Nephrol Dial Transplant (2004) 19: 100-107
© European Renal Association–European Dialysis and Transplant Association
Original Article
Haemodialysis prescription, adherence and nutritional indicators in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
1Clinic for Nephrology, Hypertension and Dialysis, Augusta-Kranken-Anstalt, Ruhr University, Bochum, Germany, 2University Renal Research and Education Association, 8Department of Veterans Affairs Medical Center and Division of Nephrology, University of Michigan, Ann Arbor, MI, 7Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA, 3Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, 6Department of Renal Medicine, Lister Hospital, Stevenage, UK, 4Department of Nephrology, Universita Federico II, Naples, Italy and 5Nephrology and Haemodialysis Service, Hôpital St-André, Bordeaux, France
Correspondence and offprint requests to: Dr Friedrich K. Port, MD, MS, University Renal Research and Education Association, 315 W. Huron St, Suite 260, Ann Arbor, MI 48103, USA. Email: fport{at}urrea.org
Background. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study designed to evaluate practice patterns in random samples of haemodialysis facilities and patients across three continents. Participating countries include France, Germany, Italy, Spain and the UK (Euro-DOPPS), Japan and the USA. DOPPS data collection has used the same questionnaires and protocols across all participating countries to assess components of dialysis therapy and outcomes. This study focuses on dialysis prescription, adherence and nutrition among the Euro-DOPPS countries.
Methods. In each Euro-DOPPS country, patients were selected randomly from 20–21 representative facilities. Simple means and frequencies were calculated to compare relevant data elements to gain insights into differences in therapeutic aspects among nationally representative patients. Participants entering the study within 90 days of beginning dialysis therapy were excluded from these analyses.
Results. Among the five countries, mean delivered dose as measured by normalized urea clearance (Kt/V) varied from 1.28 to 1.50 and was accompanied by differences in dialysis prescription components, including blood flow rates, treatment times, and dialyser membrane and flux characteristics. By country, a nearly 2-fold difference was observed in indicators of patient adherence and management (skipping and shortening dialysis, hyperkalaemia, hyperphosphataemia and high interdialytic weight gain). Indicators of malnutrition varied substantially.
Conclusions. This study demonstrates differences in the management of haemodialysis patients across Euro-DOPPS and offers opportunities for improving dialysis dose, adherence and nutrition. Correlation of differences in practice patterns at the dialysis unit level with patient outcomes will offer new insights into improving dialysis therapy.
Keywords: adherence; dialysis dose; Europe; haemodialysis; nutritional parameters; outcomes
Professor Erwin Hecking died September 18, 2002
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