title: Dialysis access, infections, and hospitalisations in unplanned dialysis start patients: results from the OPTiONS study.
abstract: BACKGROUND
  Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient outcomes and healthcare utilisation depending on initial dialysis access (CVC or PD catheter) and subsequent pathway of UPS patients.
  
  
  METHODS
  In this study patient demographics, access procedures, hospitalisations, and major infectious complications were analysed over 12 months in 270 UPS patients. PD technique survival and impact of switching from HD to PD was examined along with logistic regression to investigate factors predicting AV fistula formation.
  
  
  RESULTS
  72 UPS patients started with PD catheter and 198 with CVC. PD patients were older and more comorbid but had a significantly lower number of access procedures while there was no difference in hospitalisation or major infections. 13/72 initial PD patients switched to HD and 1-year technique survival was 79%. 158/198 patients remained on HD and 73/158 reported permanent access formation. Older age, OR = 0.34 (CI,0.17-0.68) and cardiac failure, OR = 0.31(CI,0.13-0.78), were significant negative predictors of receiving fistula. Younger patients, OR = 0.29 (CI, 0.11-0.79) and those who received AVF, OR = 0.11 (CI,0.03-0.38), had significantly lower odds of death.
  
  
  CONCLUSIONS
  UPS with initial PD was possible in many patients and was associated with lower requirement for access procedures. AVF formation in UPS patients starting on HD was associated with better 1-year survival. Modality switching in UPS patients requires careful clinical management, including clinical practice patterns promoting permanent HD access formation.
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm - Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Machowska
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Krankenhaus, Stuttgart - Germany.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: Department of Renal Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire - UK.
authors.forename: Satyanarayana Reddy
authors.initials: SR
authors.lastname: Vanga
authors.affiliation: Center of Nephrology, Mettmann - Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Koch
authors.affiliation: Department of Nephrology, Odense University Hospital, Odense - Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Aarup
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm - Sweden.
authors.forename: Abdul R
authors.initials: AR
authors.lastname: Qureshi
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm - Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Integrated Market Access, QuintilesIMS, Reading - UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Rutherford
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062905:Central Venous Catheters; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods / Q000401:mortality