Abstract
Medical organizations have proposed indices to assess the quality of dialytic therapy offered to patients with chronic kidney disease (CKD). Recently, the Ministry of Health of Brazil published the ordinance n° 389/2014, which establishes targets in the care of patients with CKD. We evaluate the performance of hemodialysis (HD) clinics in relation to the goals established in this ordinance. Cross-sectional study, prospective, observational, involving 1,633 patients with CKD on HD in eight clinics. Demographic characteristics, Kt/V, hemoglobin, phosphorus, parathormone (PTH) and the mortality rate were recorded. The results were compared to the goals established in the ordinance No. 389/2014: Kt/V > 1.2 in more than 70% of patients, hemoglobin between 10 and 12 g/dl in more than 80%, phosphorus between 3.5 and 5.5 mg/dl in more than 50%, and PTH < 600pg/ml in more than 80% of patients. The age was 56.4 ± 15.2 years, the median time on dialysis was 28.4 months. The HD session time was 3.74 ± 0.31 hours. For Kt/V, six clinics reached the goal. For hemoglobin, none of the clinics reached the goal. For phosphorus, only two clinics meet the goal and for PTH four clinics. Six clinics hit two goals and two clinics did not achieve any goal. Mortality was lower in clinics that reached targets (10.2vs. 21.6% per year; p = 0.0546). For Kt/V most clinics reached the goal established by the ordinance. For hemoglobin and phosphorus, the objectives were not achieved in many clinics. For PTH, the response was variable and dependent on clinical features.
Highlights
Medical organizations have proposed indices to assess the quality of dialytic therapy offered to patients with chronic kidney disease (CKD)
On July 25, 2014, the Ministry of Health published Ordinance no 389/2014, which sets indices to be achieved by dialysis clinics on the treatment of patients with stage 5D of chronic kidney disease (5D CKD).[11]
Ordinance No 389/2014 establishes the line of care for patients with chronic kidney disease in its various stages of evolution
Summary
Medical organizations have proposed indices to assess the quality of dialytic therapy offered to patients with chronic kidney disease (CKD). Several guidelines have proposed indices to be achieved in patients on hemodialysis to improve treatment quality and, reduce mortality, which remains unacceptably high despite technological advances introduced in the last decades.[1,2,3,4,5]. On July 25, 2014, the Ministry of Health published Ordinance no 389/2014, which sets indices to be achieved by dialysis clinics on the treatment of patients with stage 5D of chronic kidney disease (5D CKD).[11] So it seems important to assess the behavior of these indices in Brazilian dialysis clinics in order to establish the diagnosis of where we are, which way we should we go and whether the targets set by the Ministry of Health are feasible
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