Author:
Tachikart Amin,Vachey Clément,Vauchy Charline,Savet Caroline,Ducloux Didier,Courivaud Cécile
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 start dialysis (USD). The main objective of this study was to identify factors associated with USD in patients regularly followed-up by a nephrologist using a classification of USD considering the preparation to renal replacement therapy.
Methods
This retrospective cohort study included adult patients who started dialysis between 2012 and 2018 in the Franche-Comté region of France after a minimum of two nephrology consultations. We classified dialysis initiation context as follows: USD for patients with no dialysis access (DA) created or planned, unplanned non urgent start dialysis (UNUSD) for patients starting with a recent or non-functional DA and planned start dialysis (PSD) for those starting with a functional and mature DA.
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 unplanned non urgent starters (UNUS). The factors independently associated with USD 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, UNUS and US (p = 0.001).
Conclusion
The two factors independently associated with USD were cardiac failure and stroke.
Publisher
Springer Science and Business Media LLC
Reference22 articles.
1. Chen Y-M, Wang Y-C, Hwang S-J, Lin S-H, Wu K-D. Patterns of Dialysis initiation affect outcomes of Incident Hemodialysis Patients. Nephron. 2016;132(1):33–42.
2. Ozeki T, Shimizu H, Fujita Y, Inaguma D, Maruyama S, Ohyama Y, et al. The type of Vascular Access and the incidence of Mortality in Japanese Dialysis Patients. Intern Med. 2017;56(5):481–5.
3. Selim G, Stojceva-Taneva O, Spasovski G, Tozija L, Grozdanovski R, Georgievska-Ismail L, et al. Timing of nephrology referral and initiation of dialysis as predictors for survival in hemodialysis patients: 5-year follow-up analysis. Int Urol Nephrol janv. 2015;47(1):153–60.
4. Laris-González A, Madero-Rovalo M, Pérez-Grovas H, Franco-Guevara M, Obrador-Vera GT. [Prevalence, risk factors and consecuences of late nephrology referral]. Rev Investig Clin Organo Hosp Enfermedades Nutr févr. 2011;63(1):31–8.
5. Caro Martínez A, Olry de Labry Lima A, Muñoz Terol JM, Mendoza García ÓJ, Remón Rodríguez C, García Mochón L, et al. Optimal start in dialysis shows increased survival in patients with chronic kidney disease. PLoS ONE. 2019;14(7):e0219037.