What Drives Early Dialysis Initiation and How Do We Optimize Timing of RRT?

Slinin, Yelena; Ishani, Areef

doi:10.2215/cjn.08350814

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…In our study, we found that patients who have no dialysis facilities in their county of residence started dialysis at a higher average eGFR than patients in counties with three or more dialysis facilities during the study period, even after removing patients on home dialysis. This does differ from some prior studies, which suggested that patients with a longer distance to a dialysis facility tended to wait longer to initiate dialysis, and this warrants further exploration (18 –20). Past studies have suggested that dialysis facilities in more heavily populated urban areas are more likely to offer peritoneal dialysis.…”

Section: Discussioncontrasting

confidence: 94%

County-Level Dialysis Facility Supply and Distance Traveled to Facilities among Incident Kidney Failure Patients

Velázquez¹,

Thorsness²,

Trivedi³

et al. 2022

Kidney360

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Background: The availability of dialysis facilities and distance traveled to receive care can impact health outcomes for patients with newly onset kidney failure. We examine recent changes in county-level number of dialysis facilities between 2012 and 2019, and assess the association between county-level dialysis facility supply and the distance incident kidney failure patients travel to receive care. Methods: We conducted a cross-sectional study of 828,427 adult patients initiating in-center hemodialysis for incident kidney failure between January 1, 2012 and December 31, 2019. We calculated the annual county-level number of dialysis facilities, and counties were categorized as having 0, 1, 2, or 3 or more dialysis facilities at the time of treatment initiation. We then measured the distance traveled between a patient's home address and dialysis facility at treatment initiation (in miles) and evaluated the association between county-level number of dialysis facilities and distance traveled to initiate treatment. Results: The average annual county-level number of facilities increased from 1.8 to 2.3 between 2012 and 2019. In our study period, 4.8% of incident adult kidney failure patients resided in a county that had zero dialysis facilities between 2012 to 2019. Compared to counties with three or more dialysis facilities, patients living in counties with no facilities in our study period traveled 14.3 miles (95% CI: 13.4 to 15.2) further for treatment. Conclusions: Kidney failure patients in counties that had no dialysis facilities traveled further, limiting their access to dialysis. Counties with no dialysis facilities at the end of the study period were more rural and had higher poverty than other counties.

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Section: Discussioncontrasting

confidence: 94%

County-Level Dialysis Facility Supply and Distance Traveled to Facilities among Incident Kidney Failure Patients

Velázquez¹,

Thorsness²,

Trivedi³

et al. 2022

Kidney360

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“…One meta‐analysis of nine studies reported similar results for both modalities . Use of PD as the renal replacement modality was associated with higher eGFR at initiation compared with hemodialysis . Our subgroup analysis is supportive of this finding; the early start of HD was associated with a higher mortality risk.…”

Section: Discussionmentioning

confidence: 99%

Timing of Dialysis Initiation and Mortality Risk in Chronic Kidney Disease: A Meta‐Analysis

2018

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The optimal time of dialysis initiation among patients with chronic kidney disease (CKD) is unclear in recent years. We performed a meta-analysis to assess the association of early vs. late initiation of dialysis with estimated glomerular filtration rate. PUBMED, EMBASE, the Cochrane Library, and article reference lists were searched for relevant observational trials. A pooled hazard ratio (HR) with 95% CI was used to estimate the mortality risk. Twenty-six cohort studies and one randomized controlled trial were identified. Early start of dialysis was associated with the increased risk of mortality (HR = 1.23, 95% CI: 1.04-1.43) compared with late start of dialysis. In the subgroup analysis, age younger than 65 years at the early start of dialysis demonstrated higher mortality (HR = 1.20, 95% CI: 1.05-1.35) than the late start. Compared with peritoneal dialysis, the pooled HR with HD was 1.25 (95% CI: 1.17-1.34). Early start of dialysis increased the mortality risk compared with late start among patients with CKD.

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“…The timing of elective dialysis initiation continues to be a vexing issue and the subject of much debate (21)(22)(23)(24). In the early days of maintenance dialysis, patients were commenced when they were symptomatically uremic.…”

Section: Optimal Timing Of the Start Of Rrt: Was It Left Too Late?mentioning

confidence: 99%

Timing of Initiation of RRT and Modality Selection

Bargman¹

2015

Clinical Journal of the American Society of Nephrology

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There is no shortage of studies and registry data examining outcomes of patients on dialysis and those with a renal transplant. However, recently, there has been a greater focus on the events leading up to the institution of kidney replacement therapy. Associative data suggest that early and consistent predialysis care leads to better outcomes, including greater take-on to home-based therapy, diminished use of tunneled venous hemodialysis catheters, and improved early and even late survival. What transpires during predialysis visits is also important. Simple dissemination of facts to the unprepared patient is unlikely to be effective in moving the patient and family along in the process of the series of choices that have to be made around therapy. A more flexible and circumspect approach is needed, including recognizing when the patient is or is not ready for change. There seems to be no optimal timing of dialysis start that can be applied to the ESRD population as a whole, although the pendulum seems to be swinging back toward symptom-based rather than eGFR-based starts.

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What Drives Early Dialysis Initiation and How Do We Optimize Timing of RRT?

Cited by 4 publications

References 12 publications

County-Level Dialysis Facility Supply and Distance Traveled to Facilities among Incident Kidney Failure Patients

County-Level Dialysis Facility Supply and Distance Traveled to Facilities among Incident Kidney Failure Patients

Timing of Dialysis Initiation and Mortality Risk in Chronic Kidney Disease: A Meta‐Analysis

Timing of Initiation of RRT and Modality Selection

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