serval:BIB_961BE375A0D8
Quality of care and survival of haemodialysed patients in western Switzerland.
10.1093/ndt/gfm915
000256173300033
18156654
Saudan
P.
author
Kossovsky
M.
author
Halabi
G.
author
Martin
P.Y.
author
Perneger
T.V.
author
Western Switzerland Dialysis Study Group
contributor
Fellay
G.
contributor
Descombes
E.
contributor
Martin
PY.
contributor
Levy
M.
contributor
Freudiger
H.
contributor
Brunisholz
M.
contributor
Robert
D.
contributor
Giovanini
M.
contributor
Uldry
PY.
contributor
Vogel
G.
contributor
Haldimann
B.
contributor
Blanc
E.
contributor
Evequoz
P.
contributor
Schmid
M.
contributor
Scherrer
P.
contributor
Burnier
M.
contributor
Teta
D.
contributor
Halabi
G.
contributor
Guignard
JP.
contributor
von Albertini
B.
contributor
Hudry
MT.
contributor
Gautier
T.
contributor
Halabi
G.
contributor
Glueck
Z.
contributor
article
2008
Nephrology, Dialysis, Transplantation
1460-2385
0931-0509
journal
23
6
1975-1981
BACKGROUND: Many factors affect survival in haemodialysis (HD) patients. Our aim was to study whether quality of clinical care may affect survival in this population, when adjusted for demographic characteristics and co-morbidities.
METHODS: We studied survival in 553 patients treated by chronic HD during March 2001 in 21 dialysis facilities in western Switzerland. Indicators of quality of care were established for anaemia control, calcium and phosphate product, serum albumin, pre-dialysis blood pressure (BP), type of vascular access and dialysis adequacy (spKt/V) and their baseline values were related to 3-year survival. The modified Charlson co-morbidity index (including age) and transplantation status were also considered as a predictor of survival.
RESULTS: Three-year survival was obtained for 96% of the patients; 39% (211/541) of these patients had died. The 3-year survival was 50, 62 and 69%, respectively, in patients who had 0-2, 3 and >or=4 fulfilled indicators of quality of care (test for linear trend, P < 0.001). In a Cox multivariate analysis model, the absence of transplantation, a higher modified Charlson's score, decreased fulfilment of indicators of good clinical care and low pre-dialysis systolic BP were independent predictors of death.
CONCLUSION: Good clinical care improves survival in HD patients, even after adjustment for availability of transplantation and co-morbidities.
Age Factors
Aged
Aged, 80 and over
Analysis of Variance
Cause of Death
Female
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic/diagnosis
Kidney Failure, Chronic/mortality
Male
Middle Aged
Multivariate Analysis
Quality Indicators, Health Care
Quality of Health Care
Renal Dialysis/methods
Renal Dialysis/mortality
Retrospective Studies
Risk Assessment
Severity of Illness Index
Sex Factors
Statistics, Nonparametric
Survival Analysis
Switzerland/epidemiology
Treatment Outcome
eng
60_published
true
Publication types: Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
University of Lausanne
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