Unplanned Dialysis Initiation: A Single-Center Experience

 

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Unplanned Dialysis Initiation: A Single-Center Experience

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HTAY
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HTAY HTAY htay.htay@singhealth.com.sg Department of Renal Medicine, Singapore General Hospital DUKE-NUS Medical School, Singapore Singapore Singapore *
Marjorie Wai Yin Foo marjorie.foo.w.y@singhealth.com.sg Department of Renal Medicine, Singapore General Hospital DUKE-NUS Medical School, Singapore Singapore Singapore -
Mathini Jayaballa mathini.jayaballa@singhealth.com.sg Department of Renal Medicine, Singapore General Hospital DUKE-NUS Medical School, Singapore Singapore Singapore -
Khin Zar Li Lwin Khin.Zar.l.l@singhealth.com.sg Department of Renal Medicine, Singapore General Hospital DUKE-NUS Medical School, Singapore Singapore Singapore -
Elizabeth Ley Oei elizabeth.oei.ley@singhealth.com.sg Department of Renal Medicine, Singapore General Hospital DUKE-NUS Medical School, Singapore Singapore Singapore -
Angela Yee Moon Wang angela.wang.y.m@singhealth.com.sg Department of Renal Medicine, Singapore General Hospital DUKE-NUS Medical School, Singapore Singapore Singapore -
Chieh Suai Tan tan.chieh.suai@singhealth.com.sg Department of Renal Medicine, Singapore General Hospital DUKE-NUS Medical School, Singapore Singapore Singapore -
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Unplanned dialysis initiation is associated with a high risk of complications, but a considerable number of patients require urgent dialysis initiation. The study aimed to examine the incidence of unplanned dialysis, as well as the dialysis modality chosen for long-term treatment among patients with unplanned dialysis initiation.

This was a single-center, retrospective study including all patients with kidney failure from January to December 2024. The study examined the incidence of unplanned dialysis initiation. Descriptive statistics were used to summarize and present the data.

A total of 483 patients had stage 5 chronic kidney disease (CKD), of whom 99 (20.5%) opted for conservative management. The remaining 384 patients underwent dialysis. Among these, 163 (42.5%) initiated dialysis in a planned manner with an arteriovenous fistula (AVF), arteriovenous graft (AVG), or Tenckhoff catheter in place before the initiation of dialysis. The remaining 221 patients (57.5%) did not have permanent access and commenced unplanned dialysis using a central venous catheter (CVC). Of these 221 patients, 193 (87.3%) continued on hemodialysis (HD), while only 28 (12.7%) transitioned to peritoneal dialysis (PD). The proportion of patients who opted for peritoneal dialysis (PD) as their preferred modality was significantly higher among those with planned dialysis initiation compared to those with unplanned initiation (36.2% vs. 12.7%; p < 0.001). 

Unplanned dialysis initiation was common and was associated with an increased likelihood of remaining on hemodialysis rather than transitioning to peritoneal dialysis.

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