Abstract
BackgroundEmergency 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.MethodsData 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.ResultsIn 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.ConclusionES 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.
Highlights
Emergency start (ES) of dialysis has been associated with worse outcome, but remains poorly documented
A previous French epidemiologic study [11] based on the 2006 Renal Epidemiology and Information Network (REIN) data, pointed out that ES was associated with a worse one-year survival rate than “Planned Start” (PS) of dialysis (74.2% for ES vs. 87.4% for PS, p < 0.001)
Some other studies have reported worse outcomes associated with unplanned dialysis start [12, 13], but no strong data is available about the profile of patients starting dialysis in emergency conditions, and the factors leading to ES
Summary
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. Acute pulmonary oedema or threatening electrolytes disorders appear before uremic symptoms, that lead to start dialysis in emergency conditions. A previous French epidemiologic study [11] based on the 2006 Renal Epidemiology and Information Network (REIN) data, pointed out that ES was associated with a worse one-year survival rate than “Planned Start” (PS) of dialysis (74.2% for ES vs 87.4% for PS, p < 0.001). Some other studies have reported worse outcomes associated with unplanned dialysis start [12, 13], but no strong data is available about the profile of patients starting dialysis in emergency conditions, and the factors leading to ES. The group of patients exhibiting an ES is probably heterogeneous and deserve to be better described, in order to enhance their management
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