Improving the Quality of Hemodialysis Treatment: A Community-Based Randomized Controlled Trial to Overcome Patient-Specific Barriers
Abstract
CONTEXT: Mortality rates among US hemodialysis patients are the highest in the industrialized world at 23% per year. Measures of dialysis dose (Kt/V) correspond strongly with survival and are inadequate in one sixth of patients. Inadequate dialysis is also associated with increased hospitalizations and high inpatient costs. Our previous work identified 3 barriers to adequate hemodialysis: dialysis underprescription, catheter use, and shortened treatment time. OBJECTIVE: To determine the effect of a tailored intervention on adequacy of hemodialysis. DESIGN AND SETTING: Community-based randomized controlled trial with recruitment from April 1999 to June 2000 at 29 hemodialysis facilities in northeast Ohio. PARTICIPANTS: Forty-four nephrologists and their 169 randomly selected adult patients receiving inadequate hemodialysis. INTERVENTION: Nephrologists were randomly assigned to an intervention (n = 21) or control (n = 23) group. For patients in the intervention group (n = 85), depending on the barrier(s) present, a study coordinator gave nephrologists recommendations about optimizing dialysis prescriptions, expedited conversion of catheters to surgically created grafts or fistulas, and educated patients about the importance of compliance with treatment time. Patients in the control group (n = 84) continued to receive usual care. MAIN OUTCOME MEASURES: Changes in Kt/V and specific barriers after 6 months. RESULTS: At baseline, intervention and control patients had similar Kt/V measurements, specific barriers, and demographic and medical characteristics. After 6 months, intervention patients had 2-fold larger increases in Kt/V compared with control patients (+0.20 vs +0.10; P<.001) and were more likely to achieve their facility Kt/V goal (62% vs 42%; P =.01). Intervention patients also had nearly 3-fold larger increases in dialysis prescription (+0.16 vs +0.06; P<.001) and were 4 times more likely to change from use of catheters to use of fistulas/grafts (28% vs 7%; P =.04). CONCLUSIONS: An intervention tailored to patient-specific barriers resulted in increased hemodialysis dose. Extending this approach to the 33 000 persons in the United States receiving inadequate hemodialysis may substantially enhance patient survival, diminish hospitalizations, and decrease inpatient expenditures.
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Twenty-three of the included studies had been included in the previous version of the review, but three studies from that review were excluded because their interventions were not assessed as meeting the criteria for tailoring.
“Twenty‐three of the studies had been included in the previous version of the review, but we excluded three studies from that review because the interventions were not assessed on this occasion as meeting the criteria for tailoring (Davies 2002; Sehgal 2002; Verhoeven 2005).”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Sehgal 2002
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Vlatković, V., Gašić, B., Uthoff, S., & Jakovljević, B. (2007) · Scripta Medica · doi:10.5937/scrimed0701031v
“Ipak, kao najznačajniji faktor za povećanje ostvarene doze HD pokazalo se produžavanje vremena HD sesija, što je u saglasnosti i sa nalazima drugih autora [2,4,9,10].”
BackgroundImprovement of hemodialysis quality by application of various models for adequacy aseessment
Vlatković, V. (2004) · Scripta Medica · doi:10.5937/scrimed0402099x
- Authors
- Sehgal, A. R., Leon, J. B., Siminoff, L. A., Singer, M. E., Bunosky, L. M., & Cebul, R. D.
- Affiliations
- MetroHealth (US)
- Case Western Reserve University (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2002-04-17
- Volume
- 287
- Issue
- 15
- Pages
- 1961
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2086060425
- Cited by
- 62
- References
- 27
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 1 · 2013: 1 · 2012: 4
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK051472, DK 54178, DK51472, P50DK054178)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Keywords
- hemodialysis adequacy, Kt/V, dialysis dose, dialysis prescription, arteriovenous fistula, hemodialysis vascular access, personalized interventions, end-stage renal disease
- MeSH terms
- Catheters, Indwelling, Delivery of Health Care, Female, Renal Dialysis, Humans, Male, Middle Aged, Patient Compliance, Patient Education as Topic, Drug Prescriptions, Quality Assurance, Health Care, Quality Control, Quality of Life, Time Factors, Hemodialysis Solutions
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