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Titolo:
BARRIERS TO ADEQUATE DELIVERY OF HEMODIALYSIS
Autore:
SEHGAL AR; SNOW RJ; SINGER ME; AMINI SB; DEOREO PB; SILVER MR; CEBUL RD;
Indirizzi:
METROHLTH MED CTR,DIV NEPHROL,2500 METROHLTH DR CLEVELAND OH 44109 CASE WESTERN RESERVE UNIV,DEPT MED CLEVELAND OH 44106 CASE WESTERN RESERVE UNIV,DEPT BIOSTAT & EPIDEMIOL CLEVELAND OH 44106 CASE WESTERN RESERVE UNIV,CTR BIOMED ETH CLEVELAND OH 44106 CASE WESTERN RESERVE UNIV,METROHLTH MED CTR,CTR HLTH CARE RES & POLICY,INST PUBL HLTH SCI CLEVELAND OH 00000 PEER REVIEW SYST INC WESTERVILLE OH 00000 UNIV HOSP CLEVELAND,DIV NEPHROL CLEVELAND OH 44106 CTR DIALYSIS CARE CLEVELAND OH 00000
Titolo Testata:
American journal of kidney diseases
fascicolo: 4, volume: 31, anno: 1998,
pagine: 593 - 601
SICI:
0272-6386(1998)31:4<593:BTADOH>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
STAGE RENAL-DISEASE; NATIONAL COOPERATIVE DIALYSIS; HEALTH-CARE; UNITED-STATES; PREDICTORS; MORBIDITY; MORTALITY; SURVIVAL; THERAPY; QUALITY;
Keywords:
ADEQUACY OF DIALYSIS; NONCOMPLIANCE; PRESCRIPTION; CATHETERS; CLOTTING;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
36
Recensione:
Indirizzi per estratti:
Citazione:
A.R. Sehgal et al., "BARRIERS TO ADEQUATE DELIVERY OF HEMODIALYSIS", American journal of kidney diseases, 31(4), 1998, pp. 593-601

Abstract

Mortality rates among American hemodialysis patients are the highest in the industrialized world. Measures of delivered dialysis (Kt/V) correspond strongly with survival and are estimated to be inadequate in one third of patients, We sought to determine the importance of potential barriers to adequate dialysis, including patient-related and technical factors, Using a cross-sectional study design, we abstracted the charts of 721 randomly selected patients from all 22 chronic hemodialysis units in northeast Ohio. For each of 1,836 treatments provided to these patients, we assessed delivered dialysis (Kt/V) and patient-related factors tie, hypotension, intradialytic symptoms, and treatment time missed due to noncompliance or transportation problems) and technical factors tie, dialysis prescription, type of vascular access, clotting, and dialyzer reuse), We used hierarchical regression analysis to determine which potential barriers were independently related to delivered dialysis after adjustment for patient demographic and medical characteristics. Barriers independently related to dialysis delivery (all Pvalues <0.001) included patient noncompliance, present in 3% of treatments; low dialysis prescription, 14%; use of a catheter for vascular access, 11%; and clotting, 1%, The prevalence of identified barriers varied dramatically across facilities leg, the prevalence of low dialysis prescription ranged from 0% to 37%, while the prevalence of catheter use ranged from 3% to 28%), In conclusion, patient noncompliance, low dialysis prescription, catheter use, and clotting are the most important barriers to dialysis delivery, Further work is needed to develop interventions to overcome these barriers and to determine the effect of such interventions on dialysis adequacy and patient survival. (C) 1998 by the National Kidney Foundation, Inc.

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Documento generato il 22/09/20 alle ore 12:32:43