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Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS).

https://arctichealth.org/en/permalink/ahliterature179525
Source
Am J Kidney Dis. 2004 Jul;44(1):94-111
Publication Type
Article
Date
Jul-2004
Author
Ronald L Pisoni
Jennifer L Bragg-Gresham
Eric W Young
Tadao Akizawa
Yasushi Asano
Francesco Locatelli
Juergen Bommer
Jose Miguel Cruz
Peter G Kerr
David C Mendelssohn
Philip J Held
Friedrich K Port
Author Affiliation
University Renal Research and Education Association, Ann Arbor, MI, USA. rlpisoni@urrea.org
Source
Am J Kidney Dis. 2004 Jul;44(1):94-111
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Anemia - drug therapy - etiology - metabolism - mortality
Australasia
Canada
Erythropoietin - administration & dosage
Europe
Hemoglobins - analysis
Hospitalization - statistics & numerical data
Humans
Injections, Intravenous
Iron - administration & dosage
Male
Physician's Practice Patterns - statistics & numerical data
Renal Dialysis - adverse effects
Survival Rate
Treatment Outcome
United States
Abstract
Anemia is common in hemodialysis (HD) patients.
Data collected from nationally representative samples of HD patients (n = 11,041) in 2002 to 2003 were used to describe current anemia management for long-term HD patients at 309 dialysis units in 12 countries. Analyses of associations and outcomes were adjusted for demographics, 15 comorbid classes, laboratory values, country, and facility clustering.
For patients on dialysis therapy for longer than 180 days, 23% to 77% had a hemoglobin (Hgb) concentration less than 11 g/dL ( or =110 g/L) if they were older; were men; had polycystic kidney disease; had greater albumin, transferrin saturation, or calcium levels; were not dialyzing with a catheter; or had lower ferritin levels. Facilities with greater intravenous iron use showed significantly greater facility mean Hgb concentrations. Mean EPO dose varied from 5,297 (Japan) to 17,360 U/wk (United States). Greater country mean EPO doses were significantly associated with greater country mean Hgb concentrations. Several patient characteristics were associated with greater EPO doses. Even in some countries with high intravenous iron use, 35% to 40% of patients had a transferrin saturation less than 20% (below guidelines).
These findings indicate large international variations in anemia management, with significant improvements during the last 5 years, although many patients remain below current anemia guidelines, suggesting large and specific opportunities for improvement.
PubMed ID
15211443 View in PubMed
Less detail

DOPPS estimate of patient life years attributable to modifiable hemodialysis practices in Canada.

https://arctichealth.org/en/permalink/ahliterature164201
Source
Nephrol News Issues. 2007 Apr;21(5):69-70, 72, 74-6 passim
Publication Type
Article
Date
Apr-2007
Author
David C Mendelssohn
Karen E Yeates
Jean Ethier
Lilyanna Trpeski
Yingbo Na
Jennifer L Bragg-Gresham
Margaret A Eichleay
Ronald L Pisoni
Fritz K Port
Author Affiliation
University of Toronto, Ontario, Canada.
Source
Nephrol News Issues. 2007 Apr;21(5):69-70, 72, 74-6 passim
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Attitude to Health
Canada
Humans
Life expectancy
Quality Assurance, Health Care
Renal Dialysis - mortality - standards - statistics & numerical data
Treatment Outcome
Abstract
We examined data from the Canadian Organ Replacement Registry, and from a special substudy of CORR, to determine whether changes have occurred in practice patterns before and after the 1999 Canadian Society of Nephrology guidelines were published. Second, we used data from the Dialysis Outcomes and Practice Patterns Study to calculate the impact of observed deviations from guideline targets and estimated potential gains in life years that might accrue if guideline targets were achieved in all Canadian hemodialysis patients. For dialysis dose and hemoglobin targets, there was a significant improvement in Canadian facility performance over time. On the other hand, vascular access care showed a worse pattern with increased catheter use. A calculation of attributable risk, which assumes causality, suggests that 49 percent of deaths could be averted if all patients currently outside the guidelines achieved them over the next five years. When expressed as an annual death rate per hundred patient years, this corresponds to a decrease from 18 to 10.1 deaths per 100 patient years. We conclude that promoting a facility-based culture of quality improvement based on achievement of guideline targets is supported by international and Canadian observational data from the DOPPS. In the future, the impact of such an approach should be assessed empirically by correlating changes in practice over time with changes in outcomes.
PubMed ID
17427445 View in PubMed
Less detail

Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II).

https://arctichealth.org/en/permalink/ahliterature171801
Source
Nephrol Dial Transplant. 2006 Mar;21(3):721-8
Publication Type
Article
Date
Mar-2006
Author
David C Mendelssohn
Jean Ethier
Stacey J Elder
Rajiv Saran
Friedrich K Port
Ronald L Pisoni
Author Affiliation
Division of Nephrology, Humber River Regional Hospital, University of Toronto, Weston, ON, Canada. dmendelssohn@hrrh.on.ca
Source
Nephrol Dial Transplant. 2006 Mar;21(3):721-8
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Arteriovenous Shunt, Surgical - statistics & numerical data
Canada
Catheters, Indwelling - statistics & numerical data
Equipment Failure - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Humans
Incidence
Kidney Failure, Chronic - therapy
Male
Middle Aged
Prospective Studies
Renal Dialysis - instrumentation - standards - statistics & numerical data
Abstract
The optimal vascular access for chronic maintenance haemodialysis (HD) is the native arteriovenous fistula (AVF). Vascular access practice patterns are reported for a Canadian cohort of patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS II).
DOPPS II is a prospective, observational study in 12 countries, including Canada. A representative random sample of 20 Canadian HD facilities and patients within those units were studied during 2002-2004. Canadian results were compared with those found in Europe and the USA.
AVF use in Canadian prevalent (53%) and incident (26%) patients was lower than Canadian guidelines recommend (60%), and lower than in Europe [prevalent (74%), incident (50%)]. Despite 85% of Canadian HD patients having seen a nephrologist for > 1 month prior to starting dialysis, central venous catheter use in Canada (33% in prevalent patients, 70% in incident patients) was much higher than in Europe (prevalent 18%, incident 46%) and slightly higher than in the USA (prevalent 25%, incident 66%). This pattern is contrary to the preferences of Canadian medical directors and vascular access surgeons. The typical time from referral until permanent vascular access creation is substantially longer in Canada (61.7 days) than in Europe (29.4 days) or the USA (16 days). This longer delay time and higher catheter use in Canada may be a consequence of the significantly lower number of access surgeons per 100 HD patients in Canada (2.9) compared with the USA (8.1) and Europe (4.6). Furthermore, the median hours per week devoted to vascular access-related surgery per 100 patients is substantially lower in Canada (0.027 h) compared with the USA (0.082 h) and Europe (0.059 h).
These findings suggest that Canadian chronic HD patients often rely on central venous catheters for vascular access, despite their known association with numerous detrimental outcomes in HD. Nephrologists, vascular access surgeons, interventional radiologists, other physicians and health care funding bodies must be more broadly educated about the priority of AVF creation as the preferred vascular access for chronic HD patients. They must work together to secure both the human and financial resources and other health care system enhancements to increase AVF creation rates in a timely manner.
PubMed ID
16311264 View in PubMed
Less detail

Optimizing hemodialysis practices in Canada could improve patient survival.

https://arctichealth.org/en/permalink/ahliterature161943
Source
CANNT J. 2007 Apr-Jun;17(2):22-34
Publication Type
Article
Author
Karen E Yeates
David C Mendelssohn
Jean Ethier
Lilyanna Trpeski
Jingbo Na
Jennifer L Bragg-Gresham
Margaret A Eichleay
Ronald L Pisoni
Fritz K Port
Author Affiliation
Division of Nephrology at Queen's University Kingston, Ontario.
Source
CANNT J. 2007 Apr-Jun;17(2):22-34
Language
English
French
Publication Type
Article
Keywords
Canada - epidemiology
Guideline Adherence - organization & administration
Health services needs and demand
Health Services Research
Humans
Kidney Failure, Chronic - mortality - therapy
Nephrology - organization & administration
Organizational Innovation
Outcome Assessment (Health Care)
Physician's Practice Patterns - organization & administration
Practice Guidelines as Topic
Renal Dialysis - adverse effects - methods - mortality - standards
Societies, Medical
Survival Rate
Total Quality Management - organization & administration
Abstract
Data from the Canadian Organ Replacement Registry (CORR) and the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to determine whether practice patterns have changed in Canada since the introduction of the Canadian Society of Nephrology (CSN) Guidelines in 1999. DOPPS data were then used to calculate the impact of not meeting the proposed guideline targets and to estimate the potential life years gained if all Canadian hemodialysis patients achieved guideline targets. For dialysis dose and hemoglobin targets, Canadian facility performance has significantly improved over time. The vascular access use patterns show trends toward a worse pattern with increased catheter use. A calculation of the percentage of attributable risk suggests that 49% of deaths could possibly be averted if all patients currently outside the guidelines achieved them over the next five years. This corresponds to a decrease in the annual death rate from 18 to 10.1 per hundred patient years. These data support the need for improved adherence to guidelines. If Canadian caregivers were to optimize practice patterns, patient outcomes could be improved.
PubMed ID
17691708 View in PubMed
Less detail

Reliability and validity of the coping strategy inventory-short form applied to hemodialysis patients in 13 countries: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

https://arctichealth.org/en/permalink/ahliterature285545
Source
J Psychosom Res. 2016 Dec;91:12-19
Publication Type
Article
Date
Dec-2016
Author
Elodie Speyer
Hal Morgenstern
Yasuaki Hayashino
Peter G Kerr
Hugh Rayner
Bruce M Robinson
Ronald L Pisoni
Source
J Psychosom Res. 2016 Dec;91:12-19
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adolescent
Adult
Aged
Aged, 80 and over
Australia
Canada
Cohort Studies
Cost of Illness
Cross-Cultural Comparison
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic - psychology - therapy
Male
Middle Aged
Personality Inventory - statistics & numerical data
Pilot Projects
Prospective Studies
Psychometrics - statistics & numerical data
Renal Dialysis - psychology
Reproducibility of Results
Sweden
Young Adult
Abstract
The Coping Strategies Inventory-Short Form (CSI-SF) measures four coping strategies based on 16 items: 4 items each indicating problem- vs. emotion-focused engagement or disengagement. Here we provide the first assessment of reliability and construct validity of the CSI-SF among hemodialysis patients across 13 countries.
The CSI-SF was completed by patients in 9 languages in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-11). Cronbach's alpha was used to assess internal consistency. Exploratory and confirmatory factor analyses were applied to assess the factor structure of the CSI-SF by country and language. CSI-SF data were analyzed from 7201 patients (60% male; median age 62.5 [range 18-96] years).
Good internal consistency (a=0.56-0.80) was seen for three scales in English (US, UK, Canada, Australia, New Zealand), German, and Swedish versions. The fourth scale was internally consistent if two items were dropped. In these countries, both exploratory and confirmatory factor analyses indicated a factor structure consistent with the four CSI-SF scales. Other language versions showed a factor structure inconsistent with these four scales.
The slightly modified English, German, and Swedish versions of the CSI-SF are reliable and valid instruments for measuring coping strategies in hemodialysis patients.
PubMed ID
27894457 View in PubMed
Less detail

Selected lessons learned from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

https://arctichealth.org/en/permalink/ahliterature45698
Source
Contrib Nephrol. 2005;149:58-68
Publication Type
Article
Date
2005
Author
Ronald L Pisoni
Roger N Greenwood
Author Affiliation
University Renal Research and Education Association, Ann Arbor, Michigan, USA.
Source
Contrib Nephrol. 2005;149:58-68
Date
2005
Language
English
Publication Type
Article
Keywords
Anemia - etiology - therapy
Arteriovenous Shunt, Surgical - utilization
Catheters, Indwelling - utilization
Depression - diagnosis - etiology
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Minerals - metabolism
Multicenter Studies
Nutrition
Renal Dialysis - adverse effects - methods - mortality - psychology
Treatment Outcome
Abstract
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study of the relationships between hemodialysis (HD) patient outcomes and HD treatment practices. The DOPPS began in 1996 in the United States, expanding to France, Germany, Italy, Japan, Spain, and the United Kingdom in 1998-1999, and then to Australia, Belgium, Canada, New Zealand, and Sweden in 2002. More than 300 dialysis units have participated in the DOPPS since 1996, with mortality data collected from nearly 90,000HD patients and detailed longitudinal data from nearly 30,000 HD patients. Large sample size and the large treatment practice variation observed in the DOPPS--given its international scope of participation--provide strong statistical power to investigate many different HD practices. Furthermore, the detailed patient data collected in the DOPPS allow relationships to account for differences in a large number of patient characteristics. More than 55 papers have been published from the DOPPS; here we provide a summary of selected DOPPS findings regarding nutrition, mineral metabolism, anemia management, vascular access, depression, and use of multivitamins and statins.
PubMed ID
15876829 View in PubMed
Less detail

6 records – page 1 of 1.