Advertisement

Dialysis access, infections, and hospitalisations in unplanned dialysis start patients: results from the OPTiONS study

Abstract

Introduction

Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient outcomes and healthcare utilisation depending on initial dialysis access (CVC or PD catheter) and subsequent pathway of UPS patients.

Methods

In this study patient demographics, access procedures, hospitalisations, and major infectious complications were analysed over 12 months in 270 UPS patients. PD technique survival and impact of switching from HD to PD was examined along with logistic regression to investigate factors predicting AV fistula formation.

Results

72 UPS patients started with PD catheter and 198 with CVC. PD patients were older and more comorbid but had a significantly lower number of access procedures while there was no difference in hospitalisation or major infections. 13/72 initial PD patients switched to HD and 1-year technique survival was 79%. 158/198 patients remained on HD and 73/158 reported permanent access formation. Older age, OR = 0.34 (CI,0.17-0.68) and cardiac failure, OR = 0.31(CI,0.13-0.78), were significant negative predictors of receiving fistula. Younger patients, OR = 0.29 (CI, 0.11-0.79) and those who received AVF, OR = 0.11 (CI,0.03-0.38), had significantly lower odds of death.

Discussion

UPS with initial PD was possible in many patients and was associated with lower requirement for access procedures. AVF formation in UPS patients starting on HD was associated with better 1-year survival. Modality switching in UPS patients requires careful clinical management, including clinical practice patterns promoting permanent HD access formation.

Int J Artif Organs 2017; 40(2): 48 - 59

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/ijao.5000557

Authors

Anna Machowska, Mark D. Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul R. Qureshi, Bengt Lindholm, Peter Rutherford

Article History

Disclosures

Financial support: This observational study, Offering Patients Therapy Options in Unplanned Start (OPTiONS), was supported by a grant from Baxter Healthcare. Anna Machowska was funded by the European Union Marie Curie Initial Training Network grant (Call: FP7-PEOPLE-2011-ITN) for the project European Training & Research in Peritoneal Dialysis (EuTRiPD). This study was also supported by a grant from Baxter Healthcare Corporation to Karolinska Institutet that provided the basis for Baxter Novum.
Conflict of interest: Bengt Lindholm and Anna Machowska are employed by Baxter Healthcare Corporation. Peter Rutherford was employed by Baxter Healthcare at the time of the study and is now employed by Quintiles. None of the other authors declare any conflict of interest.

This article is available as full text PDF.

  • If you are a Subscriber, please log in now.

  • Article price: Eur 36,00
  • You will be granted access to the article for 72 hours and you will be able to download any format (PDF or ePUB). The article will be available in your login area under "My PayPerView". You will need to register a new account (unless you already own an account with this journal), and you will be guided through our online shop. Online purchases are paid by Credit Card through PayPal.
  • If you are not a Subscriber you may:
  • Subscribe to this journal
  • Unlimited access to all our archives, 24 hour a day, every day of the week.

Authors

Affiliations

  • Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm - Sweden
  • Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Krankenhaus, Stuttgart - Germany
  • Department of Renal Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire - UK
  • Center of Nephrology, Mettmann - Germany
  • Department of Nephrology, Odense University Hospital, Odense - Denmark
  • Integrated Market Access, QuintilesIMS, Reading - UK

Article usage statistics

The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.

This article has supplementary materials available to download.

  • If you are a Subscriber, please log in now.

  • Article price: Eur 36,00
  • You will be granted access to the article for 72 hours and you will be able to download any format (PDF or ePUB). The article will be available in your login area under "My PayPerView". You will need to register a new account (unless you already own an account with this journal), and you will be guided through our online shop. Online purchases are paid by Credit Card through PayPal.
  • If you are not a Subscriber you may:
  • Subscribe to this journal
  • Unlimited access to all our archives, 24 hour a day, every day of the week.