Introduction and Aims:
In developed countries, 0.07% of population receives chronic hemodialysis. This number is expected to rise. This demand renders risk management
and quality control essential for dialysis management.
Our prospective observational study presents a different approach for this issue, adding clinical and patient-care parameters to laboratory criteria.
Patients and Methods:
We examined 132 chronic hemodialysis patients: 28% female, 70.1±13.7 years of age, dialysis vintage: 5.19±2.0 years. Events recorded for a 12 month
period were: shock, pulmonary edema, pericardial effusion, vascular access: failure, infection, and hemoglobin (Hb) extremities. Severity of each
parameter was indicated by: need for acute definitive intervention, hospitalization, death. Data were analyzed to identify predictors of each outcome.
Results:
Common Events: shock (8.4%) and extreme Hb values (32.8%). Serum transferrin level, but not transferrin saturation, was associated with increased
incidence of shock. The factor most strongly associated with studied outcomes is dialysis shift. Vascular access failure and pericardial effusion were
both more frequently observed in patients on morning-shift. Event-related hospitalization was more frequent in patients on-morning shift and among
patients with post dialysis hypertension.
Conclusions:
Dialysis shift, certain clinical, medication, inflammation-reactant and facility related factors, are quality of care measures, influencing wellbeing in
chronic hemodialysis.
Author(s): Ze'ev Katzir, Relu Cernes, Alexander Biro, Zvi Barnea, Zehavit Ziv-Ner and Iga Shmain-Naidanov