Guidance Needed for Patients who Start Dialysis Acutely

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SEATTLE—Patients who start dialysis acutely may be at greater risk for hospital care and other complications than patients who start dialysis in a planned manner, according to a new study presented at the 33rd Annual Dialysis Conference.

The study suggests that healthcare professionals should try to identify patients starting dialysis acutely to help educate and guide them toward a more optimal course of care.

“The problem is that there is no one tracking these patients,” said study investigator Susan Porteous, RN, who is with St Joseph's Healthcare, Hamilton, Ontario. “So they end up in centers with a catheter, they haven't had any education, and so we need to back track.”

These patients should be identified so they can be educated about home therapies.

The preferred method to start dialysis is in a planned manner that includes modality education and help with a smooth transition to the chosen modality, Porteous said. For a variety of reasons, however, a significant number of patients start dialysis acutely. She and her colleagues decided to investigate what happens to these patients. They defined patients as “acute starts” if they began dialysis because of a sudden change in their status leading that led to a sudden dialysis start. The study included patients who continued on chronic dialysis for longer than three months.

Porteous' team retrospectively reviewed data on acute dialysis starts over a 13-month period (August 1, 2011 to May 31, 2012). Patients' initial and current dialysis access and current therapy were identified following more than three months of continuous dialysis therapy. The study also looked at whether patients had modality education prior to or following the start of dialysis.

Of 61 patients included in the study, seven died. Three patients had recovered kidney function, one was on peritoneal dialysis, one was on home hemodialysis (HD), 23 received outpatient hospital HD, and 20 received HD at a satellite location. Six patients received HD in an acute hospital.

In terms of vascular access, 53 of 61 (87%) patients used a central venous catheter (CVC) and eight used a fistula (13%). As of March 2013, 35 patients have a CVC, 15 patients have a fistula or graft, and one patient has a peritoneal tube.

“We are a big center, and we found that only two of the 61 patients ended up on a home therapy,” Porteous said. “That is not very good, so we backtracked and we educated some of them.”

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