#149 Evolution of clinical performance metrics in chronic dialysis patients: a comparative analysis of DaVita Kidney Care Brazil and global standards

Abstract Background and Aims The quality of dialysis care is assessed by key clinical indicators, including dialysis adequacy (Kt/V), vascular access type (fistula vs. catheter), and anemia management. Achieving optimal levels in these areas is critical to improving patient outcomes and reducing complications. While global nephrology guidelines emphasize Kt/V ≥1.2, DaVita Kidney Care (DKC) Brazil has adopted a more ambitious threshold of Kt/V ≥1.3 to drive further improvements in dialysis adequacy. This study evaluates the evolution of these clinical performance metrics at DKC Brazil, comparing them to global and national benchmarks using data from the SBN Census 2023, ISN Atlas 2023, Lancet Report 2024, and the ERA-EDTA 2022 Registry. To analyze the evolution of clinical performance indicators at DKC Brazil (December 2024), particularly Kt/V achievement, vascular access rates (AVF vs. CVC), and anemia management, and compare these outcomes with national and international data. Methods We retrospectively analyzed data from DKC Brazil's BI dashboard (December 2024), assessing trends in dialysis adequacy (Kt/V), vascular access, and anemia management from January of 2023 to December 2024. These were compared with national data from the SBN Census 2023 and global benchmarks from the ERA-EDTA Registry 2022, ISN Atlas 2023, and recent literature (Lancet 2024). Key metrics included: - Kt/V ≥1.3 (as per DKC Brazil's internal KPI) vs. the benchmark of Kt/V ≥1.2 - Percentage of patients with arteriovenous fistula (AVF) vs. central venous catheter (CVC) - Anemia management (Hb levels, iron and ESA therapy usage) Results Dialysis Adequacy (Kt/V Achievement) At DKC Brazil (December 2024), 78% of patients achieved Kt/V ≥1.3, reflecting a continuous improvement in dialysis adequacy.This is significant when compared to early 2023, where only 75% met Kt/V ≥1.2, demonstrating a consistent upward trend despite adopting a stricter KPI.The ERA-EDTA Registry 2022 reported a median Kt/V of ∼1.2, indicating that DKC Brazil's performance is aligned with or surpasses international standards. Vascular Access (AVF vs. CVC Usage) The use of arteriovenous fistula (AVF) at DKC Brazil increased to 78.5% in Dec 2024, surpassing the SBN Census 2023 national average of 74%.This trend aligns with global best practices, as the ERA-EDTA Registry reports an AVF prevalence of ∼80% across European countries.Conversely, CVC usage at DKC Brazil decreased to 21.5%, approaching international benchmarks for catheter reduction. Anemia Management 83% of patients at DKC Brazil maintained Hb between 10-12 g/dL, within the KDIGO-recommended range.ESA (erythropoiesis-stimulating agents) use was optimized, with targeted therapy adjustments based on ferritin and transferrin saturation (TSAT) levels.The prevalence of Hb <10 g/dL decreased by 10% compared to early 2023, indicating improved anemia control. Conclusion DKC Brazil has demonstrated continuous improvement in dialysis adequacy, vascular access optimization, and anemia management, aligning with global nephrology benchmarks. The adoption of a more ambitious Kt/V threshold (≥1.3) has driven improvements while remaining close to the standard benchmark of ≥1.2. The increase in AVF rates and reduction in CVC usage reflects a strategic shift towards best practices in vascular access. Anemia management has improved significantly, optimizing Hb levels and reducing ESA dependency. These findings highlight DKC Brazil's progress in enhancing dialysis care and provide valuable insights for further clinical quality initiatives, reinforcing Brazil's position within the global nephrology landscape.