The objective of this review is to describe the adequacy of delivered dialysis provided to in-center hemodialysis patients in the United States and to compare the findings with published guidelines.
The medical records of random samples of 6,138,6,919, and 6,861 patients in hemodialysis facilities were studied from all Medicare-eligible adult in-center hemodialysis patients alive on December 31,1993,1994, and 1995, respectively.
The main clinical measure used was the urea reduction ratio (URR), the mean of which was 0.63 in 1993,0.64 in 1994, and 0.66 in 1995.
The proportion of patients with URR = 0.65, as recommended by the Renal Physicians Association and a National Institutes of Health Consensus Development Conference Statement, increased from 43% in 1993 to 49% in 1994 and 59% in 1995.
In each of these 3 years, women were more likely than men to have a URR = 0.65 (1993 : 54% v 31%, odds ratio 2.6 ; 1994 : 61% v 38%, odds ratio 2.5 ; and 1995 : 70% v 50%, odds ratio 2.4), as were older patients (65+years) compared with younger patients (18 to 44 years) (1993 : 47% v 37%, odds ratio 1.4 ; 1994 : 54% v 45%, odds ratio 1.5 ; and 1995 : 65% v 53%, odds ratio 1.6) and white patients compared with black patients (1993 : 46% v 36%, odds ratio 1.5 ; 1994 : 53% v 43%, odds ratio 1.5 ; and 1995 : 63% v 54%, odds ratio 1.4).
There was also substantial geographic variation in the proportion of patients receiving hemodialysis with a URR = 0.65. (...)
Mots-clés Pascal : Hémodialyse, Adulte, Homme, Assurance qualité, Efficacité traitement, Marqueur biologique, Urée, Etats Unis, Amérique du Nord, Amérique, Base donnée, Relation médecin malade, Epuration extrarénale
Mots-clés Pascal anglais : Hemodialysis, Adult, Human, Quality assurance, Treatment efficiency, Biological marker, Urea, United States, North America, America, Database, Physician patient relation, Extrarenal dialysis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0392102
Code Inist : 002B27B03. Création : 12/09/1997.