Abstract: SA-PO331
Risk Factors of Acute Dialysis Initiation in CKD Patients Followed in Multidisciplinary Low Clearance Clinics: A Retrospective Cohort Study
Session Information
- Hemodialysis and Frequent Dialysis: Potpourri
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ghonimi, Tarek Abdellatif, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
- Hamad, Abdullah Ibrahim, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
- Abdellatif, Mohamed Tarek, Misr University for Science and Technology College of Medicine, 6th of October City, Giza, Egypt
Background
A significant proportion of advanced CKD patients followed in multi-disciplinary clinics (MDCs) clinics still initiate dialysis in an unplanned fashion rather than electively started. The aim of the present study is to identify risk factors that could help predicts the need for unplanned dialysis initiation among patients with advanced CKD.
Methods
We performed a retrospective study involving advanced CKD patients followed in MDCs for the last 2 years. Patients were classified as having an acute unplanned dialysis start or electively started dialysis.
Results
378 patients are included in the study. 100 patient started acute dialysis while 75 patients started dialysis electively. CHF, CAD were significantly more in patients with acute start (p = 0.05 and p= 0.000 respectively). Patients with acute start had less educations, less numbers of clinic visits and less seen in vascular clinic (p = 0.000, p = 0.000 and p = 0.002 respectively). Patients with acute dialysis start had significant hospital stay and significant high icu admission (=0.003 and P = 0.00). In regression analysis, abscence of diabetes and CHF significantly reduce the odds for acute dialysis start (OR 0.452, 95% CI 0.212–0.965 I, P=0.04), (OR 0.120, 95% CI 0.037–0.388, p = 0.000 respectively). Also, Patient not seen in vascular clinic have significant risk factor for acute dialysis start (OR 24.675, 95% CI 6.856–88.811, p = 0.000)
Conclusion
Acute dialysis initiation is common among advanced CKD patients, even if they are followed in a multidisciplinary chronic kidney disease clinic. Timely education, follow up and access creation for patients at risk may lower hospital admission, hospital stay, ICU admission, decrease cost and morbidity in those type of patients.
| Characteristic | Acute dialysis No 100 (%) | elective dialysis No 75 (%) | P |
| Age ( year) | 57.0 ± 1.5 | 53.0 ± 1.6 | 0.079 |
| Co-morbidities: Diabetes Hypertension Coronary artery disease Congestive heart failure Cerebrovascular disease Dyslipidemia Covid-19 infection | 77 (77) 96 (96) 27 (27) 30 (30) 11 (11) 60 (60) 22(22) | 48 (64) 71 (94.6) 11 (14.6) 4 (5.3) 6 (8) 49 65.3) 15 (20) | 0.060 0.676 0.050 0.000 0.365 0.471 0.644 |
| ICU admission | 18 (18) | 1 (1.3) | 0.000 |
| Mortality during Admission | 5 (5) | 1 (1.3) | 0.187 |
| Follow up clinic days | 109.5±104 | 165.7±140.7 | 0.002 |
| Hospital stay ( days) | 17.2±24.5 | 0.89±1.9 | 0.003 |
| Education before dialysis | 69 (69) | 72 (96) | 0.000 |
| Seen in vascular clinic | 42 (42) | 72 (96) | 0.000 |
| Laboratory tests at first visit: Creatinine Umol/l (SD) Urea Umol/l (SD) GFR ( ml/m/1.73m2 Albumin g/l K+ mmol/l ( SD) HB g/dl ( SD) Protein/Creatinine ratio mg/mmol (SD) | 473.3 ±167.2 23.2 ± 8.0 12.2± 5.1 29.2± 6.6 4.9±2.9 9.9±3.5 617.9± 1021 | 536.4 ± 174.4 23.9±7.3 10.3±3.9 32.5± 5.9 4.5± 0.5 10.2±1.5 495.1±565.5 | 0.016 0.543 0.010 0.001 0.298 0.468 0.350 |
| GFR 6 months before dialysis start ml/m/1.73m2 (SD) | 12.5 ± 5.4 | 10.2 ± 4.0 | 0.002 |