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Related Concept Videos

Dialysis01:15

Dialysis

Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
Dialysis01:27

Dialysis

Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
Hemodialysis III: Nursing Management01:25

Hemodialysis III: Nursing Management

The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this measurement...

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Variable mortality rates among dialysis treatment centers.

W M McClellan1, W D Flanders, R A Gutman

  • 1Emory School of Medicine, Atlanta, Georgia.

Annals of Internal Medicine
|August 15, 1992
PubMed
Summary

Mortality risk varies significantly among dialysis facilities, even after accounting for patient health factors. This suggests facility-level differences play a key role in patient outcomes for end-stage renal disease.

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Area of Science:

  • Nephrology
  • Public Health
  • Health Services Research

Background:

  • End-stage renal disease (ESRD) treatment relies heavily on dialysis facilities.
  • Significant variations in patient mortality rates exist across dialysis centers.

Purpose of the Study:

  • To investigate the variability in mortality risk among patients treated at different renal dialysis facilities within a specific geographic region.
  • To determine if patient characteristics explain the observed differences in mortality risk between facilities.

Main Methods:

  • A cohort of 3612 ESRD patients aged 20+ from a southeastern state was followed for one year.
  • Data on demographics, comorbidities, and illness severity were collected from patient records.
  • Facility-specific mortality risk estimates were calculated using Cox proportional hazards models.

Main Results:

  • Facility-specific mortality rates ranged from 2.0 to 10.5 deaths per 10,000 patient-days.
  • Higher mortality was observed in older patients, white patients, and those with specific comorbidities (e.g., diabetic nephropathy, heart failure).
  • Despite controlling for patient factors, a twofold range in mortality risk persisted between facilities, with adjusted risk strongly correlating with unadjusted risk.

Conclusions:

  • Patient factors associated with mortality risk are unevenly distributed across dialysis facilities.
  • Adjusting for patient characteristics did not significantly alter the observed variation in mortality risks or the relative performance ranking of facilities.