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
Observational Study
. 2022 Apr;35(3):977-988.
doi: 10.1007/s40620-021-01188-7. Epub 2021 Nov 24.

Effect of emergency start and central venous catheter on outcomes in incident hemodialysis patients: a prospective observational cohort

Ulviyya Alizada  1 , Erik-André Sauleau  1   2 , Thierry Krummel  3 , Olivier Moranne  4 , Isabelle Kazes  5 , Cécile Couchoud  6 , Thierry Hannedouche  7   8 ; the REIN registry
Affiliations
Observational Study

Effect of emergency start and central venous catheter on outcomes in incident hemodialysis patients: a prospective observational cohort

Ulviyya Alizada et al. J Nephrol. 2022 Apr.

Abstract

Background: Unfavorable conditions at hemodialysis inception reduce the survival rate. However, the relative contribution to outcomes of predialysis follow-up, symptoms, emergency start or central venous catheter (CVC) is unknown.

Methods: We analyzed the determinants of survival according to dialysis initiation conditions in the nationwide REIN registry, using two methods based either on clinical classification or data mining. We divided patients into four groups according to dialysis initiation (emergency vs planned, symptoms or not, previous follow-up). "Followed planned starters" began dialysis as outpatients and with an arteriovenous fistula (AVF). "Followed symptomatic non-urgent starters" were patients who started earlier because of any non-urgent symptomatic event. "Followed urgent starters" had seen a nephrologist before inception but started dialysis in an emergency condition. "Unknown urgent starters" were patients without any follow-up and who had a CVC at inception.

Results: "Followed urgent" starters had the lowest 2-year survival rate (66.8%) compared to "followed planned" (77.3%), "followed symptomatic non urgent" (79.2%), and "unknown urgent" (71.7%). Compared to other groups, the risk of mortality was lower in followed symptomatic non urgent (HR 0.86 95% CI 0.75-0.99) and higher in followed urgent starters (HR 1.05 (95% CI 0.94-1.18). In data mining Classification And Regression Tree regrouping in five categories, the lowest 2-year survival (52.3%) was in over 70-year-old starters with a CVC. The survival was 93.2% in under 57-year-old patients without active cancer, 82.5% in 57-70-year-old individuals without cancer, 72.4% in over 70-year-old patients without CVC and 61.4% in under 70-year-old subjects with cancer. The hazard ratio of data mining categories varied between 2.12 (95% CI 1.73-2.60) in 57-70-year-old subjects without cancer and 4.42 (95% CI 3.64-5.37) in over 70-year-old patients with CVC. Therefore, regrouping incident patients into five data mining categories, identified by age, cancer, and CVC use, could discriminate the 2-year survival in patients starting hemodialysis.

Conclusions: Although each classification captured different prognosis information, both analyses showed that starting hemodialysis on a CVC has more dramatic outcomes than emergency start per se.

Keywords: Chronic hemodialysis; Epidemiology, Data mining; Survival.

PubMed Disclaimer

References

    1. Winkelmayer WC, Owen WF, Levin R, Avorn J (2003) A propensity analysis of late versus early nephrologist referral and mortality on dialysis. J Am Soc Nephrol JASN 14(2):486–492 - DOI
    1. Smart NA, Dieberg G, Ladhani M, Titus T (2014) Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease. Cochrane Database Syst Rev 6:CD007333
    1. Smart NA, Titus TT (2011) Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. Am J Med 124(11):1073-1080.e2 - DOI
    1. Cooper BA, Branley P, Bulfone L et al (2010) A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 363(7):609–619 - DOI
    1. Jungers P, Joly D, Nguyen-Khoa T, Mothu N, Bassilios N, Grünfeld J-P (2006) Continued late referral of patients with chronic kidney disease. Causes, consequences, and approaches to improvement. Presse Med 35(1 Pt 1):17–22 - DOI

Publication types

LinkOut - more resources