Kidney Res Clin Pract.
2023 May;42(3):379-388. 10.23876/j.krcp.22.103.
Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study
- Affiliations
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- 1Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- 2Hallym University Kidney Research Institute, Seoul, Republic of Korea
- 3Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
- 4Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
- 5Department of Bigdata and Applied Statistics, Dongguk University, Gyeongju, Republic of Korea
- 6Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
- 7Department of Quality Assessment Administration, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
- 8Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
- KMID: 2543792
- DOI: http://doi.org/10.23876/j.krcp.22.103
Abstract
- Background
It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. Methods: We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. Results: After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03–1.18; p = 0.004). Conclusion: Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.
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