Issa Al Salmi|Maria Larkina|Wang Mia|Lalita Subramanian|Hal Morgenstern|Stefan H. Jacobson|Raymond M. Hakim|Francesca Tentori|Rajiv Saran|Takashi Akiba|Natalia Tomilina|Friedrich K. Port|Bruce M. Robinson|Ronald L. Pisoni
Missed Hemodialysis Treatments: International Variation, Predictors, and Outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Royal Hospital|Arbor Research Collaborative for Health|University of Michigan–Ann Arbor|Arbor Research Collaborative for Health|University of Michigan–Ann Arbor|Karolinska Institutet|Vanderbilt University|Arbor Research Collaborative for Health|Vanderbilt University|University of Michigan–Ann Arbor|Tokyo Women's Medical University|Moscow State University of Medicine and Dentistry|Arbor Research Collaborative for Health|University of Michigan–Ann Arbor|Arbor Research Collaborative for Health|University of Michigan–Ann Arbor|Arbor Research Collaborative for Health
rationale objectivemissed hemodialysis hd treatments due hospitalization associated poor clinical outcomes related part treatment nonadherence using data dialysis outcomes practice patterns study dopps phase 5 20122015 report findings international investigation missed treatments among patients prescribed thriceweekly hdstudy designprospective observational studysetting participants8501 patients participating dopps hd therapy 120 days 20 countries longitudinal crosssectional analyses performed based 4493 patients countries 4month missed treatment risk 5predictorsthe main predictor patient outcomes 1 missed treatments 4 months dopps phase 5 enrollment predictors missed treatments included country patient characteristics clinical factorsoutcomesmortality hospitalization laboratory measures patientreported outcomes 4month missed treatment riskanalytical approachoutcomes assessed using cox proportional hazards logistic linear regression adjusting casemix countryresultsthe 4month missed treatment risk varied 50fold across 20 dopps countries ranging 1 italy japan 24 united states missed treatments likely younger age less time dialysis therapy shorter hd treatment time lower ktv longer travel time hd centers symptoms depression missed treatments positively associated allcause mortality hr 168 95 ci 137205 cardiovascular mortality sudden deathcardiac arrest hospitalization serum phosphorus level 55 mgdl parathyroid hormone level 300 pgml hemoglobin level 10 gdl higher kidney disease burden worse general mental healthlimitationspossible residual confounding temporal ambiguity crosssectional analysesconclusionsin countries 4month missed treatment risk 5 hd patients likely die hospitalized poorer patientreported outcomes laboratory measures 1 missed treatments occurred 4month period large variation missed treatments across 20 nations suggests occurrence potentially modifiable especially united states countries missed treatment risk high missed hemodialysis hd treatments due hospitalization associated poor clinical outcomes related part treatment nonadherence using data dialysis outcomes practice patterns study dopps phase 5 20122015 report findings international investigation missed treatments among patients prescribed thriceweekly hd prospective observational study 8501 patients participating dopps hd therapy 120 days 20 countries longitudinal crosssectional analyses performed based 4493 patients countries 4month missed treatment risk 5 main predictor patient outcomes 1 missed treatments 4 months dopps phase 5 enrollment predictors missed treatments included country patient characteristics clinical factors mortality hospitalization laboratory measures patientreported outcomes 4month missed treatment risk outcomes assessed using cox proportional hazards logistic linear regression adjusting casemix country 4month missed treatment risk varied 50fold across 20 dopps countries ranging 1 italy japan 24 united states missed treatments likely younger age less time dialysis therapy shorter hd treatment time lower ktv longer travel time hd centers symptoms depression missed treatments positively associated allcause mortality hr 168 95 ci 137205 cardiovascular mortality sudden deathcardiac arrest hospitalization serum phosphorus level 55 mgdl parathyroid hormone level 300 pgml hemoglobin level 10 gdl higher kidney disease burden worse general mental health possible residual confounding temporal ambiguity crosssectional analyses countries 4month missed treatment risk 5 hd patients likely die hospitalized poorer patientreported outcomes laboratory measures 1 missed treatments occurred 4month period large variation missed treatments across 20 nations suggests occurrence potentially modifiable especially united states countries missed treatment risk high