Facility-Level Interpatient Hemoglobin Variability in Hemodialysis Centers Participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS): Associations With Mortality, Patient Characteristics, and Facility Practices

摘要: Background Hemodialysis patients with larger hemoglobin level fluctuations have higher mortality rates. We describe facility-level interpatient variability, its relation to patient mortality, and factors associated variability or achieving levels of 10.5-12.0 g/dL. Facility-level may reflect within-patient anemia-control practices. Study Design Prospective cohort study. Setting & Participants Data from the Dialysis Outcomes Practice Patterns (DOPPS; 26,510 hemodialysis patients, 930 facilities, 12 countries, 1996-2008) Centers for Medicare Medicaid Services (CMS; 193,291 3,741 US 2002). Predictors Standard deviation (SD) in single-measurement facility cross-sections (facility-level SD); characteristics; Patient-level mortality; additionally, practices correlated SD Results varied more than 5-fold across DOPPS facilities (range, 0.5-2.7 g/dL; mean, 1.3 g/dL) by country 1.1 Japan-DOPPS [2005/2006] 1.7 g/dL Spain-DOPPS [1998/1999]), substantial decreases seen many countries 1998 2007. was related inversely age, but minimally 30 other characteristics mean levels. Several anemia management were strongly having a When examined CMS data, positively during prior 6 months. Patient rates greater (DOPPS: HR, 1.08 per 0.5-g/dL [95% CI, 1.02-1.15; P = 0.006]; CMS: 1.16 1.11-1.21; Limitations Residual confounding. Conclusions not tightly linked numerous characteristics, be modifiable optimization improve survival.