Effects of dialysate to serum sodium (Na) alignment in chronic hemodialysis (HD) patients: retrospective cohort study from a quality improvement project.

Background: Evidence indicates favorable effects of dialysate (DNa) to serum sodium concentration (SNa) alignment, however, results from larger sample populations are needed. For this reason, we conducted a retrospective propensity score-matched cohort study from a quality improvement project to investigate the effects of alignment on population of maintenance hemodialysis patients.

Methods: At 4 participating hemodialysis (HD) clinics, patients with SNa lower than the standard DNa of 137 mEq/L who received HD with DNa aligned to the average of the last 4 SNa measurements were evaluated (clinicaltrials.

Performance of the Surprise Question Compared to Prediction Models in Hemodialysis Patients: A Prospective Study.

Background: The surprise question (SQ) ("Would you be surprised if this patient were still alive in 6 or 12 months?") is used as a mortality prognostication tool in hemodialysis (HD) patients. We compared the performance of the SQ with that of prediction models (PMs) for 6- and 12-month mortality prediction.

Methods: Demographic, clinical, laboratory, and dialysis treatment indicators were used to model 6- and 12-month mortality probability in a HD patients training cohort (n = 6,633) using generalized linear models (GLMs).

A year-long quality improvement project on fluid management using blood volume monitoring during hemodialysis.

Background: Inadequate removal of extracellular volume markedly increases blood pressure and contributes to high morbidity and mortality in hemodialysis patients. Advances in fluid management are needed to improve clinical outcomes. The aim of this quality improvement project was to examine the advantages of using a hematocrit-based, blood volume monitor (Crit-Line * ) for 12 months, as part of a clinic-wide, fluid management program in one dialysis facility.

Methods and challenges for the practical application of Crit-Line™ monitor utilization in patients on hemodialysis.

The Crit-Line™ monitor measures relative changes in intravascular blood volume during hemodialysis. The device is also used to monitor hematocrit and oxygen saturation. Using this device to decrease fluid volume has yielded inconsistent results on outcome measures such as hospitalization rates, erythropoietin utilization, and blood pressure reduction.

Seasonal variations in mortality, clinical, and laboratory parameters in hemodialysis patients: a 5-year cohort study.

Background And Objectives: Mortality varies seasonally in the general population, but it is unknown whether this phenomenon is also present in hemodialysis patients with known higher background mortality and emphasis on cardiovascular causes of death. This study aimed to assess seasonal variations in mortality, in relation to clinical and laboratory variables in a large cohort of chronic hemodialysis patients over a 5-year period.

Design, Setting, Participants, & Measurements: This study included 15,056 patients of 51 Renal Research Institute clinics from six states of varying climates in the United States.

The practical problem of improving quality in multicenter dialysis facilities.

Multifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit.