The monitoring program for patients on regular hemodialysis treatment (RDT) is not well defined yet by current international guidelines (CIG).
Methods
To evaluate the extent to which CIG are implemented, we sent a questionnaire to 100 Italian hemodialysis units (DU) with questions concerning: (a) the frequency with which routine tests were performed for the follow-up of patients on RDT; (b) which other non-routine tests were performed. We analyzed the response data and compared them with the CIG.
Results
We received 37 replies. We found several differences between the monitoring program of our respondents and the CIG.
Conclusion
Because of the small number of responses, this survey is only preliminary; however, it shows the difficulty nephrologists have in using the CIG to create a correct monitoring program in patients on RDT. Although our analysis is limited to 37 DUs, it suggests that specific guidelines are necessary to optimize the management of patients on RDT.
HakimR.M., BreyerJ., IsmailN., SchulmanG.. Effects of dose of dialysis on morbidity and mortality.Am J Kidney Dis1994; 23: 661–9.
2.
GotchF.A., LevinN.W., PortF.K., WolfeR.A., UehlingerD.E.. Clinical outcome relative to the dose of dialysis is not what you think: the fallacy of the mean.Am J Kidney Dis1997; 30: 1–15.
3.
OwenW.F., ChertowG.M., LazarusJ.M., LowrieE.G.. Dose of hemodialysis and survival: differences by race and sex.JAMA1998; 280: 1764–68.
Clinical practice guidelines for hemodialysis adequacy, update 2006.Am J Kidney Dis2006; 48(Suppl 1): S2–90.
6.
Clinical practice guidelines for vascular access.Am J Kidney Dis2006; 48(Suppl 1): S176–247.
7.
Clinical practice guidelines for vascular access.Am J Kidney Dis2006; 48(Suppl 1): S248–73.
8.
LowrieE.G., LewN.L.. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities.Am J Kidney Dis1990; 15: 458–82.
9.
Clinical practice guidelines for nutrition in chronic renal failure.K/DOQI, National Kidney Foundation.Am J Kidney Dis2000; 35(6 Suppl. 2): S1–140. Erratum in: Am J Kidney Dis 2001; 38: 917.
10.
MartinK.J., OlgaardK., CoburnJ.W.. Diagnosis, assessment, and treatment of bone turnover abnormalities in renal osteodystrophy.Am J Kidney Dis2004; 43: 558–65.
K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.Am J Kidney Dis2005; 45: S1–153.
13.
K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease.Am J Kidney Dis2003; 42: S1–201.
14.
CoenG., BallantiP., BonucciE.. Bone markers in the diagnosis of low turnover osteodystrophy in hemodialysis patients.Nephrol Dial Transplant1998; 13: 2294–302.
15.
CouttenyeM.M., D'HaeseP.C., Van HoofV.O.. Low serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in hemodialysis patients.Nephrol Dial Transplant1996; 11: 1065–72.
16.
UrenaP., HrubyM., FerreiraA., AngK.S., de VernejoulM.C.. Plasma total versus bone alkaline phosphatase as markers of bone turnover in hemodialysis patients.J Am Soc Nephrol1996; 7: 506–12.
17.
SlatopolskyE.. The interaction of parathyroid hormone and aluminum in renal osteodystrophy.Kidney Int1987; 31: 842–54.
18.
KauszA.T., AntonsenJ.E., HerczG.. Screening plasma aluminum levels in relation to aluminum bone disease among asymptomatic dialysis patients.Am J Kidney Dis1999; 34: 688–93.
19.
JohnsonD.W., McIntyreH.D., BrownA., FreemanJ., RigbyR.J.. The role of DEXA bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients.Perit Dial Int1996; 16: 34–40.
20.
K/DOQI Clinical Practice Guidelines for managing Dyslipidemias in Chronic Kidney Disease.Am J Kidney Dis2003; 41(Suppl 3): S1–92.
21.
DavisonA.M.. European Best Practice Guidelines for Hemodialysis (Part 1). Section VII (Vascular disease and risk factors) Microinflammatory state.Nephrol Dial Transplant2002; 17(Suppl 7): S100–9.
ParfreyP.S., FoleyR.N., HarnettJ.D., KentG.M., MurrayD., BarreP.E.. Outcome and risk factors of ischemic heart disease in chronic uremia.Kidney Int1996; 49: 1428–34.
24.
EvansR.W., RaderB., ManninenD.L.. The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group.JAMA1990; 263: 825–30.
25.
LocatelliF., AljamaP., BaranyP.. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure.Nephrol Dial Transplant2004; 19(Suppl 2): ii1–47.
26.
European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure.Nephrol Dial Transplant1999; 14(Suppl 5): S1–37.
27.
National Kidney Foundation.Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults.Am J Kidney Dis2006; 47(Suppl 3): S16–85.
28.
LocatelliF., FouqueD., HeimburgerO.. Nutritional status in dialysis patients: a European consensus.Nephrol Dial Transplant2002; 17: 563–72.
29.
PiferT.B., McCulloughK.P., PortF.K.. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS.Kidney Int2002; 62: 2238–45.
30.
European Best Practice Guidelines for Haemodialysis (Part 1).Section VI. Hemodialysis-associated infection.Nephrol Dial Transplant2002; 17(Suppl 7): S72–87.
LevineE., SlusherS.L., GranthamJ.J., WetzelL.H.. Natural history of acquired renal cystic disease in dialysis patients: a prospective longitudinal CT study.AJR Am J Roentgenol1991; 156: 501–6.
33.
MarpleJ.T., MacDougallM., ChonkoA.M.. Renal cancer complicating acquired cystic kidney disease.J Am Soc Nephrol1994; 4: 1951–6.
34.
DemberL.M., JaberB.L.. Dialysis-related amyloidosis: late finding or hidden epidemic?Semin Dial2006; 19: 105–9.
35.
HiguchiN., MaruyamaH.. Diagnosis and therapy for beta2-microglobulin amyloidosis in the K/DOQI guideline.Clin Calcium2004; 14: 744–9.
WolfeR.A., GaylinD.S., PortF.K., HeldP.J., WoodC.L.. Using USRDS generated mortality tables to compare local ESRD mortality rates to national rates.Kidney Int1992; 42: 991–6.
38.
DikowR., RitzE.. Cardiovascular complications in the diabetic patient with renal disease: an update in 2003.Nephrol Dial Transplant2003; 18: 1993–8.
39.
European Best Practice Guidelines for Haemodialysis (Part 1).Section IV. Dialysis fluid purity.Nephrol Dial Transplant2002; 17(Suppl 7): S45–62.
