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Deleterious effects of dialysis emergency start, insights from the French REIN registry
BACKGROUND: Emergency start (ES) of dialysis has been associated with worse outcome, but remains poorly documented. This study aims to compare the profile and outcome of a large cohort of patients starting dialysis as an emergency or as a planned step in France. METHODS: Data on all patients aged 18...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142323/ https://www.ncbi.nlm.nih.gov/pubmed/30223784 http://dx.doi.org/10.1186/s12882-018-1036-9 |
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author | Alain, Michel Adelaide, Pladys Sahar, Bayat Cécile, Couchoud Thierry, Hannedouche Cécile, Vigneau |
author_facet | Alain, Michel Adelaide, Pladys Sahar, Bayat Cécile, Couchoud Thierry, Hannedouche Cécile, Vigneau |
author_sort | Alain, Michel |
collection | PubMed |
description | BACKGROUND: Emergency start (ES) of dialysis has been associated with worse outcome, but remains poorly documented. This study aims to compare the profile and outcome of a large cohort of patients starting dialysis as an emergency or as a planned step in France. METHODS: Data on all patients aged 18 years or older who started dialysis in mainland France in 2012 or in 2006 were collected from the Renal Epidemiology and Information Network and compared, depending on the dialysis initiation condition: ES or Planned Start (PS). ES was defined as a first dialysis within 24 h after a nephrology visit due to a life-threatening event. Three-year survival were compared, and a multivariate model was performed after multiple imputation of missing data, to determine the parameters independently associated with three-year survival. RESULTS: In 2012, 30.3% of all included patients (n = 8839) had ES. Comorbidities were more frequent in the ES than PS group (≥ 2 cardiovascular diseases: 39.2% vs 28.8%, p < 0.001). ES was independently associated with worse three-year survival (57% vs. 68.2%, p = 0.029, HR 1.10, 95% CI 1.01–1.19) in multivariate analysis. Among ES group, a large part had a consistent previous follow-up: 36.4% of them had ≥3 nephrology consultations in the previous year. This subgroup of patients had a particularly high comorbidity burden. ES rate was stable between 2006 and 2012, but some proactive regions succeeded in reducing markedly the ES rate. CONCLUSION: ES remains frequent and is independently associated with worse three-year survival, demonstrating that ES deleterious impact is never overcome. This study shows that a large part of patients with ES had a previous follow-up, but high comorbidity burden that could favor acute decompensation with life-threatening conditions before uremic symptoms appearance. This suggests the need of closer end-stage renal disease follow-up or early dialysis initiation in these high-risk patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-018-1036-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6142323 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-61423232018-09-20 Deleterious effects of dialysis emergency start, insights from the French REIN registry Alain, Michel Adelaide, Pladys Sahar, Bayat Cécile, Couchoud Thierry, Hannedouche Cécile, Vigneau BMC Nephrol Research Article BACKGROUND: Emergency start (ES) of dialysis has been associated with worse outcome, but remains poorly documented. This study aims to compare the profile and outcome of a large cohort of patients starting dialysis as an emergency or as a planned step in France. METHODS: Data on all patients aged 18 years or older who started dialysis in mainland France in 2012 or in 2006 were collected from the Renal Epidemiology and Information Network and compared, depending on the dialysis initiation condition: ES or Planned Start (PS). ES was defined as a first dialysis within 24 h after a nephrology visit due to a life-threatening event. Three-year survival were compared, and a multivariate model was performed after multiple imputation of missing data, to determine the parameters independently associated with three-year survival. RESULTS: In 2012, 30.3% of all included patients (n = 8839) had ES. Comorbidities were more frequent in the ES than PS group (≥ 2 cardiovascular diseases: 39.2% vs 28.8%, p < 0.001). ES was independently associated with worse three-year survival (57% vs. 68.2%, p = 0.029, HR 1.10, 95% CI 1.01–1.19) in multivariate analysis. Among ES group, a large part had a consistent previous follow-up: 36.4% of them had ≥3 nephrology consultations in the previous year. This subgroup of patients had a particularly high comorbidity burden. ES rate was stable between 2006 and 2012, but some proactive regions succeeded in reducing markedly the ES rate. CONCLUSION: ES remains frequent and is independently associated with worse three-year survival, demonstrating that ES deleterious impact is never overcome. This study shows that a large part of patients with ES had a previous follow-up, but high comorbidity burden that could favor acute decompensation with life-threatening conditions before uremic symptoms appearance. This suggests the need of closer end-stage renal disease follow-up or early dialysis initiation in these high-risk patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-018-1036-9) contains supplementary material, which is available to authorized users. BioMed Central 2018-09-17 /pmc/articles/PMC6142323/ /pubmed/30223784 http://dx.doi.org/10.1186/s12882-018-1036-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Alain, Michel Adelaide, Pladys Sahar, Bayat Cécile, Couchoud Thierry, Hannedouche Cécile, Vigneau Deleterious effects of dialysis emergency start, insights from the French REIN registry |
title | Deleterious effects of dialysis emergency start, insights from the French REIN registry |
title_full | Deleterious effects of dialysis emergency start, insights from the French REIN registry |
title_fullStr | Deleterious effects of dialysis emergency start, insights from the French REIN registry |
title_full_unstemmed | Deleterious effects of dialysis emergency start, insights from the French REIN registry |
title_short | Deleterious effects of dialysis emergency start, insights from the French REIN registry |
title_sort | deleterious effects of dialysis emergency start, insights from the french rein registry |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142323/ https://www.ncbi.nlm.nih.gov/pubmed/30223784 http://dx.doi.org/10.1186/s12882-018-1036-9 |
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