Causes of unplanned dialysis initiation: results of the nordic peridialysis study

Abstract

Introduction and Aims: Dialysis initiation (DI) performed in an unplanned urgent way is associated with increased morbimortality, due in part to increased use of temporary vascular access, and with less probability of being offered a choice of dialysis modality including peritoneal dialysis. We investigated factors in conjunction with DI that were associated with unplanned DI (UDI). Methods: Clinical and biochemical factors potentially linked toUDIwere recorded during the pre- and peridialysis period in 840 pts (pts) (age 63616 years, 35%females, 25% diabetes,DM) starting dialysis. The pts were included in the Peridialysis project, an ongoing multicentre prospective study involving 14 hospitals in 7Nordic countries, aiming at analysing why, when and how dialysis is initiated in all pts initiating dialysis at the centers. Results: UDI was due to acute progression (15%), acute uraemia (8%), late referral (6%), delayed planning (5%), patient non-compliance (2%), refused dialysis but changed mind (2%), and other (5%), altogether accounting for 43% of all DI. Age >60 years (46% vs. 39%) and comorbidity >1 chronic disease (53% vs. 38%), but notDM or sex, associated with UDI. Estimated GFR (ml/min) at 6months (median 15.8 vs. 11.1) and 3 months (12.2 vs. 9.4) before DI was significantly higher in UDI than in planned DI pts whereas at DI it was lower in UDI (median 6.3 vs. 7.2). UDI was associated with more rapid fall in eGFR from 6 to 3 months before DI (by median 9.7 vs. 6.0 ml/min/year), and from 3 to 0 months (by median 19.7 vs. 6.9 ml/min/year). UDI pts received dialysis information at lower eGFR than planned DI pts (median 8.7 vs. 10.7 ml/min). eGFR at DI was higher in pts with >3 chronic diseases than in pts with no comorbidity (median 7.7 vs. 6.3 ml/min).[...].