The "Right" of Passage: Surviving the First Year of Dialysis

R. L. Wingard, K. E. Chan, J. M. Lazarus, R. M. Hakim
2009 American Society of Nephrology. Clinical Journal  
Mortality risk for dialysis patients is highest in the first year. We previously showed a 41% mortality benefit associated with a pilot case management program for incident hemodialysis patients (n ‫؍‬ 918). The RightStart Program (RSP) provided prompt medical management and self-management education and was recently expanded to more facilities. We conducted a matched cohort analysis to validate the expanded program's continued effectiveness. Death risk was reduced for RS patients (n ‫؍‬ 4308)
more » ... ersus matched controls (C; n ‫؍‬ 4308) by 34% (hazard ratio ‫؍‬ 0.66, P < 0.0001) at 120 d and 22% at 1 yr (hazard ratio ‫؍‬ 0.78, P < 0.0001). RS patients had lower hospitalization during the first year (RS ‫؍‬ 15.5 days per patient year versus C ‫؍‬ 16.9, P < 0.01). At 120 d, more RS patients achieved hemoglobin 11 to 12 g/dl (RS ‫؍‬ 22.4% versus C ‫؍‬ 19.7%, P < 0.01), eKt/V > 1.2 (RS ‫؍‬ 66% versus C ‫؍‬ 53.5%, P < 0.01), albumin > 4.0 g/dl (RS ‫؍‬ 26% versus C ‫؍‬ 22%, P < 0.01), and phosphorus 3.5 to 5.5 mg/dl (RS ‫؍‬ 52.4% versus C ‫؍‬ 45.4%). At 120 d, RS patients had a greater reduction in catheter use (RS ‫؍‬ 32% versus C ‫؍‬ 25%, P < 0.01) and more vitamin D orders (RS ‫؍‬ 60% versus C ‫؍‬ 55%, P < 0.01). Expansion of RS to a larger incident patient population results in significant reduction of morbidity and mortality associated with improvement of intermediate outcomes.
doi:10.2215/cjn.04360709 pmid:19995993 fatcat:cd2qybzclvflzpd2wl5yzlnjvi