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2004 National Healthcare Quality Report

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Findings

Adequacy of Hemodialysis

The adequacy of dialysis is measured by the percent of hemodialysis patients with a urea reduction ratio equal to or greater than 65; this measure indicates how well urea, a waste product in the blood, is eliminated by the artificial kidney. The first NHQR reported that 88.6% of in-center hemodialysis patients were receiving adequate dialysis as measured by urea reduction ratio of 65 or greater.

Figure 2.7. State variation in percent of hemodialysis patients with urea reduction ratio of 65 or greater

Figure 2.7. State variation in percent of hemodialysis patients with urea reduction ratio of 65 or greater

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Source: University of Michigan Kidney Epidemiology and Cost Center, 2002

Note: Values for quartiles are: 0-25th percentile = 85.79%-88.71%; >25th-50th percentile = 88.82%-90.38%; >50th-75th percentile = 90.49%-92.43%; >75th-100th percentile = 92.94%-96.04%.

  • Variation among the States for urea reduction ratio of 65 or greater in hemodialysis patients ranged from 86% to 96% (Figure 2.7).
  • Performance on this measure has increased from 74% in 1996 to 90.1% in 2002 (University of Michigan Kidney Epidemiology and Cost Center, 2003).
  • In 2002, hemodialysis adequacy was greater for females than males: 81% of males vs. 91% of females had URR of 65 or greater.

Use of Arteriovenous Fistulas for Vascular Access

Vascular access is a way to reach the blood vessels so that harmful urea can be removed from the blood. There are three general types of vascular access devices: fistulas, grafts, or catheters. Arteriovenous vascular fistula access is the preferred type of access for most renal dialysis patients. Vascular access is measured by the percentage of hemodialysis patients who dialyze using an AVF as their primary vascular access type.

Vascular access devices provide routine access to the blood stream for hemodialysis treatment. The National Kidney Foundation, in its Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Vascular Access, recommends an AVF placement goal of 50% in all new patients, with ultimate AVF use rate of 40%3.

Figure 2.8. Percent of hemodialysis patients using arteriovenous fistulas for vascular access

Figure 2.8. Percent of hemodialysis patients using arteriovenous fistulas for vascular access

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Source: CMS ESRD Clinical Performance Measures Project, 2002.

  • Among 8,487 adult, in-center hemodialysis patients, 33% were dialyzed through a fistula (ESRD Clinical Performance Measures Project, 2003). This is an increase over 2000 when 27% used fistulas for dialysis3.
  • Men were nearly twice as likely as women to be dialyzed with AVFs. Use of arteriovenous fistulas for 2002 was 42% for males and 22% for females (Figure 2.8). Males have exceeded the recommended target use rate.

 

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