Background: Many guides and scientific recommendations about hemodialysis (HD) treatment have been developed. However, its impact and application is unknown. The aim of this study is to describe how Spanish Extrahospitalary Hemodialysis Centers work.
Methods: A transversal, descriptive study was conducted by means of a survey. An 83-items questionnaire tackled different aspects involving patients and HD characteristics, Dialysis Unit organization and anemia management.
Results: One hundred surveys were distributed and 91% were answered, corresponding to 6599 patients (M 4015/F 2584). Fifteen % were younger of 50 years and 45.2% older of 70 years. Seventy seven % had arteriovenous fistulas, 8.1% had polytetrafluoroethylene grafts and 14.8% had catheters. The mean number of patients per center was 72.3 (11-212). Seventy eight % were divided in 3 shifts, with a mean relationship of 38.9 patients/physician, 4.7 patients/nurse and 9 patients/auxiliary personnel. HD characteristics were: 60.1% of the HD sessions were longer than 4 hours, 97.2% were on a 3 days/week schedule; 95.4% used a conventional technique; 49.1% were performed with high-flux membranes, 89.6% with synthetic membranes, and 11.7% used Qb higher than 400 mL/min: On the other hand, 8.8% of the patients were HVC +, 0.68% were AgHBs +, and 0.09 were HIV +. There were HCV + patients in 79% of Dialysis Units, 50% of them with complete isolation, while patients with hepatitis B were attended in 13.8%, and VIH + in 3.4% of the Units, the latter always with complete isolation. Water treatment was done with simple osmosis in 46.6% of the cases, with water collection in 86.8% with pyrogen filter in the monitors in 48.9%. Surveillance of the controls was performed by the physician in 94.3% of the cases, and by technicians or nurses in the rest. Mean Hb was 11.9(1.4) g/dL, being higher of 11 g/dL in 80.2% of the patients. Ferritin higher than 100 microg/L was found in 92.4% and transferrin saturation higher than 20% in 81.9% of patients. The percentage treated with erithropoyetic stimulant agents was 90.6%.
Conclusions: All information collected is relevant in order to know what is done and how to improve it.. It will be useful to evaluate the impact of the publication of the new Guides of HD Centers of SEN on medical practice in this area.