Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort

Higuchi, Satoshi; Nakaya, Izaya; Yoshikawa, Kazuhiro; Chikamatsu, Yoichiro; Sada, Ken‐ei; Yamamoto, Shuichi; Takahashi, Satoko; Sasaki, Hiroyo; Soma, Jun

doi:10.1016/j.ekir.2017.01.015

Cited by 2 publications

(1 citation statement)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…На протяжении предшествовавших двадцати лет наблюдалась тенденция к началу диализа при все более высокой СКФ (ранний старт ) [3]. Однако оказа-лось, что это не улучшает пациент-ориентированные исходы и приводит к необоснованным финансовым затратам [4]. По данны м метаанализа наблюдатель-ных исследований, более высокая расчетная СКФ (рСКФ) на старте ГД ассоциировалась с большей летальностью в последующий период независимо от характеристик пациентов, включая нутриционный статус [5].…”

Section: Introductionunclassified

Dialysis Start Timing: Development and Validation of Start Scoring Scale

Земченков

Gerasimchuk²,

Sabodash

et al. 2018

RJTAO

View full text Add to dashboard Cite

Aim.The optimal time for initiating of chronic dialysis remains unknown. The scale for mortality risk assessment could help in decision-making concerning dialysis start timing.Methods.We randomly divided 1856 patients started dialysis in 2009–2016 into developmental and validation group (1:1) to create and validate scoring system «START» predicting mortality risk at dialysis initiation in order to ﬁ nd unmodiﬁ able and modiﬁ able factors which could help in the decision-making of dialysis start. In the series of univariate regression models in the developmental set, we evaluated the mortality risk linked with available parameters: age, eGFR, serum phosphate, total calcium, hemoglobin, Charlson comorbidity index, diabetes status, urgency of start (turned to be signiﬁ cant) and gender, serum sodium, potassium, blood pressure (without impact on survival). Similar hazard ratios were converted to score points.Results.The START score was highly predictive of death: C-statistic was 0.82 (95% CI 0.79–0.85) for the developmental dataset and 0.79 (95% CI 0.74–0.84) for validation dataset (both p < 0.001). On applying the cutoff between 7–8 points in the developmental dataset, the risk score was highly sensitive 81.1% and speciﬁ c 67.9%; for validation dataset, the sensitivity was 78.9%, speciﬁ city 67.9%. We conﬁ rmed the similarity in survival prediction in the validation set to developmental set in low, medium and high START score groups. The difference in survival between three levels of START-score in validation set remained similar to that of developmental set: Wilcoxon = 8.78 (p = 0.02) vs 15.31 (p < 0.001) comparing low–medium levels and 25.18 (p < 0.001) vs 39.21 (p < 0.001) comparing medium–high levels.Conclusion.Developed START score system including modiﬁ able factors showed good mortality prediction and could be used in dialysis start decision-making.

show abstract

Section: Introductionunclassified

Dialysis Start Timing: Development and Validation of Start Scoring Scale

Земченков

Gerasimchuk²,

Sabodash

et al. 2018

RJTAO

View full text Add to dashboard Cite

show abstract

Temporary central venous catheter at hemodialysis initiation and reasons for use: a cross-sectional study

et al. 2021

View full text Add to dashboard Cite

Background Creating permanent vascular access (VA) is recommended before hemodialysis initiation in patients with end-stage renal disease (ESRD). Although many patients are still introduced to hemodialysis with temporary central venous catheters (CVCs), the reasons for their use remain unclear. We aimed to clarify the characteristics of Japanese patients introduced to hemodialysis using temporary CVCs, the reasons for their use, and whether this rate can be reduced in the future. Methods We conducted this cross-sectional study in an acute care general hospital in Japan. We enrolled 393 patients aged ≥ 18 years who received a permanent VA creation for initiating hemodialysis. We classified participants into the temporary CVC group or the permanent VA group according to the VA type at hemodialysis initiation and compared their backgrounds. We identified why permanent VA could not be used at hemodialysis initiation for patients in the temporary CVC group. Results Of the 393 patients, 137 (35%) initiated hemodialysis with a temporary CVC, and arteriovenous fistulas (AVFs) were created as the first VA in all patients during hospitalization following hemodialysis initiation. The remaining 256 patients (65%) initiated hemodialysis via AVF cannulation. The duration of predialysis nephrology care was significantly shorter in the temporary CVC group than that in the permanent VA group. The median time from AVF creation to the first successful cannulation was also shorter in the temporary CVC group (8 vs. 66 days, P < 0.001), but the estimated glomerular filtration rate values at hemodialysis initiation did not differ. Reasons for temporary CVC use were varied and complex. Problems on the part of healthcare providers, patient behavioral issues, and characteristics of causative kidney disease itself were underlying reasons. Delayed referral to a nephrologist was less frequent than expected (16%) and the most commonly reported reason (20%) was that a nephrologist was unable to predict the timing of hemodialysis initiation. Conclusions Patients with ESRD should be referred to a nephrologist earlier for AVF creation. However, given the already relatively high rate of hemodialysis initiation with permanent VA in Japan, we considered it surprisingly difficult to further reduce the temporary CVC usage rate in Japan.

show abstract

Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort

Cited by 2 publications

References 31 publications

Dialysis Start Timing: Development and Validation of Start Scoring Scale

Dialysis Start Timing: Development and Validation of Start Scoring Scale

Temporary central venous catheter at hemodialysis initiation and reasons for use: a cross-sectional study

Contact Info

Product

Resources

About