Hemodialysis Adequacy GoalAdequacy Goal · to or greater than the lower limit ofto or greater than the lower limit of the normal range ... • All patients measured for calcium &All

Hemodialysis Adequacy GoalHemodialysis Adequacy Goal

≥95% f h di l i ti t• ≥95% of hemodialysis patient population achieve Kt/V Daugirdas II ≥1 2≥1.2

• ≥95% of hemodialysis patient population achieve URR ≥65%

National CPM Data Collection % Patients with Kt/V ≥ 1.2

4th Quarter 2007100

70

80

90

40

50

60

& p

atie

nts

20

30

40

17 5 2 10 11 13 15 US 3 6 7 12 18 1 4 8 9 14 16Kt/V 87 89 90 90 90 91 91 91 92 92 92 92 92 93 93 93 93 93 93

0

10

Percentage of HD Patients with Reported Kt/V >= 1 2

90%100%

Percentage of HD Patients with Reported Kt/V >= 1.2 by State and Network 9/10 for Selected Collection Periods

60%70%80%90%

ient

s

20%30%40%50%

% p

at

4Q96 4Q98 4Q00 4Q02 4Q03 4Q05 4Q06 4Q07 4Q08IL 66% 78% 82% 88% 91% 92% 93% 93% 93%

0%10%

% % % % % % % % %IN 76% 86% 89% 92% 93% 95% 94% 94% 94%KY 64% 78% 86% 91% 89% 93% 94% 94% 94%OH 71% 84% 87% 90% 91% 92% 93% 94% 94%Net 9/10 70% 82% 86% 90% 91% 93% 93% 94% 94%

National CPM Data Collection % Patients with URR ≥ 65%

4th Quarter 2007

100

70

80

90

50

60

70

patie

nts

20

30

40%

17 5 10 2 7 18 3 9 11 13 15 US 1 4 6 8 12 14 16URR 83 85 87 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 90

0

10

U 83 85 87 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 90

Anemia Management GoalAnemia Management GoalGoal has been replaced by –p y

“A Statement on the Use of ESA in CKD Patients Requiring Dialysis”Patients Requiring Dialysis

Developed by the Medical Review Board

http://www.therenalnetwork.org/qi/anemiaMRB6.07.php

National CPM Data Collection% Pts with mean Hgb ≥ 11g/dl% ts t ea gb g/d

4th Quarter 2007

100

70

80

90

100

40

50

60

70

% p

atie

nts

10

20

30

40%

2 4 8 9 13 5 6 10 11 12 16 US 3 7 15 17 18 1 14Hgb ≥ 11 g/dL 77 80 80 80 80 81 81 81 82 82 82 82 83 83 83 84 84 85 86

0

10

National CPM Data Collection% Pts with mean Hgb 10-12% ts t ea gb 0

4th Quarter 2007

50

60

30

40

patie

nts

10

20

% p

6 13 7 11 8 9 12 5 14 US 10 18 3 15 16 17 1 2 4Hgb 10-12 45 45 46 46 48 48 48 49 50 50 51 51 52 52 53 53 54 54 56

0

gg/dL^^ 45 45 46 46 48 48 48 49 50 50 51 51 52 52 53 53 54 54 56

National CPM Data Collection% Pts with mean Hgb <10g/dl% ts t ea gb 0g/d

4th Quarter 20079

7

8

4

5

6

% p

atie

nts

1

2

3

17 1 15 18 3 4 6 7 10 14 16 US 5 12 13 8 9 11 2Hgb < 10

g/dL 3 4 4 4 5 5 5 5 5 5 5 5 6 6 6 7 7 7 8

0

1

g/dL

Percentage of HD Patients with HGB>= 11 gm/dL by State and Network 9/10 for Selected Collection Periods

90%100%

50%60%70%80%90%

atie

nts

10%20%30%40%50%

% p

a

4Q98 4Q00 4Q02 4Q04 4Q05 4Q06 4Q07 4Q08

IL 55% 73% 79% 83% 81% 82% 80% 76%

0%

IN 61% 75% 81% 84% 81% 82% 80% 74%KY 57% 73% 79% 82% 81% 83% 80% 74%OH 59% 70% 77% 83% 83% 83% 80% 75%Net 9/10 58% 72% 79% 83% 82% 83% 80% 75%

Percentage of PD Patients with HGB >= 11 gm/dL by State and Network 9/10 for Selected Collection Periods

90%100%

50%60%70%80%

ient

s

10%20%30%40%50%

% p

at

S-D 99 S-D 01 S-D 02 O-D 04 O-D 05 O-D 06 O-D 07 O-D 08IL 65% 71% 76% 77% 75% 77% 73% 72%

0%10%

IN 70% 78% 79% 78% 78% 77% 77% 70%KY 68% 76% 77% 84% 78% 83% 76% 73%OH 68% 71% 74% 79% 77% 78% 76% 74%Net 9/10 68% 73% 76% 79% 77% 78% 75% 72%

National CPM Data Collection% Pts with mean TSAT ≥ 20%% ts t ea S 0%

4th Quarter 200786

82

84

86

76

78

80

patie

nts

70

72

74% p

16 4 12 17 2 8 15 9 10 US 1 11 14 3 6 13 5 7 1866

68

70

TSAT ≥ 20% 73 75 76 77 78 78 78 79 79 80 81 81 81 82 83 83 84 84 84

National CPM Data Collection% Pts with mean Ferritin ≥ 100 ng/mL% ts t ea e t 00 g/

4th Quarter 2007

100

70

80

90

100

40

50

60

70

atie

nts

10

20

30

40

& p

2 17 4 8 12 15 7 11 13 US 1 3 5 6 9 10 14 16 18Ferritin 91 92 93 94 94 94 95 95 95 95 96 96 96 96 96 96 96 96 97

0

10

Nutrition GoalNutrition Goal• All patients will have serum p

albumin measured and evaluated each month.

• A stabilized serum albumin equal to or greater than the lower limit ofto or greater than the lower limit of the normal range (approximately 3.5g/dl for bromcresol green)

National CPM Data Collection% Pts with mean serum albumin ≥ 3 5/3 2g/dL% Pts with mean serum albumin ≥ 3.5/3.2g/dL

(BCG/BCP)^^ 4th Quarter 2007

80

90

100

50

60

70

atie

nts

20

30

40& p

a

4 9 11 7 1 2 13 17 5 8 10 12 16 US 15 14 3 6 180

10

20

serum alb 77 79 79 80 81 81 81 81 82 82 82 82 82 82 83 84 85 85 85

Percentage of HD Patients with Average Albumin >= 3.5 gm/dL by State and Network for Selected Collection Periods

80%

90%

100%

50%

60%

70%

atie

nts

20%

30%

40%% p

a

4Q96 4Q98 4Q00 4Q02 4Q04 4Q05 4Q06 4Q07 4Q08

IL 76% 82% 82% 83% 85% 81% 81% 81% 81%

0%

10%

% % % % % % % % %IN 82% 83% 78% 82% 80% 78% 78% 79% 78%KY 81% 80% 77% 80% 80% 75% 75% 79% 78%OH 79% 79% 77% 80% 83% 78% 79% 80% 79%N t9/10 9% 81% 9% 81% 83% 9% 9% 80% 9%Net 9/10 79% 81% 79% 81% 83% 79% 79% 80% 79%

Percentage of PD Patients with Average Albumin >= 3.5 gm/dL by State and Network 9/10 for Selected Collection Periods

90%100%

by State and Network 9/10 for Selected Collection Periods

50%60%70%80%90%

ents

20%30%40%50%

% p

atie

S-D00 S-D01 S-D02 O-D04 O-D05 O-D06 O-D07 O-D08IL 63% 67% 65% 69% 55% 62% 65% 65%

0%10%

IN 64% 66% 73% 61% 57% 60% 58% 59%KY 59% 59% 60% 70% 56% 50% 60% 61%OH 56% 54% 62% 67% 57% 57% 62% 61%Net 9/10 60% 61% 65% 67% 56% 58% 62% 62%

Mineral Metabolism Goals

• All patients measured for calcium &• All patients measured for calcium & phosphorus every month≥ 75% f ti t ill h C /PO• ≥ 75% of patients will have a Ca/PO4product of < 55 mg2/dL2

• All patients will be measured for “intact” PTH quarterly

National CPM Data Collection % Patients with Adjusted Calcium% Patients with Adjusted Calcium

8.4 – 10.24th Quarter 2007

80

90

100

50

60

70

80

tient

s

20

30

40

50

& p

at

3 5 17 10 2 8 15 6 12 13 18 US 7 11 14 16 4 9 10

10

20

calcium 81 82 82 83 84 84 84 85 85 85 85 85 86 86 86 86 87 87 88

National CPM Data Collection % Patients with Mean Phosphorus p

3.5 – 5.54th Quarter 2007

60

70

40

50

ents

10

20

30

% p

atie

6 7 16 5 8 13 17 9 11 US 3 15 10 12 1 18 2 4 14phosphorus 45 48 49 50 51 51 51 52 52 52 53 53 54 54 55 55 56 57 58

0

10

p p 45 48 49 50 51 51 51 52 52 52 53 53 54 54 55 55 56 57 58

Network Fistula Goals2006 20092006 – 2009

Prevalent AV fistula goals for each year inPrevalent AV fistula goals for each year in each Network

Network 9Dec ’06 rate = 42.0%

Network 10Dec ’06 rate = 42.6%

2007 Goal = 50.0%2008 Goal = 58.0%2009 Goal = 66 0%

2007 Goal = 50.0%2008 Goal = 58.0%2009 Goal = 66 0%2009 Goal = 66.0% 2009 Goal = 66.0%

National CPM Data Collection% Prevalent Pts with AVF

4th Quarter 2007100

70

80

90

50

60

70

patie

nts

30

40% p

5 9 6 11 13 14 8 4 3 10 US 7 12 2 17 18 15 1 160

10

20

5 9 6 11 13 14 8 4 3 10 US 7 12 2 17 18 15 1 16AVF 42 43 44 45 45 46 47 48 49 49 49 50 50 51 51 55 57 58 61

National CPM Data Collection% Prevalent Pts with Catheter

4th Quarter 2007

50

35

40

45

50

25

30

35

patie

nts

10

15

20%

14 18 16 1 6 8 15 17 US 2 3 4 11 12 13 7 9 10 5catheter 21 21 23 24 24 25 27 27 27 28 28 28 31 31 31 32 32 32 34

0

5

cat ete 21 21 23 24 24 25 27 27 27 28 28 28 31 31 31 32 32 32 34

National CPM Data Collection% Prevalent Pts with Catheter > 90 Daysy

4th Quarter 2007

50

35

40

45

20

25

30

35

% p

atie

nts

10

15

20%

14 16 17 18 1 6 8 4 US 2 3 9 12 15 7 10 11 13 5catheter 17 17 17 17 18 19 19 21 21 23 23 23 23 23 24 25 25 25 28

0

5

8 9 9 3 3 3 3 3 5 5 5 8

% Prevalent Patients Using a Fistula by St t & N t kState & Network

90.0%

100.0%

60.0%

70.0%

80.0%

Network Goal 58%

30.0%

40.0%

50.0%DEC2004DEC2005DEC2006

Network Goal – 58%

IN KY OH NW9 IL0.0%

10.0%

20.0%DEC2006DEC2007DEC2008

IN KY OH NW9 ILDEC2004 33.7% 36.8% 34.6% 34.7% 36.6%DEC2005 35.3% 41.6% 38.2% 38.0% 39.3%DEC2006 37.5% 46.8% 42.6% 41.9% 42.7%DEC2007 40 5% 50 7% 44 2% 44 3% 46 1%DEC2007 40.5% 50.7% 44.2% 44.3% 46.1%DEC2008 43.6% 53.8% 47.2% 47.3% 48.9%

% Prevalent Patients Using a Catheterb St t & N t kby State & Network

50.0%

30 0%35.0%40.0%45.0%

15.0%20.0%25.0%30.0%

DEC2004DEC2005DEC2006

IN KY OH NW9 IL0.0%5.0%

10.0%DEC2006DEC2007DEC2008

DEC2004 32.1% 30.8% 34.7% 33.3% 30.5%DEC2005 34.5% 29.1% 35.0% 33.9% 31.9%DEC2006 35.7% 27.3% 32.2% 32.4% 31.9%DEC2007 34 3% 26 6% 32 1% 31 7% 31 7%DEC2007 34.3% 26.6% 32.1% 31.7% 31.7%DEC2008 33.7% 24.7% 29.9% 30.1% 30.7%