NDT Advance Access originally published online on July 5, 2005
Nephrology Dialysis Transplantation 2005 20(9):1854-1863; doi:10.1093/ndt/gfh972
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Variability in quality of care among dialysis units in western Switzerland
1 Division of Nephrology and 3 Quality of Care Unit, University Hospital of Geneva, 2 Division of Nephrology and 4 Quality of Care Unit, University Hospital of Lausanne, Switzerland and 5 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Centre, Philadelphia, PA, USA
Correspondence and offprint requests to: P. Saudan, Division of Nephrology, University Hospital, 1211 Geneva 14, Switzerland. Email: Patrick.Saudan{at}hcuge.ch
Background. Quality indicators for dialysis care vary across countries and regions, but regional variability across centres has received little attention. We analysed variations in quality indicators among dialysis facilities in western Switzerland to identify opportunities for improving care for patients with end-stage kidney disease.
Methods. A cross-sectional study of 617 dialysis patients treated at 19 facilities examined the distribution of indicators of quality of care addressing: adequacy of dialysis (Kt/V 
1.2 for haemodialysis, Kt/V 2 for peritoneal dialysis), anaemia control (haemoglobin 110 g/l), calcium and phosphate control (product 
4.4 mmol2/l2), adequate nutrition (serum albumin >35 g/l), hypertension control (pre-dialysis blood pressure <140/90 mmHg) and type of vascular access. Centre quality targets were the following: achievement of quality criteria for 80% of their patients, except 85% for anaemia control and 60% for arterio-venous fistulae.
Results. Most centres fulfilled quality targets for dialysis adequacy, but substantial variations existed among centres (haemodialysis, 76%, range 36–100; peritoneal dialysis, 76%, range 33–100). Results were similar for anaemia (77%, range 35–100), calcium x phosphate product (69%, range 29–92), albumin (63%, range 26–95), hypertension control (33%, range 13–54) and arterio-venous fistula (61%, range 49–92). The between-centre variability was significantly greater than would be expected by chance, for all indicators. Dialysis facilities with >40 patients better fulfilled quality targets than university-based centres. Adjustment for patient characteristics did not modify these results.
Conclusions. Substantial variations in quality indicators existed between dialysis centres in western Switzerland, which could not be attributed to different centre policies, or to differences in available measures of patient case mix. These findings indicate opportunities for improvement in dialysis practice which may translate into improved clinical outcomes.
Keywords: dialysis; end-stage renal failure; quality assessment; quality of care
*P. Saudan and G. Halabi contributed equally to this work.
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