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Kidney Week

Abstract: FR-PO748

Impact of PEAK Methodology on Interdialytic Weight Gain: A Multi-center Experience

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Altaher, Atef Zohdi, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
  • Bento, Marta Catarina branco ferreira, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
  • Cowperthwaite, Janet, DaVita-Saudi Arabia, Riyadh, Saudi Arabia

Hemodialysis (HD) patients who experience larger interdialytic weight gains (IDWG) are at increased risk of cardiovascular and all-cause mortality. Diastolic dysfunction, associated with fluid overload is reported in a significant numbers of dialysis patients directly reducing survival. In addition reports suggest that IDWG > 4% increases the risk of death substantially. This risk prompted us to focus quality improvement activities on the IDWG of chronic patients on HD.


PEAK methodology based on six sigma and lean processes was introduced incrementally into each of the 15 DaVita KSA clinics included in this study. During the implementation period the teams were provided with education about PEAK and supported to hold daily reviews of the current status, then to discuss ideas and action plans to implement patient centered strategies to promote compliance. The percentage of patients showing ≥ 4% IDWG on each treatment day during the 9 month study period was counted. The data included all prevalent and incident patients with valid data reported in the electronic medical records system (n=1472). Average data were calculated for each treatment week and month. Results were compared at 3, 6 and 9 months using Chi2 test.


The percentage of patients not achieving IDWG in each of the clinics at the start of the study period ranged from 20.5%-66.1%. Improvement in IDWG was observed in 11 of 15 and 12 of 15 clinics after 3 and 6 months, respectively. After 9 months, the percentage of patients not achieving target IDWG ranged from 15.6%-63.7% and had decreased by 36% of the initial value for the whole population. At the end of the study the percentage of patients not achieving target had decreased in all 14 clinics.


By implementing the PEAK methodology and encouraging team focus on this defined outcome, all clinics that implemented the program achieved a decrease in average IDWG in their patient populations.

Percentage of patients with IDWG ≥ 4% over 9 months observation period (whole population)
Initial IDWG ≥4%3 months6 months9 months
% of patientsP initial vs. 3 months% of patientsP initial vs. 6 months% of patientsP initial vs. 9 months
37.7%34.4%NS33.5%NS28.9%P < 0.001


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