DOPPS estimate of patient life years attrributable to modifiable hemodialysis practices in Spain
Estimación, según el estudio DOPPS, de los años de vida de pacientes atribuibles a las prácticas de hemodiálisis modificables en España
Luis Piera, José Miguel Cruz, Jennifer L. Bragg-Gresham, Margaret A. Eichleay, Ronald L. Pisoni, Friedrich K. Port
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Bragg-Gresham, Margaret A. Eichleay, Ronald L. Pisoni, Friedrich K. Port" "autores" => array:1 [ 0 => array:1 [ "nombre" => "Luis Piera, José Miguel Cruz, Jennifer L. Bragg-Gresham, Margaret A. Eichleay, Ronald L. Pisoni, Friedrich K. Port" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estimación, según el estudio DOPPS, de los años de vida de pacientes atribuibles a las prácticas de hemodiálisis modificables en España" ] ] "pdfFichero" => "P-E-S-A4556-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:3 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436260" ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436261" "palabras" => array:1 [ 0 => "mortality risk guidelines calcium values albumin anemia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "The increased mortality risk in hemodialysis (HD) patients unable to meet six targets in different areas of HD practice has been reported previously. Using a prevalent cross-sectional sample of Spanish HD patients (n = 613) from the second stage of the Dialysis Outcomes and Practice Patterns Study to determine the percentage with low dialysis dose, hyperphosphatemia, hypercalcemia, hypoalbuminemia, anemia, and catheter use and based on the mortality hazard ratios and the total HD population in Spain, according to the Spanish Society of Nephrology Report, we estimated the number of patient life years that could potentially be gained in our country. These characteristics of HD practice were selected because each is modifiable through changes in practice, each is associated with mortality, and each has a large number of patients outside the target guidelines. The targets that define ¿within guidelines¿ are as follows: dialysis dose (single pool Kt/V >1.2), anemia (hemoglobin >110 g/L), albumin after standardization (>40 g/L), serum phosphorus (1.1-1.5 mmol/L), serum calcium (2.1-2.4 mmol/L), and facility catheter use ( <10 cox proportional hazards regression models were used to calculate the relative risk of mortality for all patients outside each guideline in calcium values adjusted low serum albumin a separate survival model six hd practices simultaneously account correlation that may exist between some facility age sex race time on esrd and 14 summary comorbid conditions patient years attributable practice patterns estimated are reported here as potential gained comparison estimates by individual shows spain increasing above 40 g l would lead an gain 9 269 7 increase additionally if facilities could decrease catheter use less than 10 2 842 be 4 though it unrealistic goal spanish currently guidelines achieved target levels 17 300 life over next five 15 more achievable bringing 50 who targets within result 266 conclusion this analysis suggests large opportunities improve care</10>" ] "es" => array:1 [ "resumen" => "El creciente riesgo de mortalidad en los pacientes sometidos a hemodiálisis (HD) que son incapaces de alcanzar seis objetivos en diferentes áreas de práctica de HD ya se había constatado anteriormente. Mediante el uso de una muestra representativa actual de pacientes españoles sometidos a HD (n = 613) obtenida de la segunda fase del Estudio de Pautas de Práctica y Resultados de Diálisis para determinar el porcentaje de pacientes con dosis de diálisis bajas, hiperfosfatemia, hipercalcemia, hipoalbuminemia, anemia y uso de catéteres, y en función de los coeficientes de riesgo de mortalidad y de la población total sometida a HD en España, de acuerdo con el Informe de la Sociedad Española de Nefrología, hemos calculado el número de años de vida de paciente que podrían obtenerse en nuestro país. Estas características de la práctica de hemodiálisis se seleccionaron porque cada una es modificable mediante cambios en la práctica, cada una está asociada a la mortalidad, y cada una presenta un gran número de pacientes fuera de las directrices objetivo. Los objetivos que definen la expresión ¿dentro de las directrices¿ son los siguientes: dosis de diálisis (Kt/V de compartimiento único >1,2), anemia (hemoglobina >110 g/l), albúmina después de la estandarización (>40 g/l), fósforo en suero (1,1-1,5 mmol/l), calcio en suero (2,1-2,4 mmol/l) y uso de catéteres en los centros ( <10 se utilizaron modelos de regresión riesgos proporcionales cox para calcular el riesgo mortalidad relativo todos los pacientes situados fuera cada directriz en valores calcio ajustaron niveles bajos albúmina suero un modelo separado supervivencia ajustó las seis prácticas hd simultáneamente tener cuenta la correlación que podría existir entre algunas centros factores edad sexo raza tiempo esrd y 14 condiciones comorbilidad resumidas calcularon años-persona atribuibles a una pautas práctica presentan aquí como pueden obtenerse potencialmente comparación estimaciones por pauta individual pone manifiesto españa aumento del nivel encima 40 g l daría lugar aproximado 9 269 incremento 7 asimismo si redujesen uso catéteres menos 10 podrían 2 842 4 aunque puede ser objetivo poco realista españoles encuentran actualmente directrices alcanzasen aproximadamente 17 300 años vida durante próximos cinco 15 más factible saber conseguir 50 no alcanzan objetivos alcancen resultado 266 concluir este análisis parece indicar existen grandes oportunidades mejorar cuidado prestado clientes sometidos</10>" ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002700000004/v0_201502091551/X2013251407021535/v0_201502091551/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002700000004/v0_201502091551/X2013251407021535/v0_201502091551/en/P-E-S-A4556-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251407021535?idApp=UINPBA000064" ]
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