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Delivered Dose of Peritoneal Dialysis Above Minimum

CBE ID
0318
Endorsement Status
1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
Yes
Next Maintenance Cycle
Fall 2024
1.6 Measure Description

Percentage of all patient months for adult patients (>= 18 years old) whose delivered peritoneal dialysis dose was a weekly Kt/V urea >= 1.7 (dialytic + residual). 

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.9b Other Care Setting
Dialysis Facility
1.10 Measure Rationale

Evaluation of PD adequacy every four months for adults is critical to ensure timely dose adjustment as needed, and adequate dialysis doses (Kt/V urea > 1.7 for adult patients and Kt/V urea > 1.8 for pediatric patients) have been linked to improved patient outcomes. Therefore, continued implementation of this measure is needed to ensure frequent adequacy measurement and adequate dialysis dosing. 

 

Studies have shown a Kt/V of 1.8/week or greater in adult PD patients was associated with better serum albumin levels[1] and improved survival [2]. The ADEMEX did not show clinical benefit with weekly Kt/V doses exceeding 1.7/week in adult CAPD patients [1]. 

 

  1. Paniagua R, Amato D, Vonesh E, et al. “Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial.” Journal of the American Society of Nephrology: JASN (2002) 13:1307-20. PMID: 11961019. 
  2. Lo WK, Lui SL, Chan TM, et al. “Minimal and optimal peritoneal Kt/V targets: Results of an anuric peritoneal dialysis patient´s survival analysis.” Kidney international (2005) 67:2032-8. PMID: 15840054. 
1.20 Types of Data Sources
1.25 Data Source Details

For the analyses supporting this submission, the measure is calculated using EQRS as the primary data source for the Kt/V values used to determine the numerator. If a patient’s Kt/V data are missing in EQRS, Kt/V values from Medicare claims are used as an additional source for obtaining that information. Please see the attached data dictionary for a list of specific data elements that are used from each data source.

 

EQRS is the primary basis for placing patients at dialysis facilities and dialysis claims are used as an additional source. Information regarding first ESRD service date, death, age and incident comorbidities adjustments and transplant is obtained from EQRS (including the CMS Medical Evidence Form (Form CMS-2728) and the Death Notification Form (Form CMS-2746)) and Medicare claims, as well as the Organ Procurement and Transplant Network (OPTN) and the Social Security Death Master File.