CHICAGO – In 1996, with primary funding from Amgen Inc., the Dialysis Outcome Practice Pattern Study (DOPPS), opened its doors. The concept, noted Bruce Robinson, MD, MSCE, during a panel discussion here at the American Society of Nephrology’s 2016 Kidney Week, was to identify international practice patterns in the care of hemodialysis patients that took into account patient demographics and comorbidities, and then evaluate the resulting outcomes, including mortality, hospitalizations, vascular access and quality of life. The ASN session honored the 20th anniversary of DOPPs, and included highlights of past and present data as well as findings from new research in CKD (CKDOPPS) and peritoneal dialysis (PDOPPS).
Early data collection
DOPPS began as a hemodialysis study in 1996, collecting data from 308 dialysis facilities in seven countries. DOPPS is currently in its sixth study phase, with data collection in over 560 facilities in 19 countries. In addition, The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) and The Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) have been modeled on the approach of the DOPPS. The DOPPS Program is funded by a consortium of private industry, public funders, and professional societies. A detailed list of funders is available at http://www.dopps.org/Support/DOPPSProgramSupport.aspx.
Key changes in dialysis practice patterns
Robinson looked at recent data from DOPPS and the U.S. Renal Data System and how it related to ESRD population changes in the U.S. and other countries.
Data collected by the USRDS and presented in the 2016 report shows a continued rise in the incident population (new starts on dialysis therapy) and subsequent growth in the prevalent population due to lower mortality. He said the U.S. alone could see close to 1 million people being treated for end-stage renal disease by 2030. The rise in prevalence, noted Robinson, is occurring worldwide. The DOPPS data sampling, like international trends, shows an increase in older aged patients and a rise in cases of diabetes. Yet survival continues to improve, particularly in the U.S. Some of that decline in mortality, Robinson said, can be related to the following:
- access techniques improving in the U.S. from the Fistula First program. Data has also shown that fistula survival increases when the surgeons have more training and have performed more surgeries. DOPPS data is also showing an increase in the number of upper arm fistula placements––now occurring in about one-third of patients.
- improvements in Kt/V and delivering a more adequate dialysis dose
- better phosphorus control
- stabilization of hemoglobins
DOPPS data worldwide also shows that intradialytic weight gain has been reduced and patients are being exposed to less salt, said Robinson. But, while treatment times have risen in other countries, the U.S. still lags behind.
Ferritin levels have also increased dramatically in the U.S., but not in other countries, said Robinson. Those increases are related more toward higher ferritin targets versus more use of iron, he said.
Data from the ASN presentation is available at the DOPPS website, www.DOPPS.org.