Urgent-start dialysis in patients referred early to a nephrologist—the CKD-REIN prospective cohort study
Author:
Fages Victor12, de Pinho Natalia Alencar1, Hamroun Aghilès12, Lange Céline13, Combe Christian45ORCID, Fouque Denis67ORCID, Frimat Luc8, Jacquelinet Christian13, Laville Maurice69, Ayav Carole10, Liabeuf Sophie11ORCID, Pecoits-Filho Roberto1213ORCID, Massy Ziad A114, Boucquemont Julie1, Stengel Bénédicte1, de Pinho Natalia Alencar, Ayav Carole, Briançon Serge, Cannet Dorothée, Combe Christian, Fouque Denis, Frimat Luc, Herpe Yves-Edouard, Jacquelinet Christian, Laville Maurice, Massy Ziad A, Pascal Christophe, Robinson Bruce M, Stengel Bénédicte, Lange Céline, Legrand Karine, Liabeuf Sophie, Metzger Marie, Speyer Elodie, Hannedouche Thierry, Moulin Bruno, Mailliez Sébastien, Lebrun Gaétan, Magnant Eric, Choukroun Gabriel, Deroure Benjamin, Lacraz Adeline, Lambrey Guy, Bourdenx Jean Philippe, Essig Marie, Lobbedez Thierry, Azar Raymond, Sekhri Hacène, Smati Mustafa, Jamali Mohamed, Klein Alexandre, Delahousse Michel, Combe Christian, Martin Séverine, Landru Isabelle, Thervet Eric, Massy Ziad A, Lang Philippe, Belenfant Xavier, Urena Pablo, Vela Carlos, Frimat Luc, Chauveau Dominique, Panescu Viktor, Noel Christian, Glowacki François, Hoffmann Maxime, Hourmant Maryvonne, Besnier Dominique, Testa Angelo, Kuentz François, Zaoui Philippe, Chazot Charles, Juillard Laurent, Burtey Stéphane, Keller Adrien, Kamar Nassim, Fouque Denis, Laville Maurice,
Affiliation:
1. UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France 2. Service de Néphrologie, Dialyse, Transplantation Rénale et Aphérèse, CHU de Lille, Lille, France 3. Agence de Biomédecine, La Plaine Saint-Denis, France 4. Service de Néphrologie, Transplantation, Dialyse, Aphérèses, CHU de Bordeaux, Bordeaux, France 5. INSERM Unité 1026, Université de Bordeaux, Bordeaux, France 6. Université Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France 7. Service de Néphrologie, Lyon-Sud Hospital, Pierre-Bénite, France 8. Service de Néphrologie, Université de Lorraine, APEMAC, CHRU de Nancy – Hôpitaux de Brabois, Nancy, France 9. Association Utilisation Rein Artificiel Région Lyonnaise, Lyon, France 10. CHRU de Nancy, Université de Lorraine, INSERM, CIC Epidémiologie Clinique, Hôpitaux de Brabois, Nancy, France 11. Département de Recherche Clinique, Service de Pharmacologie Clinique, CHU d’Amiens, Université de Picardie Jules Verne, INSERM U-1088, Amiens, France 12. Arbor Research Collaborative for Health, Ann Arbor, MI, USA 13. Pontificia Universidade Catolica do Prana, Curitiba, Brazil 14. Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
Abstract
Abstract
Background
The lack of a well-designed prospective study of the determinants of urgent dialysis start led us to investigate its individual- and provider-related factors in patients seeing nephrologists.
Methods
The Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study that included 3033 patients with CKD [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from 40 nationally representative nephrology clinics from 2013 to 2016 who were followed annually through 2020. Urgent-start dialysis was defined as that ‘initiated imminently or <48 hours after presentation to correct life-threatening manifestations’ according to the Kidney Disease: Improving Global Outcomes 2018 definition.
Results
Over a 4-year (interquartile range 3.0–4.8) median follow-up, 541 patients initiated dialysis with a known start status and 86 (16%) were identified with urgent starts. The 5-year risks for the competing events of urgent and non-urgent dialysis start, pre-emptive transplantation and death were 4, 17, 3 and 15%, respectively. Fluid overload, electrolytic disorders, acute kidney injury and post-surgery kidney function worsening were the reasons most frequently reported for urgent-start dialysis. Adjusted odds ratios for urgent start were significantly higher in patients living alone {2.14 [95% confidence interval (CI) 1.08–4.25] or with low health literacy [2.22 (95% CI 1.28–3.84)], heart failure [2.60 (95% CI 1.47–4.57)] or hyperpolypharmacy [taking >10 drugs; 2.14 (95% CI 1.17–3.90)], but not with age or lower eGFR at initiation. They were lower in patients with planned dialysis modality [0.46 (95% CI 0.19–1.10)] and more nephrologist visits in the 12 months before dialysis [0.81 (95% CI 0.70–0.94)] for each visit.
Conclusions
This study highlights several patient- and provider-level factors that are important to address to reduce the burden of urgent-start dialysis.
Funder
Agence Nationale de la Recherche AstraZeneca
Publisher
Oxford University Press (OUP)
Subject
Transplantation,Nephrology
Cited by
4 articles.
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