High Incidence of Suboptimal Dialysis Initiation Among Advanced CKD Patients

Recent findings reveal that many patients with advanced chronic kidney disease (CKD) often start dialysis under suboptimal conditions, according to a study published in Kidney360. Suboptimal dialysis initiation is defined as starting dialysis during hospitalization or with a central venous catheter.

The research, led by a team from McMaster University in Hamilton, Ontario, involved a prospective cohort study that assessed risk factors associated with suboptimal dialysis among patients monitored in multidisciplinary kidney clinics. The primary outcome was the rate of suboptimal dialysis initiation in patients under 75 years of age.

Out of 366 patients included in the study, 33% experienced a suboptimal start to dialysis, which accounted for 69% of all dialysis initiations during a median follow-up duration of 1.9 years. Notably, the study identified a correlation between higher hemoglobin levels and a reduced risk of suboptimal dialysis initiation, with an adjusted hazard ratio of 0.96. The average hemoglobin level among those who initiated dialysis suboptimally was reported at 10.7 g/dL.

Conversely, a higher comorbidity index and an increased number of nephrologist consultations within six months were linked to an elevated risk of suboptimal dialysis initiation, with adjusted hazard ratios of 1.17 and 1.70, respectively. Interestingly, factors such as health literacy, knowledge regarding kidney disease, and influenza vaccination did not demonstrate significant associations with the likelihood of suboptimal dialysis initiation.

The authors concluded that easily modifiable risk factors related to patients were not identified in this study. They suggested that enhancing kidney failure risk prediction tools tailored to the advanced CKD population might be beneficial. Such tools could incorporate a timeline of 6-12 months for kidney replacement therapy (KRT) preparation and advocate for prompt initiation of KRT preparation in high-risk patients.