Morbidity and mortality of dialysis
NIH Consens Statement 1993 Nov 1-3;11(2):1-33 [0 references]
Not applicable: Guideline was not adapted from another source.
- Patients, including children, in the predialysis phase should be referred to a renal team consisting of a nephrologist, dietitian, nurse, social worker, and mental health professional in an effort to reduce the morbidity and mortality incurred during both the predialysis period and when receiving the subsequent dialysis therapy.
- The social and psychological welfare and the quality of life of the dialysis patient are favorably influenced by early predialytic and continued involvement of a multidisciplinary renal team.
- Attempts should be made through predialytic intervention and the appropriate initiation of dialysis access to avoid a catastrophic onset of dialysis.
- Quantitative methods to measure the delivered dose of hemodialysis and peritoneal dialysis have now been developed. These methods permit an objective evaluation of the relationship between the delivered dose of dialysis and patient morbidity and mortality. These methods suggest that the dose of hemodialysis and peritoneal dialysis has been suboptimal for many patients in the United States.
- Factors contributing to underdialysis of some patients include problems with vascular and peritoneal access, nonadherence to the dialysis prescription, and underprescription of the dialysis dose.
- Until prospective, randomized, controlled trials have been completed, a delivered hemodialysis dose at least equal to a measured K[subdr]t/V of 1.2 (single pool) and a delivered peritoneal dialysis dose at least equal to a measured K[subpr]t/V of 1.7 (weekly) are recommended.
- Cardiovascular mortality accounts for approximately 50 percent of deaths in dialysis patients. Relevant risk factors should be treated as soon as possible after diagnosis of chronic renal failure. These factors include hypertension, smoking, and chronic anemia.
- Patients with diabetes mellitus face especially severe cardiovascular risk, which contributes to reduced survival on dialysis.
- Malnutrition is another important co-morbid condition contributing to mortality. A serum albumin of less than 3.5 g/dL is clearly associated with increased relative risk. Early detection and treatment of malnutrition should substantially improve survival.
- Control of renal osteodystrophy requires patient adherence to the prescribed regimen and careful attention by the renal team to calcium and phosphorus intake and to the use of phosphate binders and calcitriol.
- Early creation of an A-V fistula is preferable to placement of a synthetic graft for vascular access. Both require an experienced, meticulous surgeon.
- Skilled management by nursing and other clinical personnel will help prolong the life of the vascular access.
- Attention to catheter design, placement, and care, and to exchange procedures can minimize infection in patients on peritoneal dialysis.
- Biocompatible dialysis membranes may reduce infection and amyloid deposition in hemodialysis patients, but evidence is inconclusive at present.
- Financial support to conduct clinical investigation, including outcomes and health services delivery research, should be Incorporated into the budgets of the Medicare End-Stage Renal Disease program, Health Care Financing Administration, Agency for Health Care Policy Research, and the Food and Drug Administration. This support will enable the conduct of studies that promise to improve morbidity and mortality, enhance cost-effective care, and create long-term financial savings in the Medicare ESRD program.
Office of Medical Applications of Research (OMAR) - Federal Government Agency [U.S.]
Consensus Development Panel
A nonadvocate, non-Federal 13-member panel representing the fields of general medicine, nephrology, pediatrics, biostatistics, nutrition, and nursing as well as the public.
Names of Panel Members: C. Craig Tisher, M.D.; Christine P. Bastl, M.D.; Bruce R. Bistrian, M.D.; Russell Chesney, M.D.; Cecil Coggins, M.D.; Marie Diener-West, Ph.D.; Darrell D. Fanestil, M.D.; Jared Grantham, M.D.; Robert Kunau, M.D.; Robert G. Luke, M.D.; Sandra L. Madison, R.N.; Manuel Martinez-Maldonado, M.D.; Richard Salick
This is the current release of the guideline.
This guideline has been reviewed by the developers within the last 5 years and is still considered to be current.
An update is not in progress.
Electronic copies: Available from the NIH Consensus Development Conference Program Web site at http://odp.od.nih.gov/consensus.
Print copies: Single copies are available from the NIH Consensus Development Program Information Center, PO Box 2577, Kensington, MD 20891; Tollfree phone (in U.S.), 1-888-NIH-CONSENSUS.
This summary was completed by ECRI on August 1, 1998. The information was verified by the guideline developer on December 1, 1998.
No copyright restrictions apply.