[The start of renal replacement therapy in a Spanish department]

Abstract

Background: Early nephrological referral and planned start of dialysis are associated with better prognosis after the beginning of renal replacement therapy (RRT). The aim of our study was to analyse patient clinical and analytic characteristics at the time of initiating dialysis and to evaluate if morbimortality was affected by planned start.

Patients and methods: We performed a retrospective study of all patients commencing RRT in a Spanish Hospital of The National Health System over two years (2003-2004). A total of 117 patients (47 female and 70 male) were included. We carried out a retrospective analysis of the demographic characteristics, patients' clinical and analytic conditions at the time of starting dialysis and hospitalization days and mortality in six months after starting dialysis. Patients were classified as planned (P) or unplanned (NP), depending on whether the first dialysis was planned or an emergency.

Results: Sixty five patients (56.4%) started dialysis in a planned group while 52 (43.6%) were unplanned. In the former group, 83.1% of the patients had a vascular or peritoneal access available when starting RRT, whereas in the later group only the 3.8% had it. Planned dialysis initiation was associated with a high level of serum haemoglobin, haematocrit, calcium and albumin (p < 0.001), and a low level of serum urea, creatinine (p < 0.001) and phosphate (p < 0.05). More patients of the unplanned group were admitted at hospital at the initiation of dialysis (90.4% vs. 6.1%) and during the first 6 months (48% vs. 15.3%). The period of hospitalization was longer for the unplanned group (23.6 days vs 3 days) (p < 0.001). The 6-month-mortality was lower in the planned group (4.6% vs. 11.5%), whitout statistical difference.

Conclusions: Planned dialysis initiation is associated with better clinical and metabolical conditions, greater probability of a vascular or peritoneal access availability and lower rate of hospitalization and mortality within 6 months after starting RRT