Improvements in dialysis patient mortality are associated with improvements in urea reduction ratio and hematocrit, 1999 to 2002

Am J Kidney Dis. 2005 Jan;45(1):127-35. doi: 10.1053/j.ajkd.2004.09.023.


Background: Benefits in terms of reductions in mortality corresponding to improvements in Kidney Disease Outcomes Quality Initiative (K/DOQI) compliance for adequacy of dialysis dose and anemia control have not been documented in the literature. We studied changes in achieving K/DOQI guidelines at the facility level to determine whether those changes are associated with corresponding changes in mortality.

Methods: Adjusted mortality and fractions of patients achieving K/DOQI guidelines for urea reduction ratios (URRs; > or =65%) and hematocrit levels (> or =33%) were computed for 2,858 dialysis facilities from 1999 to 2002 using national data for patients with end-stage renal disease. Linear and Poisson regression were used to study the relationship between K/DOQI compliance and mortality and between changes in compliance and changes in mortality.

Results: In 2002, facilities in the lowest quintile of K/DOQI compliance for URR and hematocrit guidelines had 22% and 14% greater mortality rates (P < 0.0001) than facilities in the highest quintile, respectively. A 10-percentage point increase in fraction of patients with a URR of 65% or greater was associated with a 2.2% decrease in mortality (P = 0.0006), and a 10-percentage point increase in percentage of patients with a hematocrit of 33% or greater was associated with a 1.5% decrease in mortality (P = 0.003). Facilities in the highest tertiles of improvement for URR and hematocrit had a change in mortality rates that was 15% better than those observed for facilities in the lowest tertiles (P < 0.0001).

Conclusion: Both current practice and changes in practices with regard to achieving anemia and dialysis-dose guidelines are associated significantly with mortality outcomes at the dialysis-facility level.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anemia / prevention & control*
  • Guideline Adherence
  • Hematocrit / standards
  • Hematocrit / statistics & numerical data
  • Hemodialysis Units, Hospital / trends
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / therapy
  • Practice Guidelines as Topic / standards
  • Proportional Hazards Models
  • Quality Assurance, Health Care / methods
  • Quality Assurance, Health Care / statistics & numerical data
  • Renal Dialysis / mortality*
  • Renal Dialysis / standards
  • Retrospective Studies
  • Survival Analysis
  • United States / epidemiology
  • Urea / blood*


  • Urea