title: Factors Associated with Unplanned Dialysis Starts in Patients followed by Nephrologists: A Retropective Cohort Study.
abstract: The number of patients starting dialysis is increasing world wide. Unplanned dialysis starts (patients urgently starting dialysis in hospital) is associated with increased costs and high morbidity and mortality. Risk factors for starting dialysis urgently in hospital have not been well studied. The primary objective of this study was to identify risk factors for unplanned dialysis starts in patients followed in a multidisciplinary chronic kidney disease (CKD) clinic. We performed a retrospective cohort study of 649 advanced CKD patients followed in a multidisciplinary CKD clinic at a tertiary care hospital from January 01, 2010 to April 30, 2013. Patients were classified as unplanned start (in hospital) or elective start. Multivariable logistic regression was used to identify variables associated with unplanned dialysis initiation. 184 patients (28.4%) initiated dialysis, of which 76 patients (41.3%) initiated dialysis in an unplanned fashion and 108 (58.7%) starting electively. Unplanned start patients were more likely to have diabetes (68.4% versus 51.9%; p = 0.04), CAD (42.1% versus 24.1%; p = 0.02), congestive heart failure (36.8% versus 17.6%; p = 0.01), and were less likely to receive modality education (64.5% vs 89.8%; p < 0.01) or be assessed by a surgeon for access creation (40.8% vesrus 78.7% p < 0.01). On multivariable analysis, higher body mass index (OR 1.07, 95% CI 1.02, 1.13), and a history of congestive heart failure (OR 2.41, 95% CI 1.09, 5.41) were independently associated with an unplanned start. Unplanned dialysis initiation is common among advanced CKD patients, even if they are followed in a multidisciplinary chronic kidney disease clinic. Timely education and access creation in patients at risk may lead to lower costs and less morbidity and mortality.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Pierre Antoine
authors.initials: PA
authors.lastname: Brown
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ayub
authors.initials: A
authors.lastname: Akbari
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Amber O
authors.initials: AO
authors.lastname: Molnar
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Shaurya
authors.initials: S
authors.lastname: Taran
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Janice
authors.initials: J
authors.lastname: Bissonnette
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Manish
authors.initials: M
authors.lastname: Sood
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Hiremath
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications; D004522:Educational Status; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000706:statistics & numerical data*; D012307:Risk Factors; D062606:Tertiary Care Centers