The DOPPS estimate of patient life years attributable to modifiable hemodialysis-Practices in Japan-

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  • 血液透析の修正可能な治療指標に起因する日本の透析患者の推定生存年数―ＤＯＰＰＳより―
  • ケツエキ トウセキ ノ シュウセイ カノウナ チリョウ シヒョウ ニ キインスル ニホン ノ トウセキ カンジャ ノ スイテイ セイゾン ネンスウ DOPPS ヨリ
  • -Practices in Japan-
  • －DOPPSより－

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Abstract

A prevalent cross-sectional sample of Japanese hemodialysis (HD) patients from the Dialysis Outcomes and Practice Patterns Study was analyzed to determine the percentage of patients whose values failed to meet targets in six different areas of hemodialysis practice. Cox survival models, with adjustments for patient characteristics, were used for these analyses to estimate mortality hazard ratios. Patient-years attributable to each of the six practice patterns were estimated. To calculate the expected gain in patient-years, the five-year survival curve for the Japanese HD population (based on actual current death rates) was compared with the projected five-year survival curve for the Japanese HD population if all patients were within the six practice guidelines. These calculations were performed separately for the Japanese guidelines and the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. The proportion of patients failing to meet the six practice targets in Japan and the relative risk of mortality associated with being outside the targets were the basis for all life-years estimation. A considerably high number of Japanese HD patients were found to be outside the target ranges. Very few Japanese patients were within the targets for five or six indicators. The vast majority of patients (78.1%) were within two to four of the six indicators, and 20.5% of patients were within zero to one of the practice targets. The two individual practices resulting in the greatest life-year gains were increasing the proportion of patients with albumin levels above 4.0g/dL (43,525 life-years, 3.1% gained) and increasing the proportion of patients with hemoglobin levels above 11g/dL (24,878 life-years, 1.8% gained). The total potential life-years gained (72,958) was 27% lower than that suggested by the simple sum of patient-years obtained from the six individual practice patterns when modeled independently from each other (99,815). Results for hemoglobin in Japan vary depending on which target cut-off is used. If, instead of 11g/dL, a target value of hemoglobin ≥10g/dL were used, 16,580 patient-years could be saved if all patients achieved the target. Japanese guidelines should be revised based on the outcome of prospective, randomized controlled studies.

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