Urgent-start dialysis in patients referred early to a nephrologist-the CKD-REIN prospective cohort study

被引：9

作者：

Fages, Victor ^{[1
,2
]}

de Pinho, Natalia Alencar ^{[1
]}

Hamroun, Aghiles ^{[1
,2
]}

Lange, Celine ^{[1
,3
]}

Combe, Christian ^{[4
,5
]}

Fouque, Denis ^{[6
,7
]}

Frimat, Luc ^{[8
]}

Jacquelinet, Christian ^{[1
,3
]}

Laville, Maurice ^{[6
,9
]}

Ayav, Carole ^{[10
]}

Liabeuf, Sophie ^{[11
]}

Pecoits-Filho, Roberto ^{[12
,13
]}

Massy, Ziad A. ^{[1
,14
]}

Boucquemont, Julie ^{[1
]}

Stengel, Benedicte ^{[1
]}

机构：

[1] Univ Paris Saclay, Ctr Rech Epidemiol & Sante Populat, Clin Epidemiol Team, INSERM,UVSQ, Villejuif, France

[2] CHU Lille, Serv Nephrol Dialyse Transplantat Renale & Aphere, Lille, France

[3] Agence Biomed, La Plaine St Denis, France

[4] CHU Bordeaux, Serv Nephrol, Transplantat, Dialyse,Aphereses, Bordeaux, France

[5] Univ Bordeaux, INSERM, Unite 1026, Bordeaux, France

[6] Univ Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France

[7] Lyon Sud Hosp, Serv Nephrol, Pierre Benite, France

[8] Univ Lorraine, Serv Nephrol, CHRU Nancy, APEMAC,Hop Brabois, Nancy, France

[9] Assoc Utilisat Rein Artificiel Reg Lyonnaise, Lyon, France

[10] Univ Lorraine, Hop Brabois, CIC Epidemiol Clin, CHRU Nancy,INSERM, Nancy, France

[11] Univ Picardie Jules Verne, Dept Rech Clin, Serv Pharmacol Clin, CHU Amiens,INSERM,U1088, Amiens, France

[12] Arbor Res Collaborat Hlth, Ann Arbor, MI USA

[13] Pontificia Univ Catolica Prana, Curitiba, Parana, Brazil

[14] CHU Ambroise Pare, AP HP, Serv Nephrol Dialyse, Boulogne, France

来源：

NEPHROLOGY DIALYSIS TRANSPLANTATION | 2021年 / 36卷 / 08期

关键词：

AKI; chronic haemodialysis; chronic renal failure; epidemiology; ESRD; CHRONIC KIDNEY-DISEASE; STAGE RENAL-DISEASE; INFORMATION NETWORK REIN; SUBOPTIMAL INITIATION; EPIDEMIOLOGY; PATTERNS; RISK; CARE; CONSEQUENCES; HEMODIALYSIS;

D O I：

10.1093/ndt/gfab170

中图分类号：

R3 [基础医学]; R4 [临床医学];

学科分类号：

1001 ; 1002 ; 100602 ;

摘要：

Background. The lack of a well-designed prospective study of the determinants of urgent dialysis start led us to investigate its individual- and provider-related factors in patients seeing nephrologists. Methods. The Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study that included 3033 patients with CKD [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73m(2)] from 40 nationally representative nephrology clinics from 2013 to 2016 who were followed annually through 2020. Urgent-start dialysis was defined as that 'initiated imminently or <48 hours after presentation to correct life-threatening manifestations' according to the Kidney Disease: Improving Global Outcomes 2018 definition. Results. Over a 4-year (interquartile range 3.0-4.8) median follow-up, 541 patients initiated dialysis with a known start status and 86 (16%) were identified with urgent starts. The 5-year risks for the competing events of urgent and non-urgent dialysis start, pre-emptive transplantation and death were 4, 17, 3 and 15%, respectively. Fluid overload, electrolytic disorders, acute kidney injury and post-surgery kidney function worsening were the reasons most frequently reported for urgent-start dialysis. Adjusted odds ratios for urgent start were significantly higher in patients living alone {2.14 [95% confidence interval (CI) 1.08-4.25] or with low health literacy [2.22 (95% CI 1.28-3.84)], heart failure [2.60 (95% CI 1.47-4.57)] or hyperpolypharmacy [taking >10 drugs; 2.14 (95% CI 1.17-3.90)], but not with age or lower eGFR at initiation. They were lower in patients with planned dialysis modality [0.46 (95% CI 0.19-1.10)] and more nephrologist visits in the 12 months before dialysis [0.81 (95% CI 0.70-0.94)] for each visit. Conclusions. This study highlights several patient- and provider-level factors that are important to address to reduce the burden of urgent-start dialysis.

引用

页码：1500 / 1510

页数：11

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[41] Late referral for dialysis: improving the management of chronic renal disease [J].