Document Detail

The relationship between dialysis performance measures: adequacy and anemia management.
MedLine Citation:
PMID:  17954290     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Little is known about how urea reduction ratio (URR) and hemoglobin (Hb) level relate as clinical performance measures (CPMs) in dialysis facilities. This study examined the relationship between these CPMs as a reflection of underlying processes. STUDY DESIGN: Cross-sectional observational. SETTING & PARTICIPANTS: 47,465 records from 18,003 patients dialyzed in 270 End-Stage Renal Disease Network 5 facilities during the final quarter of 2004. PREDICTOR & OUTCOME: Facility aggregate Hb level and URR, respectively; both expressed as (1) continuous variables and (2) dichotomous indicators based on established quality thresholds. MEASUREMENTS: Weighted regression analyses were used to determine the: (1) association between CPMs and (2) likelihood of missing the performance threshold for one if also missing the other benchmark. RESULTS: The association between facility URR and Hb level was minimal, with an adjusted mean increase (beta) in URR of 0.91% +/- 0.38% for each 1-g/dL increment in Hb level (P < 0.0001) and R(2) of 0.02. The adjusted odds ratio of a facility failing to meet the URR quality threshold if missing the Hb level benchmark was 2.08 (P < 0.0001). The C statistic for the associated receiver operator characteristic curve was 0.64, with insignificant change when including Hb performance as a predictor of URR performance. LIMITATIONS: Inability to incorporate historic performance or ascertain facility process traits that influence CPMs. CONCLUSIONS: There was minimal association between facility URR and Hb level. The limited concordance in facility performance for these CPMs points to distinct processes that determine quality for each.
Yonatan S Spolter; Stephen L Seliger; Min Zhan; Van Doren Hsu; Lori D Walker; Jeffrey C Fink
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  50     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-23     Completed Date:  2007-11-27     Revised Date:  2008-05-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  774-81     Citation Subset:  IM    
Department of Medicine, University of Maryland School of Medicine, Baltimore, USA.
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MeSH Terms
Anemia / therapy
Cross-Sectional Studies
Hemoglobins / analysis*
Kidney Failure, Chronic / blood,  therapy*
Middle Aged
ROC Curve
Regression Analysis
Renal Dialysis*
Treatment Outcome
Urea / blood*
Grant Support
Reg. No./Substance:
0/Hemoglobins; 57-13-6/Urea
Comment In:
Am J Kidney Dis. 2007 Nov;50(5):691-5   [PMID:  17954280 ]
Am J Kidney Dis. 2008 May;51(5):867-8; author reply 868-9   [PMID:  18436103 ]

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