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The Comprehensive Dialysis Study (CDS): A USRDS Special Study

Nancy G. Kutner^*, Kirsten L. Johansen^,, George A. Kaysen^,, Sarah Pederson^||, Shu-Cheng Chen^||, Lawrence Y. Agodoa^**, Paul W. Eggers^**, and Glenn M. Chertow^,¶

^* Rehabilitation/Quality of Life Special Studies Center and Nutrition Special Studies Center, United States Renal Data System (USRDS), Emory University, Atlanta, Georgia; University of California San Francisco, San Francisco, California; University of California Davis, Davis, California; ^¶ Stanford University, Palo Alto, California; ^|| Coordinating Center, USRDS, University of Minnesota, Minneapolis, Minnesota; ^** National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland

Correspondence: Glenn M. Chertow, MD, MPH, Division of Nephrology, Stanford University School of Medicine, 780 Welch Road, Suite 106, Palo Alto, CA 94304. Phone: 650-725-4738; Fax: 650-721-1443; E-mail: gchertow{at}stanford.edu

Background and objectives: The Comprehensive Dialysis Study (CDS) aimed to understand factors contributing to physical, functional, and nutritional health status among patients starting dialysis.

Design, setting, participants, & measurements: A phone interview survey was conducted with patients from a geographically stratified national random sample of dialysis units, and quarterly serum samples were obtained for patients at a preidentified subset of units. The phone survey collected standardized measures of physical activity, employment and disability status, perceived health and well-being, and dietary intake. Serum samples were obtained to measure prealbumin, albumin, creatinine, normalized protein catabolic rate, and C-reactive protein. To comply with restrictions required under the Health Insurance Portability and Accountability Act (HIPAA), dialysis unit personnel could not participate in any research-related activities.

Results: Overall participation rate was 18.5%. One thousand six hundred forty-six patients affiliated with 295 dialysis units completed the phone survey; 361 patients affiliated with 68 dialysis units also completed a dietary intake survey, with 269 providing serum samples. Despite challenges in the design and implementation of CDS, the population was diverse and results should be generalizable.

Conclusions: Constraints within the dialysis industry and HIPAA requirements render the assembly of nationally representative cohorts extremely difficult. Nevertheless, the CDS represents the largest cohort of incident dialysis patients containing detailed information on self-reported physical activity and dietary intake and is one of few cohorts simultaneously measuring laboratory proxies of nutrition and inflammatory status. Data from CDS can be used to inform the design of interventions addressing several conditions that affect longevity and health status in ESRD.