Hemodialysis Quality Metrics in the First Year Following a Failed Kidney Transplant.
Aged
Female
Hemoglobins
/ analysis
Humans
Kidney Failure, Chronic
/ etiology
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Nephrology
/ statistics & numerical data
Phosphorus
/ metabolism
Quality Indicators, Health Care
Quality of Health Care
Registries
Renal Dialysis
/ standards
Risk
Treatment Failure
Treatment Outcome
United States
Hemodialysis
Quality metrics
Transplant failure
Journal
American journal of nephrology
ISSN: 1421-9670
Titre abrégé: Am J Nephrol
Pays: Switzerland
ID NLM: 8109361
Informations de publication
Date de publication:
2019
2019
Historique:
received:
09
04
2019
accepted:
17
06
2019
pubmed:
17
7
2019
medline:
4
9
2020
entrez:
17
7
2019
Statut:
ppublish
Résumé
Failure of a previously transplanted kidney is a common cause of end-stage renal disease (ESRD) and represents 5% of incident dialysis patients in the United States. Patients with native kidney failure ESRD (Nat-ESRD) who receive predialysis care from a nephrologist have better outcomes in the first 12 months on dialysis than those who don't. Because many patients with a failed kidney transplant ESRD (Tx-ESRD) receive care from nephrologists, they would also be expected to have good dialysis outcomes. We sought to compare the quality metrics of Tx-ESRD patients and Nat-ESRD patients during the first 12 months of hemodialysis. We used data from the United States Renal Data System to identify hemodialysis patients who began treatment between May 2012 and December 2013 and who received nephrology care prior to starting hemodialysis. Quality metrics by quarter for the first 12 months of treatment were dichotomized according to practice guidelines to determine the percentage of patients in each quarter who met quality of care goals. Compared to Nat-ESRD (n = 96,063) patients, Tx-ESRD (n = 5,528) patients had 10-19% lower rates of at goal hemoglobin levels, 6-12% lower rates of at goal serum phosphorus, and 3-11% lower rates of at goal albumin levels. Compared to Nat-ESRD patients, -Tx-ESRD patients had a 6% higher rate of fistula use in the first quarter but a 3-7% lower rate in subsequent quarters. Tx-ESRD patients have worse quality metrics related to anemia, phosphorus, albumin, and vascular access compared to Nat-ESRD patients. Nephrology care for patients with Tx-ESRD should be improved to address these quality metrics gaps.
Sections du résumé
BACKGROUND
Failure of a previously transplanted kidney is a common cause of end-stage renal disease (ESRD) and represents 5% of incident dialysis patients in the United States. Patients with native kidney failure ESRD (Nat-ESRD) who receive predialysis care from a nephrologist have better outcomes in the first 12 months on dialysis than those who don't. Because many patients with a failed kidney transplant ESRD (Tx-ESRD) receive care from nephrologists, they would also be expected to have good dialysis outcomes. We sought to compare the quality metrics of Tx-ESRD patients and Nat-ESRD patients during the first 12 months of hemodialysis.
METHODS
We used data from the United States Renal Data System to identify hemodialysis patients who began treatment between May 2012 and December 2013 and who received nephrology care prior to starting hemodialysis. Quality metrics by quarter for the first 12 months of treatment were dichotomized according to practice guidelines to determine the percentage of patients in each quarter who met quality of care goals.
RESULTS
Compared to Nat-ESRD (n = 96,063) patients, Tx-ESRD (n = 5,528) patients had 10-19% lower rates of at goal hemoglobin levels, 6-12% lower rates of at goal serum phosphorus, and 3-11% lower rates of at goal albumin levels. Compared to Nat-ESRD patients, -Tx-ESRD patients had a 6% higher rate of fistula use in the first quarter but a 3-7% lower rate in subsequent quarters.
CONCLUSIONS
Tx-ESRD patients have worse quality metrics related to anemia, phosphorus, albumin, and vascular access compared to Nat-ESRD patients. Nephrology care for patients with Tx-ESRD should be improved to address these quality metrics gaps.
Identifiants
pubmed: 31311008
pii: 000501605
doi: 10.1159/000501605
pmc: PMC6726525
mid: NIHMS1039315
doi:
Substances chimiques
Hemoglobins
0
Phosphorus
27YLU75U4W
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
161-167Subventions
Organisme : NIDDK NIH HHS
ID : K23 DK101492
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK112905
Pays : United States
Organisme : NIMHD NIH HHS
ID : U54 MD002265
Pays : United States
Informations de copyright
© 2019 S. Karger AG, Basel.
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