Dialysis Outcomes and Practice Patterns Study estimate of patient life-years attributable to modifiable haemodialysis practices in Sweden

Abstract

Objective. To examine the association of adherence to Swedish Society of Nephrology guidelines on haemodialysis treatment and patient outcomes in Sweden. Material and methods. A prevalent cross-sectional sample of Swedish haemodialysis patients was obtained from the Dialysis Outcomes and Practice Patterns Study (DOPPS II, 2002–2004), an international, prospective, cohort study that investigates relationships between patient outcomes and haemodialysis practices. The sample was used to estimate life-years gained through adherence to six potentially modifiable practice patterns: dialysis dose, anaemia, serum phosphorus, serum calcium, serum albumin and catheter use for vascular access. Cox proportional hazards regression models were used to calculate the relative risk of mortality for all patients outside each guideline. Results. The practices resulting in the largest patient-year gains were increasing patient albumin above 35 g/l and reducing facility catheter use to below 10%. Compliance with the albumin target levels could save approximately 441 life-years (or as many as 904 years). Similarly, by 2010, 409 life-years (or as many as 837 years) could be saved if vascular access target levels were achieved. Conclusion. The analysis suggests potential opportunities to improve haemodialysis patient care in Sweden. Estimates of life-years saved may serve as motivation for the improvement of patient care through adherence to published guidelines supported by international data from the DOPPS.

Key Words::

• DOPPS
• guidelines
• haemodialysis
• life-year gain
• Sweden

Acknowledgements

The authors gratefully acknowledge support from Dr Staffan Schön and Dr Karl-Göran Prutz for their information about the Swedish renal registries SRAU and SDDB. The DOPPS is supported by scientific grants from Amgen and Kirin without restrictions on publications.