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. 2018 Sep 17;19(1):233.
doi: 10.1186/s12882-018-1036-9.

Deleterious effects of dialysis emergency start, insights from the French REIN registry

Alain Michel  1 , Adelaide Pladys  2   3 , Sahar Bayat  2   4 , Cécile Couchoud  5 , Thierry Hannedouche  6 , Cécile Vigneau  7   8   9
Affiliations

Deleterious effects of dialysis emergency start, insights from the French REIN registry

Alain Michel et al. BMC Nephrol. .

Erratum in

Abstract

Background: Emergency start (ES) of dialysis has been associated with worse outcome, but remains poorly documented. This study aims to compare the profile and outcome of a large cohort of patients starting dialysis as an emergency or as a planned step in France.

Methods: Data on all patients aged 18 years or older who started dialysis in mainland France in 2012 or in 2006 were collected from the Renal Epidemiology and Information Network and compared, depending on the dialysis initiation condition: ES or Planned Start (PS). ES was defined as a first dialysis within 24 h after a nephrology visit due to a life-threatening event. Three-year survival were compared, and a multivariate model was performed after multiple imputation of missing data, to determine the parameters independently associated with three-year survival.

Results: In 2012, 30.3% of all included patients (n = 8839) had ES. Comorbidities were more frequent in the ES than PS group (≥ 2 cardiovascular diseases: 39.2% vs 28.8%, p < 0.001). ES was independently associated with worse three-year survival (57% vs. 68.2%, p = 0.029, HR 1.10, 95% CI 1.01-1.19) in multivariate analysis. Among ES group, a large part had a consistent previous follow-up: 36.4% of them had ≥3 nephrology consultations in the previous year. This subgroup of patients had a particularly high comorbidity burden. ES rate was stable between 2006 and 2012, but some proactive regions succeeded in reducing markedly the ES rate.

Conclusion: ES remains frequent and is independently associated with worse three-year survival, demonstrating that ES deleterious impact is never overcome. This study shows that a large part of patients with ES had a previous follow-up, but high comorbidity burden that could favor acute decompensation with life-threatening conditions before uremic symptoms appearance. This suggests the need of closer end-stage renal disease follow-up or early dialysis initiation in these high-risk patients.

Keywords: Dialysis; ESRD; Emergency start; France; Outcome; Survival.

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Conflict of interest statement

Ethics approval and consent to participate

This study used data collected through the french REIN registry, a national database including every french dialysed patient since 2003. This registry has been allowed after CNIL approvement n° 903,188.

URL: https://www.agence-biomedecine.fr/Le-programme-REIN.

This study didn’t require patient’s specific written or verbal consent as this was use of already collected data. Every French dialyzed patient is included in REIN after information when he initiates chronic dialysis, unless he opposes to his name specific recording, in which case he will be anonymously recorded.

Consent for publication

Not applicable. This manuscript doesn’t contain data from any individual person.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan Meier survival curves of dialysis incident patients in 2012 according to the dialysis initiation condition: planned start (PS_2012, full line) or emergency start (ES_2012, dashed line)
Fig. 2
Fig. 2
Kaplan Meier survival curves of dialysis incident patients in 2012 according to the previous care: ES with no previous consultation (ES_2012 no consult, dashed line), ES with more than two previous consultations (ES_2012 ≥ 3 consult, dotted line) or planned start (PS_2012, full line)
See this image and copyright information in PMC

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