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Medical Review Committee

Recommended Treatment Goals and Review Guidelines

The mission of ESRD Network 11 is to assess and improve the quality of care provided to individuals with end-stage renal disease. In keeping with this mission statement, the Medical Review Committee (MRC) issues its recommended treatment goals on important clinical parameters. These parameters are based on available evidence and accepted practice guidelines such as K/DOQI (Kidney Dialysis Outcomes Quality Initiative), etc. These improvement goals are provided as assistance to dialysis facilities for use in quality improvement. Each year, the MRC reviews its recommended treatment guidelines and makes revisions based on changes in clinical practice guidelines.

Changes for 2010

• First of the month lab values.  The 2009 MRC Recommended Treatment Goals planned to start using last of the month lab values to coincide with CrownWeb specifications, however, that change was never implemented.  All lab values through Q4 2009 have been first of the month lab values, and first of the month lab values will be continued until further notice.
• Anemia Management. The MRC recommendations for hemoglobin have not changed for 2010. For the Q4 2010 time period, the best practice goal will be ≥ 57.1% of patients achieving the target range of 11-12 gm/dL.
• Hemodialysis Adequacy. Over the past several years, the Network 11 median facility results for URR and Kt/V results have continued to increase. Because of this, the MRC has increased the MRC Recommended Guideline and the Best Practice Guideline for hemodialysis adequacy to 85% and 90% respectively (see Guidelines, page 1).
• Frequent Dialysis. Home hemodialysis and more frequent dialysis modalities are increasing in Network 11. Because of that fact, the Medical Review Committee has decided to add a recommendation to address the adequacy of patients on frequent (≥ 4 times per week) hemodialysis patients (see Guidelines, page 1).
• Bone Management. After review of past results, the MRC decided to lower the recommendations for phosphorus control, to 65% for its recommended guideline and 70% for best practice (see Guidelines page 2). In addition, the MRC added a guideline recommending measurement of PTH quarterly. Although Network 11 will not be collecting PTH lab values as part of Elab, the MRC felt strongly that facilities continue to measure PTH concentration in its patients.

Link: MRC Recommended Treatment Guidelines 2010.
Link: MRC Review Guidelines 2010.
Link: Anemia and Vascular Access Guideline Rationale 2008.
Link: Anemia and Peritoneal Dialysis Adequacy Guideline Rationale 2009.
Link: Sample Facility Specific Hemoglobin Distribution Curve.

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