Factors related to unplanned dialysis start in patients followed in ESRD consultation

Abstract

Introduction. The planned start of renal replacement therapy is a priority objective in the management of patients with chronic kidney disease, having a great impact on patient survival. Objective: To analyse the clinical characteristics involved in the unplanned hemodialysis start in patients followed in ESRD consultation. Material and Method: Retrospective observational study in incident patients in the 2014-2018 period. Clinical and sociodemographic data were collected on the patient's medical record, follow-up time in the ESRD consultation, glomerular filtration at the beginning of the ESRD consultation, cause and type of hemodialysis start (planned or not), as well as the vascular access used. Results: 168 incident patients followed in ESRD consultation were included. 28.6% started hemodialysis in an unplanned way. The planned dialysis starts were due to uremic cause and unplanned due to heart failure (92% and 54% respectively, p<0.001). Patients with unplanned start used a catheter 77% of the time (p <0.001), were older (69.27 ± 9.4 vs. 65.18 ± 12.75 years) and shorter follow-up time in ESRD consultation (15.60 ± 12.37 vs. 23.64 ± 20.25 months) than patients with planned start. Conclusions: Older patients, with shorter follow-up time in an ESRD consultation, have a higher risk of starting hemodialysis in an unplanned way through a central venous catheter due to lack of definitive vascular access.