Factors Affecting Hemodialysis Adequacy and Patient Safety Open Access

Sebastian, Viju (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/tq57nr07h?locale=en





Background: This study examined longitudinal data from patients in end stage renal disease (ESRD) undergoing renal replacement therapy (RRT) in the form of hemodialysis from three facilities managed by Africa HealthCare Network based in Rwanda. The objective was to understand the factors that affect dialysis adequacy and develop an informatics solution to improve outcomes.




Methods: Data from 4203 dialysis sessions from 96 patients was collected from September 2016 to October 2017. Dialysis adequacy was measured using a value, Kt/V that is considered the gold standard and is normally calculated at the end of each session. In this measurement, Kt/V is a dimensionless ratio representing fractional urea clearance, where K is the dialyzer urea clearance (expressed in liters per hour), t is time on dialysis (expressed in hours), and V is the volume of distribution of urea (expressed in liters). The data was transformed into a patient period dataset to aid with data analysis. Descriptive analysis of the data was performed using SAS, and data quality issues that were identified were addressed using an informatics solution.




Results: The study resulted in a multilevel model that explained intra and interpersonal differences in Kt/V values over time. Gender, systolic blood pressure, temperature, pulse rate, and respiration rate were found to be significant predictors of Kt/V values (p<0.05). The results of this research can be incorporated into the dialysis information systems to identify patients that are unlikely to receive adequate dialysis dose. This information can be leveraged by nephrologists who then are able to better outline a plan of action to improve dialysis outcomes.




Conclusions: Using the predictive model we were able to plot the impact of study variables on Kt/V. The plots helped visualize the changes of Kt/V values over time and interaction of the different study variables on Kt/V. The plots show the first 30 days after RRT initialization as a critical period since the Kt/V values were significantly lower and that dialysis inadequacy is common during the initial stages of RRT initialization. The study also shows the impact of an informatics solution that assists the technicians to identify data quality issues in real time will improve data quality and also improve accuracy of the model that predicts dialysis adequacy.




Table of Contents


1.          Chapter I 7


1.1.      Introduction and Rationale. 7


1.2.      Problem statement 8


1.3.      Primary Outcome. 12


1.4.      Purpose statement 12


1.5.      Research questions. 13


1.6.      Definition of Key Terms. 14


2.          Chapter II 15


2.1.      Literature Review.. 15


2.2.      State of existing research. 16


2.3.      Data quality and Information technology. 19


2.4.      Summary. 19


3.          Chapter III Methods. 21


3.1.      Introduction. 21


3.2.      Population and Sample. 22


3.3.      Research Design. 23


3.4.      Procedures. 25


3.5.      Statistical Analysis. 25


3.6.      Data-mining techniques. 29


3.7.      Data flow in the nephrology setting. 29


3.8.      Emory University Institutional Review Board (IRB) Clearance. 30


4.          Chapter IV Results. 31


4.1.      Introduction. 31


4.2.      Key findings. 31


4.3.      Informatics solution. 36


4.4.      Other findings. 37


4.5.      Summary. 38


5.          Chapter V: Conclusions and Recommendations. 39


5.1.      Introduction. 39


5.2.      Limitations. 39


5.3.      Implications. 40


5.4.      Recommendations. 41


5.5.      Data Quality. 41


5.6.      Conclusion. 42


References. 44


Appendix. 46




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