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Effect of emergency start and central venous catheter on outcomes in incident hemodialysis patients: a prospective observational cohort

  • Original Article
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Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

Unfavorable conditions at hemodialysis inception reduce the survival rate. However, the relative contribution to outcomes of predialysis follow-up, symptoms, emergency start or central venous catheter (CVC) is unknown.

Methods

We analyzed the determinants of survival according to dialysis initiation conditions in the nationwide REIN registry, using two methods based either on clinical classification or data mining. We divided patients into four groups according to dialysis initiation (emergency vs planned, symptoms or not, previous follow-up). “Followed planned starters” began dialysis as outpatients and with an arteriovenous fistula (AVF). “Followed symptomatic non-urgent starters” were patients who started earlier because of any non-urgent symptomatic event. "Followed urgent starters" had seen a nephrologist before inception but started dialysis in an emergency condition. “Unknown urgent starters” were patients without any follow-up and who had a CVC at inception.

Results

"Followed urgent" starters had the lowest 2-year survival rate (66.8%) compared to "followed planned" (77.3%), "followed symptomatic non urgent" (79.2%), and "unknown urgent" (71.7%). Compared to other groups, the risk of mortality was lower in followed symptomatic non urgent (HR 0.86 95% CI 0.75–0.99) and higher in followed urgent starters (HR 1.05 (95% CI 0.94–1.18).

In data mining Classification And Regression Tree regrouping in five categories, the lowest 2-year survival (52.3%) was in over 70-year-old starters with a CVC. The survival was 93.2% in under 57-year-old patients without active cancer, 82.5% in 57–70-year-old individuals without cancer, 72.4% in over 70-year-old patients without CVC and 61.4% in under 70-year-old subjects with cancer. The hazard ratio of data mining categories varied between 2.12 (95% CI 1.73–2.60) in 57–70-year-old subjects without cancer and 4.42 (95% CI 3.64–5.37) in over 70-year-old patients with CVC. Therefore, regrouping incident patients into five data mining categories, identified by age, cancer, and CVC use, could discriminate the 2-year survival in patients starting hemodialysis.

Conclusions

Although each classification captured different prognosis information, both analyses showed that starting hemodialysis on a CVC has more dramatic outcomes than emergency start per se.

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Funding

This work was supported by the Agency of Biomedicine, Paris, France [Grant AOR REIN 2018].

Author information

Authors and Affiliations

  1. Public Health Departments, Group Methods in Clinical Research, University Hospital of Strasbourg, Strasbourg, France

    Ulviyya Alizada & Erik-André Sauleau

  2. School of Medicine, University of Strasbourg, Strasbourg, France

    Erik-André Sauleau & Thierry Hannedouche

  3. Department of Nephrology, University Hospital of Strasbourg, Strasbourg, France

    Thierry Krummel & Thierry Hannedouche

  4. Department of Nephrology, University Hospital of Nimes, Nimes, France

    Olivier Moranne

  5. Department of Nephrology, Regional Coordination of Champagne-Ardenne for Rein Registry, University Hospital of Reims, Reims, France

    Isabelle Kazes

  6. Agency of Biomedicine, National Coordination REIN Registry, Paris, France

    Cécile Couchoud

Authors
  1. Ulviyya Alizada
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  2. Erik-André Sauleau
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  3. Thierry Krummel
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  4. Olivier Moranne
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  5. Isabelle Kazes
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  6. Cécile Couchoud
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  7. Thierry Hannedouche
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Consortia

on behalf of the REIN registry

Contributions

UA, E-AS, TK, CC, and TH conceived and/or designed the work that led to the submission, drafted, and revised the manuscript. IK and OM acquired data, and/or played an important role in interpreting the results. All authors approved the final version. List of collaborators in the REIN registry available at: "https://www.agence-biomedecine.fr/Le-rapport-du-REIN-2018-est-en-ligne" pages 24–30.

Corresponding author

Correspondence to Thierry Hannedouche.

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Conflict of interest

All the authors declared no competing interest.

Ethical statement

The study was nested in the REIN registry approved by the CCTIRS, the CNIL, and the Scientific Council of the Agence de Biomedecine.

Informed consent

All patients gave their informed consent at inception to participate in the Registry.

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Alizada, U., Sauleau, EA., Krummel, T. et al. Effect of emergency start and central venous catheter on outcomes in incident hemodialysis patients: a prospective observational cohort. J Nephrol 35, 977–988 (2022). https://doi.org/10.1007/s40620-021-01188-7

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  • DOI: https://doi.org/10.1007/s40620-021-01188-7

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