Emergent initiation of dialysis is related to an increase in both mortality and medical costs

Abstract

The number of patients with end-stage renal disease (ESRD) has been increasing, with dialysis treatment being a serious economic problem. To date, no report in Japan considered medical costs spent at the initiation of dialysis treatment, although some reports in other countries described high medical costs in the first year. This study focused on patient status at the time of initiation of dialysis and examined how it affects prognosis and the medical costs. As a result, all patients dying within 4 months experienced emergent dialysis initiation. Emergent dialysis initiation and high medical costs were risk factors for death within 2 years. High C-reactive protein levels and emergent dialysis initiation were associated with increasing medical costs. Acute kidney injury (AKI) contributed most to emergent dialysis initiation followed by stroke, diabetes, heart failure, and short-term care by nephrologists. Therefore, emergent dialysis initiation was a contributing factor to both death and increasing medical costs. To avoid the requirement for emergent dialysis initiation, patients with ESRD should be referred to nephrologists earlier. Furthermore, ESRD patients with clinical histories of AKI, stroke, diabetes, or heart failure should be observed carefully and provided pre-planned initiation of dialysis.

Outpatient clinic specific for end-stage renal disease improves patient survival rate after initiating dialysis

“…As we previously reported 17 , emergent initiation of dialysis is related to increased mortality 18 – 20 . Patients who undergo urgent initiation of dialysis often require rapid care and the poor general condition at that time of dialysis worsens the survival rate.…”

“…In addition, the relationship between specialized management of patients with ESRD, emergent initiation of dialysis, and survival rate were confirmed. As we previously reported 17 , emergent initiation of dialysis is related to increased mortality [18][19][20] . Patients who undergo urgent initiation of dialysis often require rapid care and the poor general condition at that time of dialysis worsens the survival rate.…”

“…Emergent-start dialysis was defined as cases in which long-term VA access was not in place for HD patients and PD catheters were not placed in patients with PD before initiation of dialysis therapy, as previously reported 17 . For medical costs and the period of hospitalization for preparing and initiating dialysis therapy, hospitalization for the creation of VA or stepwise initiation of PD using the Moncrief and Popovich techniques were included in this study, even without the initiation of dialysis.…”

Decline in Walking Independence and Related Factors in Hospitalization for Dialysis Initiation: A Retrospective Cohort Study

“…Patients with CKD need to be managed so that they can be transferred to dialysis in the best possible condition. However, dialysis is often initiated on an emergency basis [ 20 ]. Furthermore, a large epidemiological study in France reported that EDS has an independent impact on mortality [ 42 ].…”

“…Independent variables were analyzed using two models. In Model 1, we entered items of clinical significance from among variables that showed significant differences ( p < 0.001) between the two groups, referring to previous studies [ 1 , 19 , 20 , 21 ]. In doing so, items that could be intermediate variables for causality (length of hospitalization, FIM-walking score at hospitalization, number of rehabilitations) were excluded.…”