How do Patients who are Known to the Renal Units Start Chronic Haemodialysis?

INTRODUCTION: A signifi cant number of known ESRD patients start dialysis as an emergency. Key factors that determine emergency dialysis initiation have not been well identifi ed.

MATERIAL and METHODS: Ninety out of 159 patients studied were known for> 6 months and divided into Emergency dialysis (EmG n=46) and Elective dialysis (EG n=44) groups.

RESULTS: Most diabetic patients started dialysis as an emergency (75% vs. 25% p=0.008). At the start, EmG had higher median urea (3.5 vs. 3.8 g/dl p=0.05), a lower bicarbonate (19 vs. 21.5 mEq/L, p=0.04) and haemoglobin (9.4 vs10.5 g/dl p=0.005). Three months pre-dialysis, EmG had a lower serum albumin (3.2 vs. 3.6 g/L, p=0.001) and haemoglobin (10.4 vs. 11, p=0.06), a higher CRP (21 vs. 5, p=0.08) and better preserved eGFR (11 vs. 9, p=0.001). In multivariate analysis, only a diagnosis of diabetes and a CRP >30 were independent risk factors for starting dialysis as an emergency. Having an albumin >3.5 was associated with a reduced risk of having an emergency start to dialysis.

CONCLUSION: Apart from having diabetes, it seems diffi cult to predict emergency start of dialysis in known ESRD patients. Randomised controlled studies can further identify importance of high CRP and low serum albumin in relation to emergency initiation of dialysis.