The DOPPS is a prospective cohort study of hemodialysis practices based on the collection of observational longitudinal data for a random sample of patients from a representative and random sample of dialysis facility units in twenty countries.

The samples of patients in each facility and of facilities in each country are designed to provide a reliable picture of practices and outcomes in each facility and geographic area.

In view of differences in patient outcomes of mortality and morbidity by country and by dialysis unit, the study helps researchers:

• Describe differences in practice patterns that correlate with differences in outcomes
• Understand how the factors associated with patient outcomes will lead to improved patient care and reduced mortality and morbidity

How has the DOPPS informed dialysis practice and policy?

Vascular Access

The DOPPS has shown that regional survival differences in mortality, particularly for the United States as compared with Europe, were largely explained by differences in facility vascular access use. US and European facilities with similar percentages of fistula, graft, and catheter use have, on average, similar survival rates.

In recent years, with the Fistula First Initiative, there has been a commendable increase in fistula use in the US, whereas in several other countries, fistula use has fallen and/or catheter use has risen substantially.

Dialysis Session Length

In recent years, DOPPS observed that dialysis session length has shortened in the US while it has lengthened in most other DOPPS countries. By both standard and IV analyses, the DOPPS has found that longer treatment time is associated with lower mortality in models adjusted for Kt/V, ultrafiltration rate, and other characteristics.

According to the DOPPS, shorter dialysis session length is now one of the key practice differences between the US and other DOPPS countries, and its implications merit attention from research and policy perspectives.

Quality of Life and the Patient Experience

In addition to the quality of life being an important predictor of mortality, it is also an important end-point in itself. Recent research on the time it takes to recover from dialysis treatment shows a great deal of variation among patients – some will recover in an hour or two but many others take all day to recover. For those patients, meaningful and enjoyable quality of life is negated for three days of every week. This is of great importance to patients, and we plan more work to address this negative experience.