Suboptimal dialysis initiation in a retrospective cohort of predialysis patients--predictors of in-hospital dialysis initiation, catheter insertion and one-year mortality.
OBJECTIVE
Previous investigations using univariate study designs have reported that delayed referral to predialysis clinics is associated with adverse outcomes at the time of dialysis initiation. However, the independent effect of delayed referral is poorly defined. Moreover, the optimal time at which to refer patients to predialysis programs remains unclear. The aim of this study was to identify independent predictors of dialysis initiation requiring hospitalization.


METHODS
A retrospective cohort of 201 predialysis patients was investigated using multivariate logistic regression analysis.


RESULTS
Multivariate analysis selected advanced age (odds ratio (OR) 1.038,95% confidence interval (CI) 1.011-1.065), history of congestive heart failure (OR 2.877, 95% CI 1.205-6.871), and shorter predialysis follow-up time (OR 0.945, 95% CI 0.920-0.971) as independent predictors of in-hospital dialysis initiation. The risk of in-hospital dialysis initiation increased by 5.5% for every month lost due to late referral.


CONCLUSIONS
Patients should be referred to predialysis programs as early as 24 months before anticipated dialysis initiation in order to minimize the risk of future adverse outcomes.
Holland
D C
DC
Department of Medicine, Queen's University, Kingston, Ontario, Canada. dh9@post.queensu.ca
Lam
M
M
D000368:Aged; D002404:Catheterization; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies