Survival of Hemodialysis Patients in the United States Is Improved With a Greater Quantity of Dialysis

https://doi.org/10.1016/S0272-6386(12)70277-9Get rights and content

Abstract

The mortality rate for hemodialysis patients in the United States is higher than in other industrialized countries. Some attribute this to insufficient quantities of prescribed and delivered dialysis. A multicenter study in Dallas dialysis centers (Dallas Nephrology Associates) was begun in 1989 to assess the impact of increasing the delivered quantity of dialysis on mortality in subsequent years. Dialysis dose was measured by urea kinetic modeling. Kt/V, reflecting the fractional volume of body water clearance of urea during a dialysis treatment, was purposefully increased from 1.18 starting in 1989 to 1.46 in 1992. Additionally, the dialysis dose measured by the urea reduction ratio, the fractional reduction of blood urea nitrogen concentration caused by a dialysis treatment, increased from 63.0% to 69.6% between 1990 and 1992. Outcome analytical methods included both crude and standardized mortality rates and mortality ratios standardized to large end-stage renal disease databases at the United States Renal Data System and at National Medical Care, Inc. Crude mortality rates at Dallas Nephrology Associates decreased from 22.5% in 1989 to 18.1% in 1992. In comparison, between 1990 and 1992 the urea reduction ration in National Medical Care facilities increased from 57.1% to 62.5%. During that time crude mortality rates decreased from 21.8% to 19.5%. Crude mortality in the United States remained essentially unchanged in the same time period. By 1992, Dallas Nephrology Associates and National Medical Care had standardized mortality ratios of 0.77 and 0.74, respectively, compared with the US dialysis population, indicating almost 30% fewer observed deaths than expected. Monitoring dialysis dose by urea kinetic modeling or urea reduction ratio are equally effective in predicting improvement in patient survival. Improved survival is possible in the US end-stage renal disease program with greater amounts of dialysis. This strategy can save an estimated 8,000 to 16,000 lives per year.

References (48)

  • M Odaka

    Mortality in chronic dialysis patients in Japan

    Am J Kidney Dis

    (1990)
  • APS Disney

    Dialysis treatment in Australia, 1982-1988

    Am J Kidney Dis

    (1990)
  • GA Posen et al.

    Results from the Canadian Renal Failure Registry

    Am J Kidney Dis

    (1990)
  • RC Van holder et al.

    Adequacy of dialysis. A critical analysis

    Kidney Int

    (1992)
  • J Levine et al.

    The role of urea kinetic modeling, TACurea, and Kt/V in achieving optimal dialysis. A critical reappraisal

    Am J Kidney Dis

    (1990)
  • RM Lindsay et al.

    A hypothesis: The protein catabolic rate is dependent upon the type and amount of treatment in dialyzed uremic patients

    Am J Kidney Dis

    (1989)
  • RM Hakim et al.

    Increasing dose of dialysis improves mortality and nutritional parameters in hemodialysis patients

    J Am Soc Nephrol

    (1992)
  • J Cheigh et al.

    Is insufficient dialysis a cause for high morbidity in diabetic patients?

    J Am Soc Nephrol

    (1991)
  • Lowrie EG, Lew NL, Liu Y: The effect of difference in urea reduction ratio (URR) on death risk in hemodialysis...
  • CR Schleifer et al.

    The influence of urea kinetic modeling (UKM) on gross mortality in hemodialysis

    J Am Soc Nephrol

    (1992)
  • F Shen et al.

    Lower mortality and morbidity associated with higher Kt/V in hemodialysis patients

    J Am Soc Nephrol

    (1990)
  • S Ahmad et al.

    Lower morbidity associated with higher Kt/V in stable hemodialysis patients

    J Am Soc Nephrol

    (1990)
  • PB Deoreo

    Analysis of time, nutrition, and Kt/V as risk factors for mortality in dialysis patients

    J Am Soc Nephrol

    (1991)
  • EE Berger et al.

    Mortality and the length of dialysis

    JAMA

    (1991)
  • Cited by (0)

    View full text