Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 23;36(8):1500-1510.
doi: 10.1093/ndt/gfab170.

Urgent-start dialysis in patients referred early to a nephrologist-the CKD-REIN prospective cohort study

Victor Fages  1   2 , Natalia Alencar de Pinho  1 , Aghilès Hamroun  1   2 , Céline Lange  1   3 , Christian Combe  4   5 , Denis Fouque  6   7 , Luc Frimat  8 , Christian Jacquelinet  1   3 , Maurice Laville  6   9 , Carole Ayav  10 , Sophie Liabeuf  11 , Roberto Pecoits-Filho  12   13 , Ziad A Massy  1   14 , Julie Boucquemont  1 , Bénédicte Stengel  1 ; CKD-REIN study collaborators
Collaborators, Affiliations

Urgent-start dialysis in patients referred early to a nephrologist-the CKD-REIN prospective cohort study

Victor Fages et al. Nephrol Dial Transplant. .

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.

Keywords: AKI; ESRD; chronic haemodialysis; chronic renal failure; epidemiology.

PubMed Disclaimer

Publication types