Improving outcomes in patients receiving dialysis: The peer kidney care initiative

James B. Wetmore, David T. Gilbertson, Jiannong Liu, Allan J. Collins

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


The past decade has witnessed a marked reduction in mortality rates among patients receiving maintenance dialysis. However, the reasons for this welcome development are uncertain, and greater understanding is needed to translate advances in care into additional survival gains. To fill important knowledge gaps and to enable dialysis provider organizations to learn from one another, with the aim of advancing patient care, the Peer Kidney Care Initiative (Peer) was created in 2014 by the chief medical officers of 14 United States dialysis provider organizations and the Chronic Disease Research Group. Areas of particular clinical importance were targeted to help shape the public health agenda in CKD and ESRD. Peer focuses on the effect of geographic variation on outcomes, the implications of seasonality for morbidity and mortality, the clinical significance of understudied disorders affecting dialysis patients, and the debate about howbest tomonitor and evaluate progress in care. In the realm of geovariation, Peer has provided key observations on regional variation in the rates of ESRD incidence, hospitalization, and pre-ESRD care. Regarding seasonality, Peer has reported on variation in both infectionrelated and non-infection-related hospitalizations, suggesting that ambient environmental conditions may affect a range of health outcomes in dialysis patients. Specific medical conditions that Peer highlights include Clostridium difficile infection, which has become strikingly more common in patients in the year after dialysis initiation, and chronic obstructive pulmonary disease, the treatments for which have the potential to contribute to sudden cardiac death. Finally, Peer challenges the nephrology community to consider alternatives to standardized mortality ratios in assessing progress in care, positing that close scrutiny of trends over time may be the most effective way to drive improvements in patient care.

Original languageEnglish (US)
Pages (from-to)1297-1304
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Issue number7
StatePublished - 2016

Bibliographical note

Publisher Copyright:
© 2016 by the American Society of Nephrology.


  • Cardiac
  • Chronic
  • Death
  • Dialysis
  • End-stage renal disease
  • Hospitalization
  • Humans
  • Incidence
  • Morbidity
  • Outcomes
  • Patient care
  • Renal dialysis
  • Renal insufficiency
  • Sudden


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