Early intervention dramatically improves outcomes for new dialysi...( Washington DC (October 16 2007) A p...),Health

Washington, DC (October 16, 2007) A program of education, close medical follow-up, and self-empowerment for patients with end-stage renal disease (ESRD) newly starting dialysis, reduces complications and improves outcomesincluding significant reductions in mortality and hospitalization rates, reports a study in the November Clinical Journal of the American Society of Nephrology.

The researchers initiated a structured quality improvement program, called RightStart, for ESRD patients within their first two weeks and continuing for up to three months of starting dialysis. "This program for new patients has shown itself to dramatically improve outcomes, when compared to a control group that did not receive the intervention," comments Dr. Raymond Hakim of Fresenius Medical Care in Brentwood, Tenn.

"The goal of this research was to implement a patient care strategy that focused on improving clinical outcomes in the first 90 days of hemodialysis, through intensified medical, nursing, and dietary focus and empowerment of patients to influence their own health," Dr. Hakim explains. The program included one-on-one time with nurses, who provided an educational program focusing on patient self-management.

Because new patients are often malnourished, a key emphasis was nutrition teaching, especially the need for adequate amounts of protein and calories. Dietary restrictions were introduced only as needed for the individual patient. Each patient was assigned to a case manager, who actively identified and addressed any medical problems developing in the first weeks and months on dialysis, along with the multidisciplinary team.

The study tracked survival, hospitalization rates, and other outcomes for 918 patients participating in RightStart. Outcomes were compared with those of 1,020 new dialysis patients at clinics not using the RightStart program. "It is important to note that the ESRD community provides excellent care to dialysis patients overall,
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