Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995

Steven D. Helgerson, William M. McClellan, Pamela R. Frederick, Shelli K. Beaver, Diane L. Frankenfield, Michael McMullan

Research output: Contribution to journalArticle

Abstract

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. In conclusion, marked differences existed in 1993, 1994, and 1995 between observed practice and consensus guidelines for the delivery of adequate dialysis. Nevertheless, notable improvement occurred during this time period. A system to monitor further improvements in hemodialysis care in the United States is in place.

Original languageEnglish (US)
Pages (from-to)851-861
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume29
Issue number6
StatePublished - Jun 1997
Externally publishedYes

Fingerprint

Renal Dialysis
Dialysis
Odds Ratio
Urea
Consensus Development Conferences
National Institutes of Health (U.S.)
Medicare
Practice Guidelines
Medical Records
Guidelines
Physicians
Kidney

Keywords

  • End-stage renal disease
  • Hemodialysis
  • Quality of care indicators
  • Urea reduction ratio

ASJC Scopus subject areas

  • Nephrology

Cite this

Helgerson, S. D., McClellan, W. M., Frederick, P. R., Beaver, S. K., Frankenfield, D. L., & McMullan, M. (1997). Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995. American Journal of Kidney Diseases, 29(6), 851-861.

Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995. / Helgerson, Steven D.; McClellan, William M.; Frederick, Pamela R.; Beaver, Shelli K.; Frankenfield, Diane L.; McMullan, Michael.

In: American Journal of Kidney Diseases, Vol. 29, No. 6, 06.1997, p. 851-861.

Research output: Contribution to journalArticle

Helgerson, SD, McClellan, WM, Frederick, PR, Beaver, SK, Frankenfield, DL & McMullan, M 1997, 'Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995', American Journal of Kidney Diseases, vol. 29, no. 6, pp. 851-861.
Helgerson SD, McClellan WM, Frederick PR, Beaver SK, Frankenfield DL, McMullan M. Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995. American Journal of Kidney Diseases. 1997 Jun;29(6):851-861.
Helgerson, Steven D. ; McClellan, William M. ; Frederick, Pamela R. ; Beaver, Shelli K. ; Frankenfield, Diane L. ; McMullan, Michael. / Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995. In: American Journal of Kidney Diseases. 1997 ; Vol. 29, No. 6. pp. 851-861.
@article{f1ea635db9744fdc9aec13687fc5b794,
title = "Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995",
abstract = "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. In conclusion, marked differences existed in 1993, 1994, and 1995 between observed practice and consensus guidelines for the delivery of adequate dialysis. Nevertheless, notable improvement occurred during this time period. A system to monitor further improvements in hemodialysis care in the United States is in place.",
keywords = "End-stage renal disease, Hemodialysis, Quality of care indicators, Urea reduction ratio",
author = "Helgerson, {Steven D.} and McClellan, {William M.} and Frederick, {Pamela R.} and Beaver, {Shelli K.} and Frankenfield, {Diane L.} and Michael McMullan",
year = "1997",
month = "6",
language = "English (US)",
volume = "29",
pages = "851--861",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995

AU - Helgerson, Steven D.

AU - McClellan, William M.

AU - Frederick, Pamela R.

AU - Beaver, Shelli K.

AU - Frankenfield, Diane L.

AU - McMullan, Michael

PY - 1997/6

Y1 - 1997/6

N2 - 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. In conclusion, marked differences existed in 1993, 1994, and 1995 between observed practice and consensus guidelines for the delivery of adequate dialysis. Nevertheless, notable improvement occurred during this time period. A system to monitor further improvements in hemodialysis care in the United States is in place.

AB - 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. In conclusion, marked differences existed in 1993, 1994, and 1995 between observed practice and consensus guidelines for the delivery of adequate dialysis. Nevertheless, notable improvement occurred during this time period. A system to monitor further improvements in hemodialysis care in the United States is in place.

KW - End-stage renal disease

KW - Hemodialysis

KW - Quality of care indicators

KW - Urea reduction ratio

UR - http://www.scopus.com/inward/record.url?scp=0030904554&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030904554&partnerID=8YFLogxK

M3 - Article

C2 - 9186070

AN - SCOPUS:0030904554

VL - 29

SP - 851

EP - 861

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 6

ER -