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.