Causes and risk factors for acute dialysis initiation among patients with end-stage kidney disease—a large retrospective observational cohort study

Arulkumaran, N; Navaratnarajah, Arunraj; Pillay, Clio; Brown, Wendy Weinstock; Duncan, Neill; McLean, A.G.; Taube, David; Brown, Edwina A.

doi:10.1093/ckj/sfy118

Cited by 25 publications

(16 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acute KRT initiation was a main reason for almost half of respondents who (had) received CHD. Half of the patients starting dialysis experience an unplanned or acute start [40][41][42] that may hinder adequate training and preparation for home dialysis or pre-emptive KTx. However, patients facing an acute start of KRT may still be able to receive home dialysis or KTxeven if only at a later stage-if they receive adequate education and support [43].…”

Section: Discussionmentioning

confidence: 99%

Patient-reported factors influencing the choice of their kidney replacement treatment modality

Jong

Stel

Rahmel

et al. 2021

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

Background Access to various kidney replacement therapy (KRT) modalities for patients with end-stage kidney disease differs substantially within Europe. Methods European adults on KRT filled out an online or paper-based survey about factors influencing and experiences with modality choice (e.g. information provision, decision-making, reasons for choice) between November 2017 and January 2019. We compared countries with low-, middle- and high-Gross Domestic Product (GDP). Results 7,820 patients (mean age 59 years, 56% male, 63% on centre haemodialysis [CHD]) from 38 countries participated. Twenty-five percent had received no information on the different modalities and only 23% received information more than 12 months before KRT initiation. Patients were not informed about home haemodialysis [HHD] (42%) and comprehensive conservative management (33%). Besides nephrologists, nurses more frequently provided information in high-GDP countries whereas other physicians than nephrologists did so in low-GDP countries. Patients from low-GDP countries reported later information provision, less information about other modalities than CHD and lower satisfaction with information. The majority of modality decisions were made involving both patient and nephrologist. Patients reported subjective (e.g. quality of life, fears) and objective reasons (e.g. costs, availability of treatments) for modality choice. Patients had good experiences with all modalities, but experiences were better for HHD and kidney transplantation, and in middle- and high-GDP countries. Conclusion Our results suggest European differences in patient-reported factors influencing KRT modality choice, possibly caused by disparities in availability of KRT modalities, different healthcare systems and varying patients’ preferences. Availability of home dialysis and kidney transplantation should be optimized.

show abstract

Section: Discussionmentioning

confidence: 99%

Patient-reported factors influencing the choice of their kidney replacement treatment modality

Jong

Stel

Rahmel

et al. 2021

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

show abstract

“…It has to be considered that a relevant proportion of ESRD is not preventable or cannot be optimally prepared for renal replacement therapy with preventive nephrologic services. This is on the one hand due to rapid and unpredictable decline in renal function or acute health conditions (21,22). On the other hand, progression to ESRD occurs in some patients despite best therapeutic efforts.…”

Section: Meaning Of the Results And Comparison With Literaturementioning

confidence: 99%

Referral Criteria for Chronic Kidney Disease: Implications for Disease Management and Healthcare Expenditure - Analysis of a Population-Based Sample

Kiel

Weckmann

Chenot

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from:· Kidney Disease Improving Global Outcomes (KDIGO,2012)· National Institute for Health and Care Excellence (NICE,2014)· German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015)· German Society of General Practitioners and Family Physicians (DEGAM,2019)· Kidney failure risk equation (NICE,2021)MethodsData of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern.ResultsData from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥60 years. Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease >5% within the next 5 years.ConclusionsApplying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services.

show abstract

“…That was the ultimate goal of this study. Past research has shown that older age, male gender, increased comorbidity burden, diabetes, cardiovascular disease (e.g., congestive heart failure), and hypertension are associated with late referral to nephrologist care and suboptimal dialysis initiation (18)(19)(20)(21). The lack of recent nephrologist care also has been found to be a significant predictor of suboptimal dialysis starts (21).…”

Section: Discussionmentioning

confidence: 99%

Using random forests to understand unrecognized progression to late-stage CKD, a case-control study

Hane

Dunning

McPheeters

et al. 2021

Preprint

View full text Add to dashboard Cite

Background and objectives Patients with undiagnosed CKD are at increased risk of suboptimal dialysis initiation and therefore reduced access to home dialysis and transplantation as well as poor outcomes. Improved understanding of how patients remain undiagnosed is important to determine better intervention strategies. Design, setting, participants, and measurements A retrospective, matched, case-control analysis of 1,535,053 patients was performed to identify factors differentiating 4 patient types: unrecognized late-stage CKD, recognized late-stage CKD, early-stage CKD and a control group without CKD. The sample included patients with commercial insurance, Medicare Advantage, and Medicare fee-for service coverage. Patient demographics, comorbidities, health care utilization, and prescription use were analyzed using random forests to determine the most salient features discriminating the types. Models were built using all four types, as well as pairwise for each type versus the unrecognized late-stage type. Results Area under the curve for the three pairwise models (unrecognized late-stage vs recognized late-stage; unrecognized late-stage vs early-stage; unrecognized late-stage vs no CKD) were 82%, 68% and 82%. Conclusions The lower performance of the unrecognized late-stage vs early-stage model indicates a greater similarity of these two patient groups. The unrecognized late-stage CKD group is not simply avoiding or unable to get care in a manner distinguishable from the early-stage group. New outreach for CKD to undiagnosed or undetected, insured patients should look more closely at patient sets that are like diagnosed early-stage CKD patients.

show abstract

Causes and risk factors for acute dialysis initiation among patients with end-stage kidney disease—a large retrospective observational cohort study

Cited by 25 publications

References 39 publications

Patient-reported factors influencing the choice of their kidney replacement treatment modality

Patient-reported factors influencing the choice of their kidney replacement treatment modality

Referral Criteria for Chronic Kidney Disease: Implications for Disease Management and Healthcare Expenditure - Analysis of a Population-Based Sample

Using random forests to understand unrecognized progression to late-stage CKD, a case-control study

Contact Info

Product

Resources

About