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Title

DOQI Guideline Series, Part 1: Hemodialysis Adequacy (1.5 credit hours)

Abstract

Accountability in dialysis, as in all other areas of health care, has become a primary focus. Health care professionals have a responsibility to deliver quality-level care that conforms to specialized practice standards. This module examines the contributing factors and effects of inadequate dialysis. In addition, methods for obtaining accurate measurements to assess adequacy are also discussed.

Planners, content specialists and feedback personnel have declared that there is no conflict of interest in the preparation and content of this module. There is no commercial support for or endorsement of products in this module.

Author

Melissa K. Slate, RN

Melissa K. Slate’s experience includes 12 years as a registered nurse, with three years in acute and chronic dialysis in a combined inpatient and outpatient unit. Her dialysis and plasma apheresis experience covers dialysis within all areas of intensive care units, with three additional years as a nurse in the outpatient dialysis clinic setting and six years in home health care covering all types of medical-surgical cases. Since receiving an ADN from Southern West Virginia Community College (Logan) in 1993, Melissa has pursued additional studies at West Virginia Wesleyan College toward a BSN. Her teaching experience includes authoring CE articles on health care topics as well as clinical staff and patient education. She is currently employed at United Health Care as a telephonic triage nurse.

Objectives

Upon completion of this module, the learner should be able to:

Identify the purpose of the National Kidney Federation Kidney Disease Outcome Quality Initiatives as they relate to Hemodialysis Adequacy.
Describe the effects of inadequate dialysis on patient outcomes.
Discuss the target values for KT/V and URR.
Describe the correct procedure for obtaining KT/V laboratory samples and measurements.
Identify factors influencing the attainment of KT/V target goals and interventions to correct inadequate KT/V.

Resources

Center for Medicare and Medicaid Services. Overview: End Stage Renal Disease (ESRD) Quality Initiative. Dec 15, 2005. Available at: http://www.cms.hhs.gov/esrdqualityimproveinit/01_overview.asp?. Accessed May 2, 2006.

Center for Medicare and Medicaid Services. Overview Document Download: End Stage Renal Disease (ESRD) Quality Initiative. Dec 15, 2005. Available at: http://www.cms.hhs.gov/ESRDQualityImproveInit/downloads/ESRDOverview.pdf. Accessed May 2, 2006.

Daugirdas JT, Blake PG, Ing TS, eds. Handbook of Dialysis. 3rd ed. Boston, Ma: Lippincott, Williams & Wilkins; 2000.

DePalma JR, Pittard JD. Dialysis dose (part 1). Dialysis and Transplantation. April, 2001; 252-261.

Department of Health and Human Services. Hemodialysis dose and adequacy. 2003.

Lancaster LE, ed. Core Curriculum for Nephrology Nursing. 4th ed. Pitman, NJ: American Nephrology Nurses Association; 2001.

National Center for Health Statistics. Health, United States. Hyattsville, Md. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. 2004.

National Kidney Federation. K/DOQI History. New York; 2005. Available at: http://www.kidney.org/professionals/kdoqi/history.cfm. Accessed December 12, 2005.

National Kidney Federation (2000a). NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY: UPDATE. Guideline 2: Method of Measurement of Delivered Dose of Hemodialysis. New York; 2000.

National Kidney Federation (2000b). NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY: UPDATE. Guideline 4: Minimum Delivered Dose of Hemodialysis. New York; 2000.

National Kidney Federation (2000c). NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY: UPDATE. Guideline 5: Prescribed Dose of Hemodialysis. New York.

National Kidney Federation (2000d). NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY: UPDATE. Guideline 6: Frequency of measurement of hemodialysis adequacy. New York.

National Kidney Federation (2000e). NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY: UPDATE. Guideline 8: Acceptable methods for BUN sampling. New York.

National Kidney Federation (2000f). NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY: UPDATE. Guideline 10: Use of the Association of Advancement of Medical Instrumentation (AAMI) standards and recommended practices for hemodialyzer reprocessing. New York.

National Kidney Federation (2000g). NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY: UPDATE. Guideline 13: Minimum required total cell volume. New York.

O’Connor AS, Flauto RP, Sehgal AR. Improving the accuracy of KT/V Measurement: The role of the technician. Dialysis and Transplantation. 2003; 32:590-595.

US Renal Data System, USRDS 2004 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, Md;2004.

Publications based upon USRDS data reported here or supplied upon request must include this citation and the following notice: The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.

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