Abstract:
BACKGROUND:Studies evaluating patient outcomes in dialysis as a function of quality of predialysis therapeutic care are lacking. OBJECTIVE:To evaluate the association of quality of predialysis therapeutic practices with survival and hospitalization during the first year of dialysis. RESEARCH DESIGN:The AVantagE de la Néphroprotection dans l'Insuffisance Rénale study was an observational cohort study. Cox models explored the association between quality of therapeutic practices and survival over the first year whereas logistic regression measured the association with total duration of hospitalization (0 to 6 d, ≥7 d) among surviving patients at 1 year. SUBJECTS:All adult patients with chronic kidney disease starting dialysis in Lorraine (France) between 2005 and 2006. MEASURES:The appropriateness of therapeutic practices was evaluated with reference to current guidelines covering 5 aspects of chronic kidney disease: hypertension/proteinuria, anemia, bone disease, metabolic acidosis, and dyslipidemia. Each patient was then assigned a quality of therapeutic practices rating (high, moderate, or poor) depending on the number of aspects appropriately managed. RESULTS:Quality of predialysis therapeutic practices was high in 18.2% of the 566 included patients, moderate in 62.5%, and poor in 19.3%. In multivariate analysis, the higher the quality of practices, the better the survival rate during the first year of dialysis [High: hazard ratio (HR) 1; moderate: HR 1.56, P=0.09; poor: HR 1.95, P=0.02]. Conversely, quality of therapeutic practices was not associated with duration of hospitalization among the 390 surviving patients at 1 year. CONCLUSION:This study suggests that quality of predialysis therapeutic practices is positively associated with survival during the first year of dialysis.
journal_name
Med Carejournal_title
Medical careauthors
Thilly N,Boini S,Loos-Ayav C,Kessler M,Briançon S,Frimat Ldoi
10.1097/MLR.0b013e3181d56926subject
Has Abstractpub_date
2012-01-01 00:00:00pages
35-42issue
1eissn
0025-7079issn
1537-1948journal_volume
50pub_type
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