Prevalence of Suboptimal Dialysis Initiation in Advanced CKD Patients
A significant number of patients with advanced CKD start dialysis suboptimally, during hospitalization or with central venous catheters. A recent study identifies risk factors and emphasizes the importance of better prediction tools to improve dialysis timing and outcomes.
A recent study published in Kidney360 highlights that initiating dialysis in a suboptimal manner is a common occurrence among patients with advanced chronic kidney disease (CKD). Suboptimal initiation is typically characterized by starting dialysis during a hospital stay or with a central venous catheter, which can increase the risk of complications and impact patient outcomes. The research, conducted by Dr. Amber O. Molnar and colleagues at McMaster University, involved a prospective cohort of 366 patients followed over a median of 1.9 years. They found that 33% of these patients experienced suboptimal dialysis start, representing 69% of all dialysis initiations.
The study identified some factors associated with higher risk, including lower hemoglobin levels and a greater number of nephrologist visits in the six months prior to dialysis initiation. Specifically, higher hemoglobin levels appeared to reduce the likelihood of suboptimal start, with each gram per deciliter increase associated with a decreased hazard. Conversely, increased comorbidities and frequent healthcare visits were linked to greater risk. Interestingly, measures such as health literacy, kidney disease knowledge, and influenza vaccination status did not show significant associations.
The authors concluded that there are no easily modifiable patient-related risk factors for suboptimal dialysis initiation. They emphasized the importance of improved kidney failure risk prediction tools that can better inform the timing of dialysis preparation, ideally 6 to 12 months before anticipated need. Proactively starting kidney replacement therapy in high-risk patients and refining prediction models may help reduce the prevalence of suboptimal initiation, ultimately improving patient outcomes.
This study underscores the need for tailored approaches in managing advanced CKD and highlights that optimizing the timing and preparation for dialysis remains a challenge in clinical practice.
Source: https://medicalxpress.com/news/2025-07-suboptimal-dialysis-common-patients-advanced.html
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