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Titolo Clinical audit improves hypertension control in hemodialysis patients
Autore Pasquale Esposito1, Attilio Di Benedetto2, Carmine Tinelli3, Annalisa De Silvestri3, Teresa Rampino1, Daniele Marcelli4, Antonio Dal Canton1 - 1 Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo and University of Pavia - Italy - 2 NephroCare Country Italy Medical Director -3 Unit of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia – Italy - 4 NephroCare EMEALA Medical Board, Bad Homburg - Germany
Referenza Int J Artif Organs 2013; DOI: 10.5301/ijao.5000202

Background: In patients on hemodialysis (HD), hypertension is a risk factor for cardiovascular disease. In this study we tested the effectiveness of a clinical audit in improving blood pressure (BP) control in HD patients. Methods: 177 adult, prevalent patients undergoing dialysis in NephroCare centers in Italy were audited. At the conclusion of the audit, individual strategies were developed in order to improve BP control. Patient data was collected and examined at months -1 (Pre), 0 (the date of the audit- Audit), and +1 and +6 after the audit (Post-1 and Post-6, respectively). We recorded BP, information on factors affecting BP, and anti-hypertensive drug regimen. The primary outcome of the study was to decrease prevalence of hypertension (BP≥140/90 mmHg). Secondary outcomes were a reduction in average BP in hypertensive patients and/or a decrease in drug delivery associated with lower or unchanged BP.

Results: 104 patients out of 177 (58.7%) were hypertensive at Audit. BP levels were directly related to comorbidity and male sex, and inversely related to dialysate sodium concentration. The announcement of the audit alone was associated with a decreased prevalence of hypertension (Pre 64.4% to Audit 58.7%); a further decrease followed the audit (Post-1 51.1%, Post-6 47.6%, p

Conclusions: A clinical audit is an effective tool to improve BP control in HD patients.





Data 24.03.2013
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