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 |
aUnplanned 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 |
aUnplanned dialysis group was defined as starting maintenance dialysis in a life-threatening situation regardless of a permanent access device in place.
bAdjustment for sex, age at dialysis initiation, BMI at dialysis initiation, Davies comorbidity score, and eGFR at dialysis initiation.
cComorbidity 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
Blood osteoprotegerin is associated with arteriovenous access thrombosis in hemodialysis patients