrology Ward, General Hospital Valjevo, Valjevo, Serbia.
authors: Jasmina
authors: J
authors: Bogdanović
authors: Department of Nephrology, Clinical Center of Vojvodina, Novi Sad, Serbia.
authors: Ivana
authors: I
authors: Budošan
authors: Nephrology Ward, Health Center Srem, Mitrovica, Srem Mitrovica, Serbia.
authors: Anica
authors: A
authors: Cvetičanin
authors: Nephrology Ward, Health Center Vrsac, Vrsac, Serbia.
authors: Kosta
authors: K
authors: Djordjev
authors: Nephrology Ward, Health Center Smed Palanka, Smed Palanka, Serbia.
authors: Verica
authors: V
authors: Djordjević
authors: Department of Nephrology, Clinical Centre Zvezdara, Belgrade, Serbia.
authors: Živka
authors: Ž
authors: Djurić
authors: Nephrology Ward, General Hospital Pirot, Pirot, Serbia.
authors: Branimir Haviža
authors: BH
authors: Lilić
authors: Nephrology Ward, Health Centre Zagubica, Zagubica, Serbia.
authors: Nasta
authors: N
authors: Jovanović
authors: Department of Nephrology, General Hospital Zrenjanin, Zrenjanin, Serbia.
authors: Rosa
authors: R
authors: Jelačić
authors: Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia.
authors: Violeta
authors: V
authors: Knežević
authors: Department of Nephrology, Clinical Center Nis, Nis, Serbia.
authors: Svetislav
authors: S
authors: Kostić
authors: Department of Nephrology, Clinical Center of Kragujevac, Kragujevac, Serbia.
authors: Tatjana
authors: T
authors: Lazarević
authors: Department of Nephrology, Clinical Center Nis, Nis, Serbia.
authors: Stanimir
authors: S
authors: Ljubenović
authors: Department of Nephrology, Lazarevac, Serbia.
authors: Ivko
authors: I
authors: Marić
authors: Department of Nephrology, Clinical Centre Zemun, Belgrade, Serbia.
authors: Rodoljub
authors: R
authors: Marković
authors: Nephrology Ward, General Hospital, Kos Mitrovica, Serbia.
authors: Srboljub
authors: S
authors: Milenković
authors: Nephrology Ward, Health Center Kikinda, Kikinda, Serbia.
authors: Olivera
authors: O
authors: Milićević
authors: Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia.
authors: Igor
authors: I
authors: Mitić
authors: Nephrology Ward, Health Center Vrbas, Vrbas, Serbia.
authors: Vesna
authors: V
authors: Mićunović
authors: Hemodialysis Ward, Health Center Obrenovac, Obrenovac, Serbia.
authors: Milena
authors: M
authors: Mišković
authors: Hemodialysis Ward, Health Center Bačka Palanka, Bačka Palanka, Serbia.
authors: Dragana
authors: D
authors: Pilipović
authors: Clinical Center Zemun, Belgrade, Serbia.
authors: Steva
authors: S
authors: Plješa
authors: Health Center Barajevo, Barajevo, Serbia.
authors: Miroslava
authors: M
authors: Radaković
authors: General Hospital, Mladenovac, Serbia.
authors: Marina Stojanović
authors: MS
authors: Stanojević
authors: Health Center Zaječar, Zaječar, Serbia.
authors: Biserka Tirmenštajn
authors: BT
authors: Janković
authors: Health Center Pančevo, Pančevo, Serbia.
authors: Goran
authors: G
authors: Vojinović
authors: General Hospital Subotica, Subotica, Serbia.
authors: Kornelija
authors: K
authors: Šefer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy; D015415:Biomarkers; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D017583:Hemodiafiltration / Q000295:instrumentation / Q000401:mortality / Q000592:standards; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000295:instrumentation / Q000401:mortality / Q000592:standards*; D055771:Serbia / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010281:Parathyroid Hormone
keywords: Hemodialysis results; KDOQI guidelines targets; Objetivos de guía KDOQI; Resultados de hemodiálisis; Serbia