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Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate

Heaf, James ; Heiro, Maija ; Petersons, Aivars ; Vernere, Baiba ; Povlsen, Johan V ; Sørensen, Anette Bagger ; Clyne, Naomi LU orcid ; Bumblyte, Inga ; Zilinskiene, Alanta and Randers, Else , et al. (2021) In Clinical Kidney Journal 14(3). p.933-942
Abstract

Background: Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care.

Methods: In the 'Peridialysis' study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI.

Results: SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly... (More)

Background: Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care.

Methods: In the 'Peridialysis' study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI.

Results: SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI.

Conclusions: SDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Kidney Journal
volume
14
issue
3
pages
933 - 942
publisher
Oxford University Press
external identifiers
  • scopus:85093501160
  • pmid:33777377
ISSN
2048-8505
DOI
10.1093/ckj/sfaa041
language
English
LU publication?
yes
additional info
© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.
id
906b457b-c2aa-4129-8b0b-08c43653ac95
date added to LUP
2021-10-22 19:31:09
date last changed
2024-04-20 13:52:19
@article{906b457b-c2aa-4129-8b0b-08c43653ac95,
  abstract     = {{<p>Background: Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care.</p><p>Methods: In the 'Peridialysis' study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI.</p><p>Results: SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI.</p><p>Conclusions: SDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.</p>}},
  author       = {{Heaf, James and Heiro, Maija and Petersons, Aivars and Vernere, Baiba and Povlsen, Johan V and Sørensen, Anette Bagger and Clyne, Naomi and Bumblyte, Inga and Zilinskiene, Alanta and Randers, Else and Løkkegaard, Niels and Ots-Rosenberg, Mai and Kjellevold, Stig and Kampmann, Jan Dominik and Rogland, Björn and Lagreid, Inger and Heimburger, Olof and Lindholm, Bengt}},
  issn         = {{2048-8505}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{933--942}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical Kidney Journal}},
  title        = {{Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate}},
  url          = {{http://dx.doi.org/10.1093/ckj/sfaa041}},
  doi          = {{10.1093/ckj/sfaa041}},
  volume       = {{14}},
  year         = {{2021}},
}