Abstract: SA-PO972
Improvements in Quality of Care of Incident Hemodialysis Patients: An International Multicenter Study
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Drozdz, Maciej, DaVita International, London, United Kingdom
- Brzosko, Szymon, DaVita Poland, Bialystok, Poland
- Frazao, Joao M., DaVita Portugal, Amadora, Portugal
- Silva, Fatima Ferreira, Davita Portugal, Amadora, Portugal
- Kleophas, Werner, DaVita Deutschland, Dusseldorf, Germany
- Das, Partha, DaVita International, London, United Kingdom
- Jacobson, Stefan H., Karolinska Institutet, Stockholm, Sweden
Group or Team Name
- DaVita International
Background
The transition from predialysis care to initiation of hemodialysis (HD) has received increased attention, as this period is one of exceptionally high vulnerability. This analysis focuses on improvements in quality of HD care during the first 6 months.
Methods
We included 3462 patients (mean age 65.9, 41% females) on HD (incident <90 days, n=603, prevalent >90 days, mean 55 months, n=2859) from 56 DaVita centers in Poland and Portugal. We compared all incident to all prevalent patients (t-test and Chi-2) and analyzed improvements in quality of dialysis care in a subgroup of patients (n=258) who were followed prospectively for 6 months (paired t-test and McNemar analysis). Linear and logistic regression was used to identify features associated improvements in care.
Results
Incident (<90 days) vs all prevalent (>90 days) patients: Compared with all prevalent patients, incident patients had lower Kt/V: 1.4 vs 1.7 ***; lower Hb: 9.9 vs 11.0 g/dL ***; lower TSAT: 26% vs 31% ***; lower ferritin: 305 vs 541 ng/ml ***; lower albumin: 37 vs 40 g/dL ***; lower UF vol/HD session: 1687 vs 2260 mL ***, similar Charlson comorbidity index (CCI): 6.9 vs 6.9 (p=NS); more use of central dialysis catheters (CDC) 68% vs 26% ***; less use of AV fistulae (AVF) 34% vs 70% ***.
Incident patients <90 days on HD vs the same patients after 6 months of dialysis (n=258): Treatment time increased from 679 to 715 min/week ***; dialysis blood flow increased from 294-329 mL/min ***.
Linear and logistic regression including age, gender, Kt/V, albumin, diabetes and CCI showed that improvements in Kt/V at 6 months and a shift from CDC to AVF was associated with female gender, HR 0.27 (CI 0.13-0.34; ***) and HR 0.48 (CI 0.24-0.98; **), respectively.
**p<0.01, ***p<0.001, NS=not significant
Conclusion
This large European multicenter analysis of incident hemodialysis patients indicates that the use of medical protocols and medical targets assures significant improvements in quality of care and a shift from CDC to AVF, which may correspond to better outcomes.
Paired statistical analysis of quality of dialysis care over 6 months
| Kt/V | Hb | TSAT | Ferrit | Alb | Phos | PTH | CDC | AVF | MAP | UF | |
| <90 days | 1.4 | 9.8 | 26 | 332 | 37 | 4.8 | 389 | 68 | 35 | 96 | 1611 |
| >6 months | 1.5 | 10.7 | 30 | 462 | 42 | 5 | 340 | 47 | 55 | 95 | 1946 |
| p | *** | *** | *** | *** | ** | NS | ** | *** | *** | NS | *** |