Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Early intervention dramatically improves outcomes for new dialysis patients

22.10.2007
RightStart program reduces risk of death up to 1 year after starting dialysis

A program of education, close medical follow-up, and self-empowerment for patients with end-stage renal disease (ESRD) newly starting dialysis, reduces complications and improves outcomes—including significant reductions in mortality and hospitalization rates, reports a study in the November Clinical Journal of the American Society of Nephrology.

The researchers initiated a structured quality improvement program, called RightStart, for ESRD patients within their first two weeks and continuing for up to three months of starting dialysis. "This program for new patients has shown itself to dramatically improve outcomes, when compared to a control group that did not receive the intervention," comments Dr. Raymond Hakim of Fresenius Medical Care in Brentwood, Tenn.

"The goal of this research was to implement a patient care strategy that focused on improving clinical outcomes in the first 90 days of hemodialysis, through intensified medical, nursing, and dietary focus and empowerment of patients to influence their own health," Dr. Hakim explains. The program included one-on-one time with nurses, who provided an educational program focusing on patient self-management.

Because new patients are often malnourished, a key emphasis was nutrition teaching, especially the need for adequate amounts of protein and calories. Dietary restrictions were introduced only as needed for the individual patient. Each patient was assigned to a case manager, who actively identified and addressed any medical problems developing in the first weeks and months on dialysis, along with the multidisciplinary team.

The study tracked survival, hospitalization rates, and other outcomes for 918 patients participating in RightStart. Outcomes were compared with those of 1,020 new dialysis patients at clinics not using the RightStart program. "It is important to note that the ESRD community provides excellent care to dialysis patients overall," says Dr. Hakim. "However, because new dialysis patients have special needs, they require intense and focused care to improve their outcomes further."

After three months, patients who went through the RightStart program had better nutrition, as reflected by levels of albumin in the blood; and less anemia, as indicated by the hematocrit level. RightStart patients also improved their scores on tests of knowledge regarding ESRD and its treatment and on quality of life and mental health scores.

"This result may be an indication that the program had a positive impact on the depression that is common among dialysis patients, as they experience a life changing event," says Dr Hakim.

In the year after starting dialysis, RightStart patients spent fewer days in the hospital: an average of 7.2 days, compared to 10.5 days for patients not receiving RightStart.

RightStart was also associated with nearly a one-half reduction in mortality rate: 17 per 100 patient-years, compared to 30 per 100 patient-years in the comparison group. For individual patients, RightStart reduced the risk of death in the year after starting dialysis by about 40 percent. "Such results speak for themselves," Dr. Hakim says. "We are actively expanding the program, and making program changes to best meet the patients' needs, based on feedback from the patients and the outcomes data."

For patients starting dialysis, the mortality rate is "alarmingly high"—about double the rate in patients who have been on dialysis longer than 90 days, according to Dr. Hakim. In designing the RightStart program, the researchers hoped to address some of the reversible risk factors contributing to this early mortality, such as nutrition, anemia, dialysis dose, and patient empowerment. "These new patients have special needs and require more intense focus during the early period of treatment," says Rebecca Wingard, RN, MSN, CNN, Vice-President of Quality Initiatives of Fresenius Medical Services and coordinator of the RightStart program.

Dr. Hakim also calls for expanded efforts to detect, educate, and treat patients in the earlier stages of kidney disease, before dialysis is required. "The lack of payment coverage by Medicare for patients less than 65 years old is a major impediment to providing such patients with timely education and preventive measures."

Shari Leventhal | EurekAlert!
Further information:
http://www.asn-online.org

More articles from Health and Medicine:

nachricht Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania

nachricht The strange double life of Dab2
10.01.2017 | University of Miami Miller School of Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

Im Focus: Bacterial Pac Man molecule snaps at sugar

Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.

The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

Water - as the underlying driver of the Earth’s carbon cycle

17.01.2017 | Earth Sciences

Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

17.01.2017 | Materials Sciences

Smart homes will “LISTEN” to your voice

17.01.2017 | Architecture and Construction

VideoLinks
B2B-VideoLinks
More VideoLinks >>>