Knowing what we do and doing what we should: quality assurance in hemodialysis.

An international group of around 50 nephrologists and scientists, including representatives from large dialysis provider organisations, formulated recommendations on how to develop and implement quality assurance measures to improve individual hemodialysis patient care, population health and cost effectiveness. Discussed were methods thought to be of highest priority, those clinical indicators which might be most related to meaningful patient outcomes, tools to control treatment delivery and the role of facilitating computerized expert systems. Emphasis was given to the use of new technologies such as measurement of online dialysance and ways of assessing fluid status.

Replacement of acetate with citrate in dialysis fluid: a randomized clinical trial of short term safety and fluid biocompatibility.

Background: The majority of bicarbonate based dialysis fluids are acidified with acetate. Citrate, a well known anticoagulant and antioxidant, has been suggested as a biocompatible alternative. The objective of this study was to evaluate short term safety and biocompatibility of a citrate containing acetate-free dialysis fluid.

Formulation of a dry weight bioimpedance index in hemodialysis patients.

Hydration status has a major impact on hemodialysis (HD) patients. Overhydration is related to hypertension, pulmonary and peripheral edema, and other cardiovascular events; while dehydration is related to hypotension, and other severe ischemic symptoms. All result in increased morbidity and mortality.

Monitor turnaround time and time efficiency in hemodialysis delivery--a global comparison.

Background/aims: Increasing cost pressure has forced shortening of dialysis treatments. The aim of this study was to benchmark the hemodialysis (HD) delivery monitor turnaround time and time efficiency in a global comparison.

Methods: 683 HD deliveries in 26 Gambro Healthcare clinics in Europe, Taiwan and the USA were assessed using the Treatment Mapping methodology.

Treatment mapping--a systematic methodology to assess quality, efficiency and variability in the hemodialysis delivery process.

Background/aims: Radical thinking about the design of industrial processes has greatly improved the quality and efficiency of manufacturing and services. Applying similar methods in healthcare to deliver quality care at lower costs would be valuable.

Methods: We have developed and validated a methodology--Treatment Mapping--to analyze the hemodialysis (HD) delivery as an operational process.