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Quality of care and survival of haemodialysed patients in western Switzerland

Kossovsky, Michel
Halabi, George
Published in Nephrology Dialysis Transplantatio. 2008, vol. 23, no. 6, p. 1975-81
Abstract 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.
Keywords Age FactorsAgedAged 80 and overAnalysis of VarianceCause of DeathFemaleHumansKaplan-Meiers EstimateKidney Failure Chronic/diagnosis/mortality/therapyMaleMiddle AgedMultivariate AnalysisQuality Indicators Health CareQuality of Health CareRenal Dialysis/methods/mortalityRetrospective StudiesRisk AssessmentSeverity of Illness IndexSex FactorsStatistics NonparametricSurvival AnalysisSwitzerland/epidemiologyTreatment Outcome
PMID: 18156654
Full text
Research groups Western Switzerland Dialysis Study Group
Epidémiologie clinique (115)
Groupe Pierre-Yves Martin (néphrologie) (30)
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SAUDAN, Patrick et al. Quality of care and survival of haemodialysed patients in western Switzerland. In: Nephrology, dialysis, transplantation, 2008, vol. 23, n° 6, p. 1975-81. doi: 10.1093/ndt/gfm915 https://archive-ouverte.unige.ch/unige:797

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Deposited on : 2009-02-13

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