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Tuesday, September 1, 2009

Guidelines for Dialysis Care

Guidelines for Dialysis Care
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  • To measure the quality of care in a center, outcomes (results of care) must be used.
•  These outcomes must be agreed upon by providers and patients and based on the most current knowledge.
•  They are then measured for each patient, for group of patients, or for centers, and are tracked over time.

• Even with standards, patients outcome like morbidity (sickness) and mortality (death) vary from center to center.
• This may be due to, in part, to differences in care at centers or in approach to care and treatment among nephrologists (doctors who specialize in kidney disease).

How can we improve outcomes for all patients?
By finding the best way to provide dialysis care and sharing these ideas with all centers.

Clinical Practice Guidelines, or expert recommendations for how to care for patients, are efforts to do just that.

Adequacy of hemodialysis
• The first clinical practice guideline for kidney failure was written in 1993 by Renal Physicians Association (RPA) nephrologists.
• It covers the dose of treatment a patient should receive.
• Healthy kidneys work 24 hours a day, 7 days a week.
• Dialysis done three times a week provides only about 15% of the function of healthy kidneys.
• It suggested a minimum dose of hemoodialysis for all patients.

Other guidelines by RPA:
1. Appropriate Patient Preparation - care of patients with advanced CKD who are not on dialysis
2. ESRD Workgroup - care of ESRD patients
3. Shared Decision Making - starting and ending dialysis.

NKF-KDOQI™ - National Kidney Foundation's Dialysis Outcomes Quality Initiative was formed in 1995, supported by a grant from AMGEN

• Wrote guidelines on four key areas:
          •Hemodialysis adequacy - built on the 1993 RPA guidelines
          •Peritonea] Dialysis adequacy
          •Vascular access

1999 - the NKF has increased the scope of DOQ1 to include all phases of kidney disease, and updated the first set of guidelines

• Now it is known as the Kidney Disease Outcomes Quality Initiative (KDOQI)
• Its goal is to improve the care and outcomes of all people with CKD

2003: a new NKF Program called Kidney Disease: Improving Global Outcomes (KDIGO) was launched.
• Mission: to improve the care and outcomes of kidney patients around the world.
• Is an effort to write and implement global clinical practice guidelines
• To work, the KDOQI guidelines must be put into daily practice.

Example: Anemia
• Anemia is a shortage of oxygen-carrying red blood cells
• It causes fatigue, heart disease, and many other problems.
• The KDOQ1 anemia guidelines help centers identify and treat anemia so patient stay healthier.
• You maybe able to help reduce anemia by making 'sure patients get more of their blood back after a treatment, keeping dialyzers from clotting, and stopping excess blood loss when you put in or take out the needles.

Example: Adequacy
• Patients sometimes get less than the minimum dose of dialysis.
• The KDOQI guidelines suggest that the doctor prescribe a higher dose, so patients will at least read) the minimum amount of treatment or more.
• You can correctly draw blood for testing, and check that the entire prescription is given • Example: you could make sure the correct blood flow rate is used, and explain why patients should stay on for the prescribed time.
Example: Vascular Access
• The vascular access guidelines give ways to check and preserve a patient's access.
• You can help protect patient's accesses when you use good technique to put in needles, help patients put the right pressure on needle sites after a treatment, and report problems with the access to a nurse or doctor right away.
• KDOQI guidelines have also been written for heart disease, CKD, nutrition, high blood pressure, bone disease, and lipid disorders.

DOPPS (The Dialysis Outcomes and Practice Patterns Study)
• Is a long term study of patients in 12 countries (Australia, Belgium, Canada, France, Germany, Japan, Italy, New Zealand, Spain, Sweden, the United Kingdom, and the United States).
• Goal: To help patients live longer by looking at practice patterns in centers.
• The data are used to help find treatment factors that can be changed to improve patient outcomes.

Guidelines for Dialysis Care - Related Hemodialysis Article


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