Factors Associated with Unplanned Dialysis Starts in Patients followed by Nephrologists: A Retropective Cohort Study.

Pierre Antoine Brown,Swapnil Hiremath,Janice Bissonnette,Ayub Akbari,Amber O Molnar,Shaurya Taran,Manish Sood,Dominique Guerrot

doi:10.1371/journal.pone.0130080

Pierre Antoine Brown, Swapnil Hiremath + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0130080

Copy DOI

Journal: PloS one	Publication Date: Jun 5, 2015
Citations: 42	License type: CC BY 4.0

Affiliation: University of Ottawa, Ottawa Hospital

Abstract

The number of patients starting dialysis is increasing world wide. Unplanned dialysis starts (patients urgently starting dialysis in hospital) is associated with increased costs and high morbidity and mortality. Risk factors for starting dialysis urgently in hospital have not been well studied. The primary objective of this study was to identify risk factors for unplanned dialysis starts in patients followed in a multidisciplinary chronic kidney disease (CKD) clinic. We performed a retrospective cohort study of 649 advanced CKD patients followed in a multidisciplinary CKD clinic at a tertiary care hospital from January 01, 2010 to April 30, 2013. Patients were classified as unplanned start (in hospital) or elective start. Multivariable logistic regression was used to identify variables associated with unplanned dialysis initiation. 184 patients (28.4%) initiated dialysis, of which 76 patients (41.3%) initiated dialysis in an unplanned fashion and 108 (58.7%) starting electively. Unplanned start patients were more likely to have diabetes (68.4% versus 51.9%; p = 0.04), CAD (42.1% versus 24.1%; p = 0.02), congestive heart failure (36.8% versus 17.6%; p = 0.01), and were less likely to receive modality education (64.5% vs 89.8%; p < 0.01) or be assessed by a surgeon for access creation (40.8% vesrus78.7% p < 0.01). On multivariable analysis, higher body mass index (OR 1.07, 95% CI 1.02, 1.13), and a history of congestive heart failure (OR 2.41, 95% CI 1.09, 5.41) were independently associated with an unplanned start. Unplanned dialysis initiation is common among advanced CKD patients, even if they are followed in a multidisciplinary chronic kidney disease clinic. Timely education and access creation in patients at risk may lead to lower costs and less morbidity and mortality.

Highlights

Some patients initiate permanent dialysis as inpatients in an unplanned fashion
The study population consisted of patients who were being followed for advanced chronic kidney disease (CKD) at the multi-disciplinary clinics (MDCs), a specialty multi-disciplinary care clinic in the CKD program for patients approaching end-stage renal disease (ESRD)
Factors associated with unplanned start of dialysis in patients who are already followed by nephrologists in a MDC clinic are not clearly defined

Summary

Introduction

Risk Factors for Unplanned Dialysis term.[1] Patients who initiate long-term dialysis as inpatients are less likely to be on peritoneal dialysis. They are more likely to start dialysis with a central venous catheter rather than a fistula.[1,2,3,4] Such factors contribute to the economic burden of chronic kidney disease (CKD), with costs that are already very high and climbing.[5, 6] For some patients, unplanned dialysis initiation may be unavoidable, due to either sudden-onset illness or acute unforeseeable renal decline.[7] Several studies have identified late referral to a nephrologist as a major cause for unplanned starts to dialysis,[8,9,10] though early referral by itself does not ensure optimal dialysis start.[11]

Objectives

Methods

Results

Conclusion