Quality improvement in hemodialysis: A systematic review

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Published May 1, 2025
https://doi.org/10.62438/tunismed.v103i5.5567
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Vol. 103 No. 5 (2025): Tunis Med May 2025

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Abdelmounir El bachiri
Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, University Mohammed First, Morocco
Intissar Haddiya
Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, University Mohammed First,Department of Nephrology, Mohammed VI University Hospital, Oujda, Morocco

Abstract

The predominant modality of renal replacement therapy, hemodialysis (HD), is a specialized area associated with a heightened susceptibility to infections, partly due to patients' vulnerability, the invasiveness of procedures necessitating vascular access, and the cyclical nature of the treatment. These factors, along with a notable incidence of infections, present a significant public health challenge owing to their implications on both human health and economic resources.


Mortality rates in dialysis patients are markedly elevated, typically ranging from 10 to 20%, primarily linked to cardiovascular (40%) and infectious (10%) etiologies. Enhancing the caliber of care, patient safety, and clinical outcomes represents a pivotal focal point for healthcare systems globally. Nevertheless, could the adherence to universally acknowledged and validated benchmarks engender variability in outcomes within hemodialysis environments? Can interventions aim at improving quality lead to positive outcomes by reducing infections and improving results for patients undergoing hemodialysis? To respond to these inquiries, a systematic review based on the PRISMA guidelines was carried out over 14 years across various databases, identifying cases of quality improvement initiatives and detailing their effectiveness in infection prevention and quality-centred approaches to risk management. Multiple forms of interventions aimed at enhancing quality have been outlined and considered relevant, including (i) integrating the PDCA (Plan-Do-Check-Act) cycle with oversight of risk factors, (ii) utilizing the Failure Mode, Effects, and Criticality Analysis (FMECA) framework, (iii) applying LEAN management principles, and (iv) strictly following the guidelines established by the Centers for Disease Control and Prevention (CDC) and the kidney disease..(abstract truncated at 250 words).

Keywords:

Quality improvement , Hemodialysis , Infections

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References

  1. (1) A. K. Bello and al., « Epidemiology of hemodialysis outcomes », Nat Rev Nephrol, vol. 18, no 6, p. 378‑395, 2022, doi: 10.1038/s41581-022-00542-7.
  2. (2) H. N. Murdeshwar and F. Anjum, « Hemodialysis », in StatPearls, Treasure Island (FL): StatPearls Publishing, 2024. Consulté le: 29 février 2024. [En ligne]. Disponible sur: http://www.ncbi.nlm.nih.gov/books/NBK563296/
  3. (3) É. Laprugne-Garcia and S. Gardes, « [The infection risk assessment visit in hemodialysis, a new tool] », Soins, vol. 62, no 813, p. 17‑19, mars 2017, doi: 10.1016/j.soin.2017.01.003.
  4. (4) S. El Marnissi and al., « Analyse du risque infectieux autour du patient dans l’unité d’hémodialyse de l’hôpital Ibn Sina de Rabat par application de la méthode d’analyse des modes de défaillance, de leurs effets et de leur criticité », Néphrologie & Thérapeutique, vol. 16, no 2, p. 105‑117, mars 2020, doi: 10.1016/j.nephro.2019.09.005.
  5. (5) D. B. Nguyen, M. J. Arduino, and P. R. Patel, « Hemodialysis-Associated Infections », in Chronic Kidney Disease, Dialysis, and Transplantation (Fourth Edition), J. Himmelfarb and T. A. Ikizler, Éd., Philadelphia: Elsevier, 2019, p. 389-410.e8. doi: 10.1016/B978-0-323-52978-5.00025-2.
  6. (6) S. Beaudreuil, H. Hebibi, B. Charpentier, and A. Durrbachr, « Les infections graves chez les patients en dialyse péritonéale et en hémodialyse chronique conventionnelle : péritonites et infections de la voie d’abord vasculaire », Réanimation, vol. 17, no 3, p. 233‑241, mai 2008, doi: 10.1016/j.reaurg.2008.01.014.
  7. (7) J.-É. Bazin, « Tomorrow’s hospital management », Oxymag, vol. 34, no 181, p. 15‑17, 2021, doi: 10.1016/j.oxy.2021.09.005.
  8. (8) B. Lazarus, E. Bongetti, J. Ling, M. Gallagher, S. Kotwal, and K. R. Polkinghorne, « Multifaceted Quality Improvement Interventions to Prevent Hemodialysis Catheter-Related Bloodstream Infections: A Systematic Review », Am J Kidney Dis, vol. 82, no 4, p. 429-442.e1, oct. 2023, doi: 10.1053/j.ajkd.2023.02.006.
  9. (9) J. Z. Breyer and al., « Hospital quality indicators: a systematic review », International Journal of Health Care Quality Assurance, vol. 32, no 2, p. 474‑487, janv. 2019, doi: 10.1108/IJHCQA-04-2018-0091.
  10. (10) H. Lazareth and al., « Quality indicators in hemodialysis: A 5-year experience of national campaigns in France », Seminars in Dialysis, vol. 35, no 6, p. 511‑521, 2022, doi: 10.1111/sdi.13095.
  11. (11) S. Grangé, M. Hanoy, F. Le Roy, D. Guerrot, and M. Godin, « Monitoring of hemodialysis quality-of-care indicators: why is it important? », BMC Nephrol, vol. 14, p. 109, mai 2013, doi: 10.1186/1471-2369-14-109.
  12. (12) S. A. Silver and al., « Effectiveness of Quality Improvement Strategies for the Management of CKD », Clin J Am Soc Nephrol, vol. 12, no 10, p. 1601‑1614, oct. 2017, doi: 10.2215/CJN.02490317.
  13. (13) J. Hingwala, N. Tangri, C. Rigatto, and P. Komenda, « Improving the quality and efficiency of conventional in-center hemodialysis », Semin Dial, vol. 28, no 2, p. 169‑175, 2015, doi: 10.1111/sdi.12347.
  14. (14) S. Albreiki and al., « A Systematic Literature Review of Safety Culture in Hemodialysis Settings », J Multidiscip Healthc, vol. 16, p. 1011‑1022, 2023, doi: 10.2147/JMDH.S407409.
  15. (15) M. Nataatmadja, Y. Cho, and D. W. Johnson, « Continuous Quality Improvement Initiatives to Sustainably Reduce Peritoneal Dialysis-Related Infections in Australia and New Zealand », Perit Dial Int, vol. 36, no 5, p. 472‑477, sept. 2016, doi: 10.3747/pdi.2016.00114.
  16. (16) M. Fisher, L. Golestaneh, M. Allon, K. Abreo, and M. H. Mokrzycki, « Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis », Clin J Am Soc Nephrol, vol. 15, no 1, p. 132‑151, janv. 2020, doi: 10.2215/CJN.06820619.
  17. (17) M. Drozdz and al., « Improvements in six aspects of quality of care of incident hemodialysis patients – a real-world experience », BMC Nephrol, vol. 22, p. 333, oct. 2021, doi: 10.1186/s12882-021-02529-1.
  18. (18) A. Vijayan and J. M. Boyce, « 100% Use of Infection Control Procedures in Hemodialysis Facilities », Clin J Am Soc Nephrol, vol. 13, no 4, p. 671‑673, avr. 2018, doi: 10.2215/CJN.11341017.
  19. (19) L. Sola and al., « Development of a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis », Kidney Int Suppl (2011), vol. 10, no 1, p. e55‑e62, mars 2020, doi: 10.1016/j.kisu.2019.11.009.
  20. (20) T. M. Perl, K. Blot, J. Bergs, D. Vogelaers, S. Blot, and D. Vandijck, « Prevention of Central Line–Associated Bloodstream Infections Through Quality Improvement Interventions: A Systematic Review and Meta-analysis », Clin Infect Dis, vol. 59, no 1, p. 96‑105, juill. 2014, doi: 10.1093/cid/ciu239.
  21. (21) Y. Yu and al., « Impact of Continuous Quality Improvement Initiatives on Clinical Outcomes in Peritoneal Dialysis », Perit Dial Int, vol. 34, no Suppl 2, p. S43‑S48, juin 2014, doi: 10.3747/pdi.2013.00123.
  22. (22) H. Chen, P. Wang, and Q. Ji, « Analysis of the Application Effect of PDCA Cycle Management Combined With Risk Factor Management Nursing for Reducing Infection Rate in Operating Room », Front Surg, vol. 9, p. 837014, mars 2022, doi: 10.3389/fsurg.2022.837014.
  23. (23) M. D. Arenas Jiménez, G. Ferre, and F. Álvarez-Ude, « Estrategias para aumentar la seguridad del paciente en hemodiálisis: Aplicación del sistema de análisis modal de fallos y efectos (sistema AMFE) », Nefrología, vol. 37, no 6, p. 608‑621, nov. 2017, doi: 10.1016/j.nefro.2017.04.007.
  24. (24) A. Y. Metcalf, M. Habermann, T. D. Fry, and J. K. Stoller, « The impact of quality practices and employee empowerment in the performance of hospital units », International Journal of Production Research, vol. 56, no 18, p. 5997‑6014, 2018, doi: 10.1080/00207543.2018.1475763.