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

Abstract

Abstract Background Previously, a comprehensive review of the risk factors for unplanned dialysis initiation (UDI) was conducted by Hassan et al. (2019), based on studies published up to end of 2017. They demonstrated that high quality data and well-designed studies on the subject are lacking. Thus, we updated their review to establish the modifiable factors associated with UDI. Methods MEDLINE and EMBASE were searched from January 2018 to August 2023. Following several rounds of screening, we identified 17 international studies (majority of which were based in Europe) that met the eligibility criteria. Results Many of the included studies were well designed, utilised very large datasets, and adopted multivariate analyses to examine associations between patient characteristics and UDI. Definitions of UDI varied across studies, i.e. timeliness of presentation, vascular access type, initiating dialysis as an inpatient/outpatient, or for life threatening indications. The most common risk factors reported were cardiovascular disease, increased age, cause of kidney disease, cancer, diabetes, lower serum albumin, increased rate of estimated glomerular filtration rate (eGFR) decline and fewer number of nephrology visits prior to dialysis start. These were in line with those reported by Hassan et al. However, our updated review revealed several other important predictors of UDI, i.e. worse coding of chronic kidney disease (CKD) in the GP health record, lower health literacy, and having an acute kidney injury (AKI). Conclusions Our review provides new insights into reasons why people start dialysis in an unplanned manner, many of which are modifiable, thus contributing to efforts in reducing the rate of UDI.