Causes and Risk Factors for Acute Dialysis Initiation Among Patients with End-stage Kidney Disease-a Large Retrospective Observational Cohort Study

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2019 Aug 7

PMID 31384448

Citations 14

Authors

Nish Arulkumaran

Arunraj Navaratnarajah

Camilla Pillay

Wendy Brown

Neill Duncan

Adam McLean

David Taube

Edwina A Brown

Affiliations

Soon will be listed here.

Abstract

Background: Patients who require acute initiation of dialysis have higher mortality rates when compared with patients with planned starts. Our primary objective was to explore the reasons and risk factors for acute initiation of renal replacement therapy (RRT) among patients with end-stage kidney disease (ESKD). Our secondary objective was to determine the difference in glomerular filtration rate (GFR) change in the year preceding RRT between elective and acute dialysis starts.

Methods: We conducted a single-centre retrospective observational study. ESKD patients either started dialysis electively (planned starters) or acutely and were known to renal services for >90 (unplanned starters) or <90 days (urgent starters).

Results: In all, 825 consecutive patients initiated dialysis between January 2013 and December 2015. Of these, 410 (49.7%) patients had a planned start. A total of 415 (50.3%) patients had an acute start on dialysis: 244 (58.8%) unplanned and 171 (41.2%) urgent. The reasons for acute dialysis initiation included acute illness (58%) and unexplained decline to ESKD (33%). Cardiovascular disease [ = 30 (22%)] and sepsis [ = 65 (48%)] accounted for the majority of acute systemic illness. Age and premorbid cardiovascular disease were independent risk factors for acute systemic illness among unplanned starts, whereas autoimmune disease accounted for the majority of urgent starts. The rate of decline in GFR was greater in the month preceding RRT among acute dialysis starters compared with planned starters (P < 0.001).

Conclusions: Cardiovascular disease and advancing age were independent risk factors for emergency dialysis initiation among patients known to renal services for >3 months. The rapid and often unpredictable loss of renal function in the context of acute systemic illness poses a challenge to averting emergency dialysis start.

Citing Articles

Impact of arteriovenous fistula formation on trajectory of kidney function decline: a target trial emulation.

Loureiro Harrison L, Fu E, Thomson P, Traynor J, Mark P, Stoumpos S Clin Kidney J. 2024; 17(12):sfae345.

PMID: 39687920 PMC: 11647593. DOI: 10.1093/ckj/sfae345.

An updated systematic review of the risk factors for unplanned dialysis initiation.

Magadi W, Birnie K, Santhakumaran S, Caskey F, Ben-Shlomo Y Clin Kidney J. 2024; 17(12):sfae333.

PMID: 39669010 PMC: 11635165. DOI: 10.1093/ckj/sfae333.

Derivation and Validation of a Machine Learning Model for the Prevention of Unplanned Dialysis.

Klamrowski M, Klein R, McCudden C, Green J, Rashidi B, White C Clin J Am Soc Nephrol. 2024; .

PMID: 38787617 PMC: 11390024. DOI: 10.2215/CJN.0000000000000489.

Impact of recombinant human brain natriuretic peptide on emergency dialysis and prognosis in end-stage renal disease patients with type 4 cardiorenal syndrome.

Zhou Y, Wang X, Yuan H, Wu L, Zhang B, Chen X Sci Rep. 2023; 13(1):20752.

PMID: 38007545 PMC: 10676370. DOI: 10.1038/s41598-023-48125-1.

Outpatient clinic specific for end-stage renal disease improves patient survival rate after initiating dialysis.

Fukuzaki H, Nakata J, Nojiri S, Shimizu Y, Shirotani Y, Maeda T Sci Rep. 2023; 13(1):5991.

PMID: 37045851 PMC: 10097859. DOI: 10.1038/s41598-023-31636-2.

References

Ifudu O, Dawood M, Iofel Y, Valcourt J, Friedman E . Delayed referral of black, Hispanic, and older patients with chronic renal failure. Am J Kidney Dis. 1999; 33(4):728-33. DOI: 10.1016/s0272-6386(99)70226-x. View

Arora P, Obrador G, Ruthazer R, Kausz A, Meyer K, Jenuleson C . Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol. 1999; 10(6):1281-6. DOI: 10.1681/ASN.V1061281. View

Levin A . Consequences of late referral on patient outcomes. Nephrol Dial Transplant. 2000; 15 Suppl 3:8-13. DOI: 10.1093/oxfordjournals.ndt.a027977. View

Winkelmayer W, Glynn R, Levin R, Owen Jr W, Avorn J . Determinants of delayed nephrologist referral in patients with chronic kidney disease. Am J Kidney Dis. 2001; 38(6):1178-84. DOI: 10.1053/ajkd.2001.29207. View

Stack A . Determinants of modality selection among incident US dialysis patients: results from a national study. J Am Soc Nephrol. 2002; 13(5):1279-1287. DOI: 10.1681/ASN.V1351279. View

Avorn J, Winkelmayer W, Bohn R, Levin R, Glynn R, Levy E . Delayed nephrologist referral and inadequate vascular access in patients with advanced chronic kidney failure. J Clin Epidemiol. 2002; 55(7):711-6. DOI: 10.1016/s0895-4356(02)00415-8. View

Caskey F, Wordsworth S, Ben T, de Charro F, Delcroix C, Dobronravov V . Early referral and planned initiation of dialysis: what impact on quality of life?. Nephrol Dial Transplant. 2003; 18(7):1330-8. DOI: 10.1093/ndt/gfg156. View

Cass A, Cunningham J, Snelling P, Wang Z, Hoy W . Urban disadvantage and delayed nephrology referral in Australia. Health Place. 2003; 9(3):175-82. DOI: 10.1016/s1353-8292(02)00037-0. View

Goldstein M, Yassa T, Dacouris N, McFarlane P . Multidisciplinary predialysis care and morbidity and mortality of patients on dialysis. Am J Kidney Dis. 2004; 44(4):706-14. View

10.

Curtis B, Ravani P, Malberti F, Kennett F, Taylor P, Djurdjev O . The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes. Nephrol Dial Transplant. 2004; 20(1):147-54. DOI: 10.1093/ndt/gfh585. View

11.

Wauters J, Lameire N, Davison A, Ritz E . Why patients with progressing kidney disease are referred late to the nephrologist: on causes and proposals for improvement. Nephrol Dial Transplant. 2005; 20(3):490-6. DOI: 10.1093/ndt/gfh709. View

12.

Mehrotra R, Marsh D, Vonesh E, Peters V, Nissenson A . Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kidney Int. 2005; 68(1):378-90. DOI: 10.1111/j.1523-1755.2005.00453.x. View

13.

Obialo C, Ofili E, Quarshie A, Martin P . Ultralate referral and presentation for renal replacement therapy: socioeconomic implications. Am J Kidney Dis. 2005; 46(5):881-6. DOI: 10.1053/j.ajkd.2005.08.003. View

14.

Navaneethan S, Nigwekar S, Sengodan M, Anand E, Kadam S, Jeevanantham V . Referral to nephrologists for chronic kidney disease care: is non-diabetic kidney disease ignored?. Nephron Clin Pract. 2007; 106(3):c113-8. DOI: 10.1159/000102998. View

15.

Buck J, Baker R, Cannaby A, Nicholson S, Peters J, Warwick G . Why do patients known to renal services still undergo urgent dialysis initiation? A cross-sectional survey. Nephrol Dial Transplant. 2007; 22(11):3240-5. DOI: 10.1093/ndt/gfm387. View

16.

Vandenbroucke J, von Elm E, Altman D, Gotzsche P, Mulrow C, Pocock S . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007; 18(6):805-35. DOI: 10.1097/EDE.0b013e3181577511. View

17.

Chan M, Dall A, Fletcher K, Lu N, Trivedi H . Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med. 2007; 120(12):1063-70. DOI: 10.1016/j.amjmed.2007.04.024. View

18.

Navaneethan S, Aloudat S, Singh S . A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease. BMC Nephrol. 2008; 9:3. PMC: 2291456. DOI: 10.1186/1471-2369-9-3. View

19.

Crews D, Jaar B, Plantinga L, Kassem H, Fink N, Powe N . Inpatient hemodialysis initiation: reasons, risk factors and outcomes. Nephron Clin Pract. 2009; 114(1):c19-28. PMC: 2842162. DOI: 10.1159/000245066. View

20.

Mendelssohn D, Curtis B, Yeates K, Langlois S, MacRae J, Semeniuk L . Suboptimal initiation of dialysis with and without early referral to a nephrologist. Nephrol Dial Transplant. 2011; 26(9):2959-65. DOI: 10.1093/ndt/gfq843. View