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.