Monitoring Dialysis Outcomes across the World - The MONDO Global Database Consortium

Abstract

Background/Aims: Dialysis providers frequently collect detailed longitudinal and standardized patient data, providing valuable registries of routine care. However, even large organizations are restricted to certain regions, limiting their ability to separate effects of local practice from the pathophysiology shared by most dialysis patients. To overcome this limitation, the MONDO (MONitoring Dialysis Outcomes) research consortium has created a platform for the joint analysis of data from almost 200,000 dialysis patients worldwide. Methods: We examined design and operation of MONDO as well as its methodology with respect to patient inclusion, descriptive data and other study parameters. Results: MONDO partners contribute primary databases of anonymized patient data and collaboratively analyze populations across national and regional boundaries. To that end, datasets from different electronic health record systems are converted into a uniform structure. Patients are enrolled without systematic exclusions into open cohorts representing the diversity of patients. A large number of patient level treatment and outcome data is recorded frequently and can be analyzed with little delay. Detailed variable definitions are used to determine if a parameter can be studied in a subset or all databases. Conclusion: MONDO has created a large repository of validated dialysis data, expanding the opportunities for outcome studies in dialysis patients. The density of longitudinal information facilitates in particular trend analysis. Limitations include the paucity of uniform definitions and standards regarding descriptive information (e.g. comorbidities), which limits the identification of patient subsets. Through its global outreach, depth, breadth and size, MONDO advances the observational study of dialysis patients and care.

Dialysis Access as an Area of Improvement in Elderly Incident Hemodialysis Patients: Results from a Cohort Study from the International Monitoring Dialysis Outcomes Initiative

“…These data suggest that the elderly are less likely to start dialysis with an AV fistula and particularly elderly women have a higher percentage of catheters than men [12]. While we had a different study population in some regions (e.g., no patients from Japan in the Asia-Pacific dataset; for detailed information see [16]) and clear limitations in terms of documentation compared to DOPPS, their findings are consistent with our data of incident HD patients. Based on recently published data, however, the elderly population is more likely to receive predialysis care and fistula creation later than what guidelines suggest, which results in a majority of the elderly initiating dialysis using a CVC access [20].…”

“…The international MONDO initiative database contains data of HD patients from Renal Research Institute clinics in the United States, Fresenius Medical Care (FMC) clinics in Europe, Asia Pacific and Latin America, Kuratorium für Dialyse und Nierentransplantation clinics in Germany, Imperial College in the United Kingdom, Hadassah Medical Center in Israel, and Maastricht University Medical Center in the Netherlands [15,16]. We included patients from North- and South America, Asia-Pacific (including Australia) and Europe, older than 70 years and commencing HD treatment between January 1, 2006 and December 31, 2012.…”

Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

“…The MONDOs Initiative is an international retrospective cohort study that comprised all the chronic HD patients from more than 41 [18,19]. Corresponding data providers are responsible for the primary data collection and safeguarding the use of patient data following local data protection laws and privacy.…”

Methodological foundation of comprehensive support for dialysis patients based on artificial intelligence technologies

“…Today a MONDO registry exists [4], which includes data on more than 200,000 dialysis patients. However, the drawback of this registry is the inability to track the full history of appointments in retrospect, moreover, not only directly related to the hemodialysis procedure, but also with the achievement of targets for concomitant therapies, including hemoglobin, calcium-phosphorus metabolism, parathyroid hormone and other results of laboratory, clinical and functional examinations of the dialysis patient.…”