The top-performing dialysis centers also had superior coordination and staff management and dietitians who were "more resourceful and knowledgeable. "Altogether, these characteristics explained more than 30 percent of the variation in mortality risk between dialysis centers, after other factors were taken into account.

Dialysis center characteristics "reflecting a coordinated, multidisciplinary environment" are associated with lower mortality rates, the results suggest. "Our study could not say for certain whether there is a cause-and-effect relationship between these factors and patient mortality," Spiegel adds. "But it can lay the groundwork for future research in this area as part of broader quality improvement efforts."

This study had some important limitations: it was based on reports by staff members from different dialysis facilities and did not include follow-up to assess patient outcomes over time. "Future research should take our list of potential 'best practices' for dialysis and see if implementing those practices makes a difference," adds Spiegel. "Optimally, this would happen in a randomized controlled trial."

SOURCE American Society of Nephrology