title: Variability in quality of care among dialysis units in the state of São Paulo and the ordinance number 389/2014 of the Health Ministry of Brazil.
abstract: BACKGROUND
  Medical organizations have proposed indices to assess the quality of dialytic therapy offered to patients with chronic kidney disease (CKD). Recently, the Ministry of Health of Brazil published the ordinance n° 389/2014, which establishes targets in the care of patients with CKD.
  
  
  OBJECTIVE
  We evaluate the performance of hemodialysis (HD) clinics in relation to the goals established in this ordinance.
  
  
  METHODS
  Cross-sectional study, prospective, observational, involving 1,633 patients with CKD on HD in eight clinics. Demographic characteristics, Kt/V, hemoglobin, phosphorus, parathormone (PTH) and the mortality rate were recorded. The results were compared to the goals established in the ordinance No. 389/2014: Kt/V > 1.2 in more than 70% of patients, hemoglobin between 10 and 12 g/dl in more than 80%, phosphorus between 3.5 and 5.5 mg/dl in more than 50%, and PTH < 600pg/ml in more than 80% of patients.
  
  
  RESULTS
  The age was 56.4 ± 15.2 years, the median time on dialysis was 28.4 months. The HD session time was 3.74 ± 0.31 hours. For Kt/V, six clinics reached the goal. For hemoglobin, none of the clinics reached the goal. For phosphorus, only two clinics meet the goal and for PTH four clinics. Six clinics hit two goals and two clinics did not achieve any goal. Mortality was lower in clinics that reached targets (10.2vs. 21.6% per year; p = 0.0546).
  
  
  CONCLUSIONS
  For Kt/V most clinics reached the goal established by the ordinance. For hemoglobin and phosphorus, the objectives were not achieved in many clinics. For PTH, the response was variable and dependent on clinical features.
authors.affiliation: Universidade de São Paulo, Brazil.
authors.forename: Manuel Carlos Martins
authors.initials: MC
authors.lastname: Castro
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000592:standards*