Kidney Res Clin Pract > Volume 40(3); 2021 > Article |
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Characteristic | Total | Planned dialysis | Unplanned dialysisa | p-value |
---|---|---|---|---|
At the time of enrollment | ||||
Patient | 1,038 (100) | 686 (66.1) | 352 (33.9) | - |
Male sex | 577 (55.6) | 383 (55.7) | 195 (55.4) | 0.93 |
Age (yr) | 58.6 ± 14.8 | 56.1 ± 14.6 | 63.8 ± 13.8 | <0.001 |
DM | 557 (53.7) | 325 (47.4) | 235 (66.8) | <0.001 |
DM duration (yr) | 8.8 ± 10.5 | 7.3 ± 9.8 | 11.7 ± 11.1 | <0.001 |
Use of insulin | 251 (24.2) | 143 (20.8) | 108 (30.7) | 0.006 |
HTN | 910 (87.7) | 600 (87.5) | 310 (88.1) | 0.78 |
HTN duration (yr) | 9.0 ± 9.7 | 8.1 ± 7.6 | 10.6 ± 8.5 | <0.001 |
eGFR at enrollment time (mL/min/1.73 m2) | 14.1 ± 5.9 | 13.9 ± 6.0 | 14.4 ± 5.8 | 0.26 |
Early referral | 874 (84.2) | 587 (85.6) | 287 (81.5) | 0.09 |
Comorbidities at enrollment time | ||||
Cancer | 93 (9.0) | 58 (8.5) | 35 (10.0) | 0.47 |
Liver cirrhosis | 41 (4.0) | 27 (3.9) | 14 (4.9) | 0.61 |
Cerebrovascular disease | 129 (12.4) | 78 (11.4) | 51 (14.5) | 0.18 |
COPD | 11 (1.1) | 5 (0.7) | 6 (1.7) | 0.15 |
Myocardial infarction | 57 (5.5) | 29 (4.2) | 28 (8.0) | 0.01 |
Angina | 80 (7.7) | 41 (6.0) | 39 (11.1) | 0.01 |
Heart failure | 92 (8.9) | 35 (5.1) | 57 (16.2) | <0.001 |
PAOD | 41 (4.0) | 16 (2.3) | 25 (7.1) | 0.001 |
Neuromuscular disease | 1 (0.1) | 1 (0.2) | 0 (0) | 0.47 |
Systemic collagen disease | 22 (2.1) | 16 (2.3) | 6 (1.7) | 0.51 |
Davies comorbidity index | 1.0 ± 1.0 | 0.9 ± 1.0 | 1.3 ± 1.0 | <0.001 |
At dialysis initiation time | ||||
Follow-up (day)b | 434.1 ± 557.2 | 462.7 ± 581.9 | 378.4 ± 501.8 | 0.02 |
Modality, HD:PD | 936:102 | 590:96 | 346:6 | <0.001 |
Temporary catheter insertionc | 764 (81.6) | 445 (75.4) | 319 (92.2) | <0.001 |
eGFR at dialysis initiation (mL/min/1.73 m2) | 6.6 ± 4.2 | 5.9 ± 3.4 | 8.0 ± 5.1 | <0.001 |
Body mass index (kg/m2) | 23.1 ± 3.6 | 23.0 ± 3.5 | 23.3 ± 4.0 | 0.32 |
Predialysis adverse outcome | ||||
Ischemic heart disease | 53 (5.1) | 27 (3.9) | 26 (7.4) | 0.02 |
Cerebrovascular event | 33 (3.2) | 15 (2.2) | 18 (5.1) | 0.01 |
Infection requiring hospitalization | 112 (10.8) | 65 (9.5) | 47 (13.6) | 0.06 |
Data are expressed as number (%), mean ± standard deviation, or number only.
COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; HD, hemodialysis; HTN, hypertension; PAOD, peripheral arterial occlusive disease; PD, peritoneal dialysis.
Variable | Total | Planned dialysis | Unplanned dialysisa | p-value |
---|---|---|---|---|
Main indication for dialysis initiation | ||||
Azotemia without specific symptom | 228 (22.0) | 228 (33.2) | 0 (0) | <0.001 |
Uremic symptomb | 291 (28.0) | 287 (41.8) | 4 (1.1) | |
Volume overload | 351 (33.8) | 115 (16.8) | 236 (67.1) | |
Electrolyte imbalance | 89 (8.6) | 18 (2.6) | 71 (20.2) | |
Uremic encephalopathy | 30 (2.9) | 2 (0.3) | 28 (8.0) | |
Uremic pericarditis | 7 (0.7) | 0 (0) | 7 (2.0) | |
Others | 42 (4.1) | 36 (5.3) | 6 (1.7) | |
Total | 1,038 (100) | 686 (100) | 352 (100) | |
Prevalent symptoms at dialysis initiation | ||||
Loss of consciousness | 37 (3.6) | 4 (0.6) | 33 (1.0) | <0.001 |
Delirium | 63 (6.1) | 14 (2.0) | 49 (13.9) | <0.001 |
Dyspnea | 420 (40.5) | 161 (23.5) | 259 (73.6) | <0.001 |
Pericardial effusionc | 132 (12.7) | 53 (7.7) | 82 (23.9) | <0.001 |
Pulmonary edema | ||||
Mild | 171 (16.5) | 132 (19.2) | 39 (11.1) | <0.001 |
Moderate to severe | 264 (25.4) | 16 (2.3) | 248 (70.5) | |
Generalized edema | 519 (50.0) | 287 (41.8) | 232 (65.9) | <0.001 |
Metabolic acidosisd | 108 (10.4) | 49 (7.1) | 59 (16.8) | <0.001 |
Hyperkalemiae | 153 (14.7) | 70 (10.2) | 83 (23.6) | <0.001 |
General weakness | 822 (79.2) | 498 (72.6) | 324 (92.1) | <0.001 |
Anemia | 82 (7.9) | 58 (8.5) | 24 (6.8) | 0.36 |
Anorexia | 601 (57.9) | 409 (59.6) | 192 (54.6) | 0.12 |
Vomiting | 303 (29.2) | 220 (32.1) | 83 (23.6) | 0.004 |
General ache | 37 (3.6) | 23 (3.4) | 14 (4.0) | 0.61 |
Pruritus | 49 (4.7) | 35 (5.1) | 14 (4.0) | 0.42 |
Insomnia | 47 (4.5) | 33 (4.8) | 14 (4.0) | 0.54 |
Neuropathy | 89 (8.6) | 64 (9.3) | 25 (7.1) | 0.23 |
No symptom | 69 (6.7) | 68 (9.9) | 1 (0.3) | <0.001 |
Systemic infection | 40 (3.9) | 15 (2.2) | 25 (7.1) | <0.001 |
a Unplanned dialysis group was defined as starting maintenance dialysis in a life-threatening situation regardless of a permanent access device in place.
Davies index |
Planned dialysis |
Unplanned dialysisa |
eGFR difference (unplanned – planned dialysis) | p-valueb | ||
---|---|---|---|---|---|---|
No. (%) | eGFR (mL/min/1.73 m2) | No. (%) | eGFR (mL/min/1.73 m2) | |||
Low-risk | 268 (39.1) | 4.9 ± 2.5 | 71 (20.2) | 5.7 ± 3.7 | 0.8 ± 0.5 | 0.03 |
Medium-risk | 366 (53.2) | 6.5 ± 3.8 | 236 (67.1) | 8.3 ± 5.3 | 1.8 ± 0.3 | <0.001 |
High-risk | 52 (7.6) | 7.2 ± 2.9 | 45 (12.8) | 10.1± 4.3 | 2.9 ± 0.8 | <0.001 |
Variable |
Adjusted model |
|
---|---|---|
HR (95% CI) | p-value | |
Male sex | 1.30 (0.94–1.79) | 0.11 |
Age at dialysis initiation | 1.06 (1.04–1.07) | <0.001 |
BMI at dialysis initiation (dry weight) | 0.96 (0.91–1.01) | 0.092 |
Unplanned dialysisa,b | ||
Planned dialysis (all risk) | Reference - | - |
Unplanned dialysis (all risk) | 1.69 (1.22–2.33) | 0.001 |
Planned dialysis (low-riskc) | Reference - | - |
Unplanned dialysis (low-riskc) | 1.89 (0.81–4.45) | 0.14 |
Planned dialysis (medium-riskc) | Reference - | - |
Unplanned dialysis (medium-riskc) | 1.72 (1.16–2.56) | 0.007 |
Planned dialysis (high-riskc) | Reference - | - |
Unplanned dialysis (high-riskc) | 1.80 (0.80–4.04) | 0.16 |
Comorbidity indexd | ||
Low-riskc | Reference - | - |
Medium-riskc | 1.73 (1.14–2.63) | 0.01 |
High-riskc | 2.50 (1.47–4.27) | 0.001 |
Predialysis ischemic heart diseasee | ||
No | Reference - | - |
Yes | 1.74 (1.09–2.78) | 0.02 |
a Unplanned dialysis group was defined as starting maintenance dialysis in a life-threatening situation regardless of a permanent access device in place.
b Adjustment for sex, age at dialysis initiation, BMI at dialysis initiation, Davies comorbidity score, and eGFR at dialysis initiation.
c Comorbidity index was used for the Davies index and patients were divided into low, medium, and high-risk groups on the basis of this.
Min-Jeong Lee
https://orcid.org/0000-0002-2611-7333
Inwhee Park
https://orcid.org/0000-0002-9912-5393
Heungsoo Kim
https://orcid.org/0000-0002-9380-7457
Gyu-Tae Shin
https://orcid.org/0000-0002-1343-5332
Jong Cheol Jeong
https://orcid.org/0000-0003-0301-7644