The DOPPS is a prospective cohort study of hemodialysis practices based on the collection of observational longitudinal data for a random sample of patients from dialysis facilities in a representative and random sample of units in twenty countries.
The samples of patients in each facility, and sample of facilities in each country, are designed to provide a reliable picture of practices and outcomes in each facility, and in each geographic area.
In view of differences in patient outcomes of mortality and morbidity by country and by dialysis unit, the study helps researchers:
• Describe differences in practice patterns that correlate with differences in outcomes
• Understanding the factors associated with patient outcomes will lead to improved patient care and lower mortality and morbidity
How has the DOPPS shaped dialysis practice and policy?
The DOPPS has shown that regional survival differences in mortality (particularly for the United States compared with Europe) were largely explained by differences in facility vascular access use.
US and European facilities with similar percentages of fistula, graft, and catheter use have, on average, similar survival.
In recent years, with the Fistula First Initiative, there has been a commendable increase in fistula use in the United States, whereas in several other countries, fistula use has fallen and/or catheter use has risen substantially.
Dialysis Session Length
In recent years, DOPPS observes that dialysis session length has shortened in the United States, whereas it has gotten longer in most other DOPPS countries. By both standard and IV analyses, the DOPPS has found that longer treatment time is associated with lower mortality in models adjusted for Kt/V, ultrafiltration rate, and other characteristics. According to DOPPS, short dialysis session length is now one of the key practice differences between the United States and other DOPPS countries, and its implications merit attention from research and policy perspectives.
Quality of Life and the Patient Experience
In addition to quality of life being an important predictor of mortality, it is also an important end-point in itself. Recent research on the time it takes to recover from dialysis treatment shows a great deal of variation among patients – some will recover in an hour or two but many others take all day to recover. For those patients, three days of every week are completely wiped out, in terms of any meaningful and enjoyable quality of life. This is a big issue for patients, and we plan to do more work to address this experience.
EDTNA/ERCA and DOPPS
In 2005, after large study expansion within Europe, Arbor Research Collaborative for Health contracted with the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) to support the participating study sites. EDTNA/ERCA Clinical Research Associates (CRAs) provide support in Germany, Italy, Spain, Sweden, Belgium, Turkey, and the United Kingdom. The CRAs liaison with the Country Investigators, Arbor Research, and the supporting staff at the study sites. The EDTNA/ERCA has been instrumental in the success of the DOPPS within Europe.
The DOPPS Background
EDTNA/ERCA and DOPPS Program have together created the monograph “Ten Years of Collaboration: DOPPS Research, The European Dialysis Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA), Arbor Research Collaborative for Health, and the Dialysis Outcomes and Practice Patterns Study (DOPPS)” to celebrate 10 years of successful collaboration. The monograph features several articles related to DOPPS research written from a nursing perspective. Read the monograph.
The DOPPS started as a hemodialysis study in 1996, and now tracks over 50,000 patients on hemodialysis, peritoneal dialysis, and with chronic kidney disease, in over 20 countries:
The DOPPS Program collects observational, longitudinal data from around the world
to identify clinical practices with the most benefit for patients.
- DOPPS - The DOPPS is a study of hemodialysis practices begun in 1996 and now in over twenty countries.
- PDOPPS - In collaboration with the International Society of Peritoneal Dialysis, PDOPPS studies areas of greatest practice uncertainty in peritoneal dialysis. PDOPPS began in 2013 and is now in 7 countries.
- CKDopps - The CKDopps identifies practices associated with best outcomes for patients with advanced chronic kidney disease. CKDopps began in 2013 and is now in 5 countries.