Duration of dialysis and its relationship to dialysis adequacy, anemia management, and serum albumin level

An analysis of the relationship between intermediate outcomes and duration of dialysis therapy in hemodialysis patients was performed by linking Healt h Care Financing Administration (HCFA) Core Indicators data with data obtai ned from HCFA form 2728 at the initiation of dialysis therapy. Patients who recently initiated hemodialysis therapy were less likely to meet Dialysis Outcomes Quality Initiative guidelines than patients with a longer duration of dialysis therapy. For both urea reduction ratio and Kt/V, odds ratios f or adequate dialysis were approximately 0.20 for a duration of dialysis the rapy less than 0.5 years and 0.42 to 0.63 for a duration of dialysis therap y of 0.5 to 1.0 years compared with a duration of dialysis therapy of 2.0 y ears or greater. For patients with a duration of dialysis therapy less than 0.5 years (compared with :2.0 years), the odds ratio for a hematocrit less than 28% was approximately 3.0, that for a hematocrit 33% or greater was a pproximately 0.6, and that for a serum albumin level of 3.5 g/dL or greater (bromcresol green method) or 3.2 g/dL or greater (bromcresol purple method ) was approximately 0.4. There was a direct relationship between glomerular filtration rate at the initiation of dialysis therapy and both serum album in and hematocrit values. Patients administered recombinant human erythropo ietin (rHuEPO) predialysis were more likely to have greater hematocrits. Th ere also was a direct relationship between hematocrit and serum albumin lev el. Therefore, several actionable items in regard to attentive overall medi cal care can result in an improvement in the percentage of patients newly s tarted on hemodialysis therapy who meet intermediate outcomes, Including th e administration of rHuEPO predialysis, correction of iron deficiency, and timely placement of a permanent dialysis access. (C) 2001 by the National K idney Foundation, Inc.