CQI process improves peritoneal dialysis adequacy

Worldwide, dialysis adequacy has emerged as a key issue. It has been recogn ised that inadequate dialysis may result in the retention of uremic toxins, which can, among other things, suppress appetite and result in malnutritio n and morbidity. In January 1996, and Ad Hoc Committee on Peritoneal Dialys is Adequacy concluded that: 1) the dialysis prescription must be individual ised; 2) by doing so, the suggested clearance guidelines can be achieved in almost all patients; 3) a wide range of regimens are available for the ind ividualizing the prescription; and 4) well-prescribed peritoneal dialysis ( PD) is an excellent therapy for the majority of patients. According to the 1997 NKF-DOQI(TM) Clinical Practice Guidelines for Peritoneal Dialysis Adeq uacy, the delivered dose for CAPD should yield a total Kt/V-urea of at leas t 2.0 per week, and a total creatinine clearance (C-Cr) of at least 60 L/we ek/1.73 m(2). Many dialysis centers across the U.S. have implemented a cont inous quality improvement (CQI) process to help improve dialysis adequacy. RenalWest Home Dialysis in Phoenix, AZ, improved their program's dialysis a dequacy to the point where 80% of their patients met targeted adequacy mark ers within a 6-month period. Nebraska Health Systems/Clarkson Kidney Center in Omaha, NE, increased their understanding of PD adequacy by establishing a routine protocol for determining adequacy and by offering education on a dequacy studies for all unit members. Satellite Dialysis Centers in Modesto , CA, discovered that 39% of their patient population had dropped out of PD . They implemented a CQI process to help patients achieve their adequacy ta rgets and reduce PD dropout. As the recommendations of the Ad Hoc Committe gain widespread popularity, improving dialysis adequacy will become more ac hievable through the implementation of proven CQI processes.