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    "textoCompleto" => "<p class="elsevierStylePara">To the editor&#58;</p><p class="elsevierStylePara">In response to the letter of Dr&#46; del Pozo et al&#46; the Group on Quality Management of the SEN wants to thank this kind of initiatives&#44; since one of the fundamental characteristics of all quality systems&#44; and in particular of defined indicators and standards&#44; is to be open to continuous reviews and changes&#46; For this reason a multicentric study is being currently carried out to validate the proposed quality indicators&#44; with the aim to analyze their feasibility and to know the actual standards in our setting&#46;</p><p class="elsevierStylePara">The study is ongoing&#44; but the participation is still open for all interested centers&#46; In fact&#44; one of the middleterm objectives is to have a registry available&#44; representative of current quality standards in Spain&#46; At this moment we possess modules of indicators measurement&#44; developed by the main computer programs employed in hemodialysis like Nefrosoft&#174; &#40;Visuallimes&#41; and Renalsoft&#174; &#40;Baxter&#41;&#44; and others that are being developed like Nefrolink&#174;&#46; With them it is easy to share the results&#46;</p><p class="elsevierStylePara">We agree with all the suggestions made by the group of Alcoy&#46; Our intention is to progressively change both the indicators and the standards&#44; as well as the monitoring periods&#44; in such a way that at the end they fit to our every-day practice&#46; Some defined standards are probably too ambitious but we hope that the multicentric study will helps to adjust them to the daily routine&#46; For example&#44; in the multicentric study the mean of the percentage of patients with Hb values &#62; 11 g&#47;dL was 81&#46;24 &#177; 9&#46;97 &#40;similar to what Dr&#46; del Pozo et al&#46; propose&#41; and the mean of the superior quartile was 93&#46;2&#37;&#46; The mean percentage of patients with Hb &#62; 13 g&#47;dL was 20&#37; of the total sample &#40;3142 patients&#41; with a big inter-center variability&#46; The aim is to maximize the percentage of patients with Hb values in a range between 11 and 12 g&#47;dL&#46; Considering the last recommendations we agree that it is necessary to include among the indicators the percentage of patients with Hb values &#62; 13 g&#47;dL</p><p class="elsevierStylePara">We also agree that phosphorus levels should be frequently measured&#44; and it seems logical that this measurement should be as frequent as&#44; or even more frequent than&#44; PTH determination&#46; In fact&#44; in the indicators module and in our study the periodicity for phosphorus determination was established on monthly base&#46; The preliminary data from the multicentric study for these indicators were&#58; 1&#41; compliance with PTH standard &#40;between 150 y 300 pg&#47;mL&#41; 32&#37; &#177; 10&#46;9 &#37;&#44; with some centers reaching 46&#37;&#59; 2&#41; compliance with phosphorus standard &#40;&#60; 5&#46;5 mg&#47;dL&#41; 70&#46;8&#37;&#44; with a maximum of 84&#46;4&#37;&#46;</p><p class="elsevierStylePara">With respect to the last issue about the inclusion of the blood pressure measurement as a priority indicator&#44; we would like to explain&#44; that it was not initially included because the standard of this indicator is not yet enough clear&#46; In a recent study<span class="elsevierStyleSup">1</span> the achievement of the blood pressure objective &#40;BP &#60; 140&#47;90&#41; in patients in hemodialysis was associated with a higher mortality risk&#44; while achievement of other indicators yielded favorable results&#46; We conclude that the objective for the BP is extrapolated from those in the general population&#44; and that randomized controlled studies are needed to identify the optimal blood pressure value in patients on hemodialysis&#46;</p><p class="elsevierStylePara">In summary&#44; this matter is open to discussion&#44; and in permanent change&#46; Every proposed indicator can only be used as an orientation&#46; With the results of the multicentric study and also with the different inputs&#44; the quality indicators monitoring system will be progressively defined&#46; <br></br></p>"
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Response to the letter about quality indicators
Respuesta a carta sobre indicadores de calidad
M.ª Dolores Arenas Jiméneza, F.. Álvarez Udea
a Hospital Perpetuo Socorro, Alicante, Alicante, España,
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Article information
ISSN: 20132514
Original language: English
DOI:
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