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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Hemodialysis (HD) is the most common renal replacement modality chosen in Thailand. The timing of HD initiation plays a critical role in determining clinical outcomes for patients with end-stage renal disease (ESRD). Planned HD initiation, which involves pre-dialysis education, vascular access creation, and proper medical preparation, has been associated with improved outcomes compared to unplanned initiation, often necessitated by acute complications. Despite these known risks, limited data are available on the real-world impact of planned versus unplanned HD initiation in Thai ESRD patients. This study aims to compare the clinical and survival outcomes of planned and unplanned HD initiation among patients treated at Siriraj Hospital, a tertiary care center in Thailand.
A retrospective cohort study was conducted on CKD stage 5 patients who initiated HD at Siriraj Hospital between December 2013 and December 2022. Unplanned HD initiation was defined as starting HD without available long-term vascular access due to urgent conditions, such as metabolic acidosis, hyperkalemia, volume overload, uremia, or intoxication. In contrast, planned HD initiation was defined as starting HD as scheduled by a nephrologist without the presence of urgent conditions. The study compared 2-year mortality, 2-year cardiovascular events—including myocardial infarction (MI) and stroke—and vascular access outcomes, which consist of vascular access infections and dysfunction, between patients undergoing planned and unplanned hemodialysis (HD).
A total of 240 CKD stage 5 patients were analyzed. The mean age at CKD stage 5 diagnosis was 62 years with 54.6% being male patients and 63.3% having diabetes mellitus. Among the cohort, 136 patients were in the planned group and 104 in the unplanned group. Unplanned HD initiation was associated with higher crude mortality in univariate analysis (HR 1.578, P = 0.213), but it was not an independent predictor in the multivariate model (HR 0.984, P = 0.970), suggesting that confounding factors like age, comorbidities, and laboratory abnormalities may mediate this risk. Furthermore, unplanned initiation was significantly associated with increased hospitalization (HR 1.598, P = 0.004) and vascular access infection (HR 2.684, P = 0.003) in univariate analysis, and showed a trend toward a higher risk of vascular access infection in multivariate analysis (HR 2.264, P = 0.057). Unplanned initiation was also associated with a higher incidence of myocardial infarction (HR 1.566, P = 0.254) and stroke (HR 2.686, P = 0.071).
Planned HD initiation is associated with better pre-dialysis care, more favorable clinical and biochemical status, and improved access type at initiation. While unplanned initiation did not independently predict mortality, it remains a marker for suboptimal pre-dialysis care and higher infection risk. Strategies to enhance early nephrology referral and preemptive dialysis planning are essential to improving outcomes in ESRD patients. A larger study population is needed to confirm these findings.
