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 Monitoring the heart's mitochondria to predict cardiac arrest?
21.09.2017 | Boston Children's Hospital

nachricht Highly precise wiring in the Cerebral Cortex
21.09.2017 | Max-Planck-Institut für Hirnforschung

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: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

Im Focus: Fast, convenient & standardized: New lab innovation for automated tissue engineering & drug

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Comet or asteroid? Hubble discovers that a unique object is a binary

21.09.2017 | Physics and Astronomy

Cnidarians remotely control bacteria

21.09.2017 | Life Sciences

Monitoring the heart's mitochondria to predict cardiac arrest?

21.09.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>