Determinants of Urgent Dialysis Start in a Chronic Kidney Disease Cohort Followed by Nephrologists

Abstract

Abstract Background: The French Renal Epidemiology and Information Network (REIN) registry collect dialysis initiation context for each patient starting dialysis with a flawed definition of urgent dialysis start (UDS). The main objective of this study was to identify factors associated with UDS in patients regularly followed-up by a nephrologist using a classification of UDS considering the preparation to renal replacement therapy. Methods: This retrospective cohort study included adult patients who started dialysis between 2012 et 2018 in the Franche-Comté region of France after a minimum of two nephrology consultations. We classified dialysis initiation context as follows: UDS for patients with no vascular access (VA) created or planned, suboptimal dialysis start (SDS) for patients starting with a recent or non-functional VA and planned dialysis start (PDS) for those starting with a functional and mature VA. Results: Four hundred and sixty-five patients met inclusion criteria. According to REIN registry, 94 (20.3%) patients were urgent starters (US) whereas with our classification 80 (17.2%) and 73 (15.7%) where respectively US and suboptimal starters (SOS). The factors independently associated with UDS in our classification were: stroke (odds ratio(OR) = 2.76, 95% confidence interval (95%CI)=[1.41-5.43]), cardiac failure (OR=1.78, 95%CI=[1.07-2.96]) and the number of nephrology consultations prior dialysis onset (OR=0.73, 95%CI=[0.64-0.83]). Thirty-one patients died during the first year after dialysis start. According to our classification, we observed significantly different survival probabilities: 95.7%, 89.5% and 83.4% respectively for planned starters, SOS and US (p=0.001). Conclusion: The two factors independently associated with UDS were cardiac failure and stroke.