Dialysis Outcomes and Practice Patterns Study (DOPPS)

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 a representative and random sample of units in 12 countries (Australia, Belgium, Canada, France, Germany, Japan, Italy, New Zealand, Spain, Sweden, the United Kingdom, and the United States). Data collection for the study has been on-going since 1996 and has yielded detailed data on more than 38,000 patients in over 900 dialysis facilities.

DOPPS investigations focus on determining which dialysis practices are associated with the best patient outcomes, with the primary goal of improving patient longevity, quality of life, and other outcomes. With over 75 peer-reviewed publications in print or in press, the DOPPS continues to provide numerous important findings that are relevant for patients and practicing clinicians alike. The DOPPS is supported by research grants from Amgen and Kirin Pharma, without restrictions on publications.

DOPPS researchers have been invited to present a two-hour clinical symposium during the annual conference of the American Society of Nephrology (ASN). The proposed symposium is entitled “Modifiable Practice Patterns and Achievement of Better Clinical Outcomes in the DOPPS,” and would be chaired by Dr. Friedrich Port and Dr. Bruce Robinson of Arbor Research. Presentations would provide new and unpublished findings from the DOPPS. Potential areas of focus include Nutritional, Diabetes, and Anemia Management Practices, and others. The presentations will emphasize DOPPS findings that are relevant to clinical practice with the goal to improve patient care in hemodialysis units. Please visit the DOPPS stand booth # 548/550, Hall B) throughout the conference for more information. Additional details can be found in our brochure.

New research from the DOPPS will be presented during a clinical symposium at WCN 2009, the joint meeting between ERA-EDTA and ISN. The symposium, to be chaired by Dr. Friedrich Port and Dr. Jorge Andia-Cannata, will feature recent results from the DOPPS and Cosmos. Presentations will focus on clinical practice indicators at the dialysis facility level and associated outcomes with consideration of patient mix. Emphasis will be given to the international perspectives of DOPPS. More information will be released as it becomes available.

The DOPPS has published more than 60 papers in peer-reviewed medical journals, as well as numerous articles in textbooks and other forums. See our Publications section for detail on the full range of DOPPS publications.

Factors associated with health-related quality of life among hemodialysis patients in the DOPPS (Lopes et al)

Based on DOPPS I data, this study sought to identify modifiable factors associated with Health-Related Quality of Life among hemodialysis patients. Unemployment and psychiatric disease, both controllable or preventable factors, were independently and significantly associated with lower HRQOL measures. Several other comorbidities were associated with lower general scores, all of which support a greater focus on psychosocial and medical interventions to improve the well-being of hemodialysis patients.

Quality of Life Research 16(4):545-57, 2007.

Depression, benzodiazepines, and hemodialysis in Japan (Fukuhara et al.)

DOPPS data on symptoms of depression, physician-diagnosed depression, prescribed medications, and death were collected prospectively in Japan and 11 other countries. Symptoms of depression were as prevalent in Japan as elsewhere, but in Japan a much smaller percentage of patients had physician-diagnosed depression: only 2% in Japan vs. 17% elsewhere. Antidepressants were also much less commonly prescribed in Japan. In Japan, symptoms of depression were associated with prescription of benzodiazepines (without antidepressants), and patients with physician-diagnosed depression were twice as likely to be given benzodiazepines: 32% in Japan vs. 16% elsewhere. Benzodiazepine monotherapy was significantly associated with death, even after adjustments for 13 likely confounders. Hemodialysis patients in Japan with symptoms of depression are given not antidepressants but benzodiazepines, a practice associated with higher mortality.

Kidney International 70:1866-72, 2006.

Race/ethnicity and survival among hemodialysis patients (Robinson et al.)

In the U.S., hemodialysis patients who belong to racial or ethnic minority groups have longer survival than non-Hispanic white patients. This study sought to determine how much of this survival difference is explained by adjusting for case-mix and treatment characteristics. The study found that the survival advantages for racial and ethnic minority groups on HD are explained largely by measurable case-mix and treatment characteristics — particularly by the combined influence of unbalanced distributions of numerous demographic, morbidity, nutritional, and laboratory variables. Individual racial minority group or Hispanic patients should not be expected to survive longer on HD than non-Hispanic white patients with similar clinical attributes.

Journal of the American Society of Nephrology 17:2910-8, 2006.

Peripheral arterial disease and end-stage renal disease (Rajagopalan et al.)

Patients with end-stage renal disease are at high risk for cardiovascular morbidity and mortality. This study sought to describe the prevalence of peripheral arterial disease (PAD) and its effects on prognosis and health-related quality of life in an international cohort of patients on hemodialysis. The study examined international DOPPS data with logistic regression analysis and Cox regression analysis. Traditional cardiovascular risk factors including age, male sex, diabetes, hypertension, and smoking were identified, together with the duration of hemodialysis, as significant correlates of PAD. Diagnosis of PAD was associated with increased all-cause mortality, cardiac mortality, all-cause hospitalization, and hospitalization for a major adverse cardiovascular event). PAD is common in hemodialysis patients and is associated with increased risk of cardiovascular mortality, morbidity, and hospitalization, and reduced quality of life.

Circulation 114:1914-22, 2006.

Risk factors for bone fractures among hemodialysis patients (Jadoul et al.)

This study describes the prevalence of hip fractures and the incidence and risk factors associated with hip fractures and other fractures in representative groups of hemodialysis facilities and patients in the 12 countries of the DOPPS. Older age, female sex, prior kidney transplant, and low serum albumin were found to be predictive of new fractures. Elevated risk of new hip fracture was observed for selective serotonin reuptake inhibitors and combination narcotic medications. High parathyroid hormone levels were also associated with an elevated risk of any new fracture, as were several medications: narcotic pain medications, benzodiazepines, adrenal cortical steroids, and combination narcotic medications. The results suggest that greater selectivity in prescribing several classes of psychoactive drugs and more efficient treatment of secondary hyperparathyroidism may help reduce the burden of fractures in HD patients.

Kidney International 70: 1358-66, 2006.