Original InvestigationDialysisFacility-Level Interpatient Hemoglobin Variability in Hemodialysis Centers Participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS): Associations With Mortality, Patient Characteristics, and Facility Practices
Section snippets
Data Sources
Primary analyses were based on 26,510 randomly selected maintenance hemodialysis patients 18 years or older from DOPPS I (1996-2001), II (2002-2004), and III (2005-2008) who had end-stage renal disease at least 180 days before study entry. Patients receiving dialysis for fewer than 180 days were excluded from our analyses to allow stabilization of patient hemoglobin during the first 6 months of hemodialysis therapy.16, 17 DOPPS is a prospective cohort study including nationally representative
Variation in Facility-Level Hemoglobin SD
Facility-level hemoglobin SD varied more than 5-fold across facilities (range, 0.51-2.72 g/dL; median, 1.27 g/dL; Fig 1). A nearly identical distribution in facility-level hemoglobin SD was seen when restricting to facilities reporting hemoglobin values for 15 or more patients or excluding patients hospitalized in the 3 months before calculation of facility-level hemoglobin SD. Facility-level hemoglobin SD was only marginally higher in facilities with higher mean hemoglobin (+0.022 g/dL per
Discussion
These results show substantially higher mortality rates for hemodialysis patients dialyzing in facilities with larger interpatient hemoglobin variation, defined as the SD in hemoglobin values in patients within a cross-section of facility hemodialysis patients. Overall, an 8% higher mortality rate was observed for every 0.5-g/dL greater facility-level hemoglobin SD in DOPPS after adjustment for numerous patient characteristics and facility practices. These findings essentially were unchanged by
Acknowledgements
We acknowledge the great efforts and contributions of the study nurses, physicians, medical directors, and patients from the more than 300 dialysis units that participated in each phase of the DOPPS; helpful comments and suggestions of Dr Eric J. Will, St James's University Hospital, Leeds, UK, during manuscript preparation; Jennifer McCready-Maynes for editorial assistance; and the CMS for the authorized use of CMS data for this investigation. Preliminary reports of some of this work have been
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