2008 JASN IMPACT FACTOR 7.505	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text (Rapid PDF) All Versions of this Article: ASN.2006111250v1 18/8/2377    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tentori, F. Articles by Zager, P. G. Search for Related Content PubMed PubMed Citation Articles by Tentori, F. Articles by Zager, P. G.

Received November 16, 2006
Accepted on May 2, 2007

CLINICAL EPIDEMIOLOGY: Clinical Epidemiology

Which Targets in Clinical Practice Guidelines Are Associated with Improved Survival in a Large Dialysis Organization?

Francesca Tentori ^*, William C. Hunt ^*, Mark Rohrscheib , Min Zhu ^*, Christine A. Stidley ^*, Karen Servilla , Dana Miskulin , Klemens B. Meyer ^||, Edward J. Bedrick ^¶, H. Keith Johnson ^||, and Philip G. Zager ^*1

*Dialysis Clinic Inc., Health Sciences Center and ¶Department of Mathematics and Statistics, University of New Mexico, and Nephrology Section, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico; Tufts-New England Medical Center, Boston, Massachusetts; and ||Dialysis Clinic Inc., Nashville, Tennessee

¹ To whom correspondence should be addressed. E-mail: pzag{at}unm.edu.

	Abstract

Professional organizations have developed practice guidelines in the hope of improving clinical outcomes. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) has set targets for dialysis dosage (single-pool Kt/V), hematocrit, serum albumin, calcium, phosphorus, parathyroid hormone, and BP for hemodialysis (HD) patients. Several guidelines are largely based on results from observational studies. In contrast to other parameters, BP values within the KDOQI guidelines have been associated with increased mortality. Therefore, it was postulated that having multiple parameters that satisfy the current guidelines, except those for BP, is associated with improved survival among HD patients. A retrospective analysis was conducted of incident HD patients who were treated at facilities operated by Dialysis Clinic Inc., a not-for-profit dialysis provider, between January 1, 1998, and December 31, 2004 (n = 13,792). Cox proportional hazards models were used to assess the association between satisfying guidelines and mortality. Values within guidelines for single-pool Kt/V, hematocrit, serum albumin, calcium, phosphorus, and parathyroid hormone were associated with decreased mortality (P 0.0001). The largest survival benefit was found for serum albumin (hazard ratio [HR] 0.27; 95% confidence interval [CI] 0.24 to 0.31). Satisfying these six guidelines simultaneously was associated with an 89% reduction in mortality (HR 0.11; 95% CI 0.06 to 0.19]). Conversely, BP values satisfying the guideline were associated with increased mortality (HR 1.90; 95% CI 1.73 to 2.10). Because this target was largely extrapolated from the general population, a randomized, controlled trial is needed to identify the optimal BP for HD patients.

This article has been cited by other articles:

				A. Davenport, C. Gardner, M. Delaney, and on behalf of the Pan Thames Renal Audit Group The effect of dialysis modality on phosphate control : haemodialysis compared to haemodiafiltration. The Pan Thames Renal Audit Nephrol. Dial. Transplant., October 28, 2009; (2009) gfp560v1. [Abstract] [Full Text] [PDF]

				S. Hirsch The internist's role in treating hypertension in hemodialysis patients QJM, July 1, 2009; 102(7): 501 - 507. [Abstract] [Full Text] [PDF]

				L. Labriola, P. Wallemacq, B. Gulbis, and M. Jadoul The impact of the assay for measuring albumin on corrected ('adjusted') calcium concentrations Nephrol. Dial. Transplant., June 1, 2009; 24(6): 1834 - 1838. [Abstract] [Full Text] [PDF]

				A. Covic, P. Kothawala, M. Bernal, S. Robbins, A. Chalian, and D. Goldsmith Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease Nephrol. Dial. Transplant., May 1, 2009; 24(5): 1506 - 1523. [Abstract] [Full Text] [PDF]

				R. Agarwal and A. D. Sinha Cardiovascular Protection With Antihypertensive Drugs in Dialysis Patients: Systematic Review and Meta-Analysis Hypertension, May 1, 2009; 53(5): 860 - 866. [Abstract] [Full Text] [PDF]

				C. Couchoud, K. J. Jager, C. Tomson, J.-F. Cabanne, F. Collart, P. Finne, A. de Francisco, L. Frimat, L. Garneata, T. Leivestad, et al. Assessment of urea removal in haemodialysis and the impact of the European Best Practice Guidelines Nephrol. Dial. Transplant., April 1, 2009; 24(4): 1267 - 1274. [Abstract] [Full Text] [PDF]

				B. M.R. Spiegel, G. Melmed, S. Robbins, and E. Esrailian Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease: A Systematic Review Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1759 - 1768. [Abstract] [Full Text] [PDF]

				M. D. Danese, V. Belozeroff, K. Smirnakis, and K. J. Rothman Consistent Control of Mineral and Bone Disorder in Incident Hemodialysis Patients Clin. J. Am. Soc. Nephrol., September 1, 2008; 3(5): 1423 - 1429. [Abstract] [Full Text] [PDF]

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673