Which factors prompt urgent start of dialysis in patients of CKD?

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.

Kidney Failure (KF) prevalence is increasing steadily. In France, according to data from the French Renal Epidemiology and Information Network (REIN) registry, 11 343 patients started chronic renal replacement therapy (RRT) in 2018 (95.9% on dialysis and 4.1% with preemptive kidney transplantation (KT)). Over the past decades, survival among dialysis patients appears to improve. However a substantial and stable proportion of KF patients start RRT in an emergency context which is a major risk factor of mortality during the first year of dialysis.

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).

The two factors independently associated with USD were cardiac failure and stroke.

Reference:

Tachikart, A., Vachey, C., Vauchy, C. et al. Determinants of urgent start dialysis in a chronic kidney disease cohort followed by nephrologists. BMC Nephrol 24, 190 (2023). https://doi.org/10.1186/s12882-023-03222-1

Keywords:

Tachikart, A., Vachey, C., Vauchy, C. Determinants, urgent, start, dialysis, chronic, kidney, disease, cohort, followed, nephrologists, BMC, Nephrol 24.