The timing and other dialysis start features associated with survival: St-Petersburg renal replacement therapy register

Aim: to evaluate the association between survival and patient status at the start of dialysis. Methods: the analysis of survival data in St-Petersburg city RRT register among patients started dialysis in 2009-2015. Results: Among 2548 included patients 411 started RRT with PD (16.1%), 1134 (44.5%) started RRT urgently, 16.7% had diabetes mellitus. 5-year survival was 68.4%, in PD-starters it was higher (p<0,004). Estimated GFR did not differ between PD-starters and HD-starters in groups with scheduled (8.4±2.7 vs. 8.4±2.7) or urgent (4.5±2.4 vs. 4.4±2.4 ml/min) RRT start. Urgent start with PD but not with HD was associated with increased adjusted risk of death after 3 years of dialysis (calculated from 90-th day of dialysis). In adjusted Cox model for HD-starters eGFR (as continuous variable - per 1 ml/min) was associated with reduced death risk by 16% (OR 0.843; 95%CI 0.796÷0.892; p<0.001). The adjusted Cox model for quintiles of eGFR with borders 3.1-4.6-6.3-8.8 ml/min revealed increased risk of death only for eGFR<6.3 compared with upper quintile (>8.8), when urgent start was added as a variable - only for eGFR<4.6 ml/min. The risk was increased for baseline Hb<10 g/dl (OR 1.39; 95%CI 1.05÷1.84; p=0.02), hypoalbuminemia < 3.8 g/dl (OR 1.38; 1.13÷1.68; p=0.001), ferritin>500 μg/l (ОР 1.25; 1.00÷1.55; p=0.047) - as inflammation marker, hypercalcemia >2.5 mmol/l (OR 1.69; 1.00÷2.86; р=0.049), hyperphosphatemia >1.78 mmol/l (OR 1.63; 1.07÷2.48; p=0.022) or both (OR 3.98; 1.67÷9.48; p=0.002). Conclusion: the dialysis delaying up to eGFR 8.8-6.3 ml/min isn`t associated with increased risk of death; while taking in account urgent/scheduled start eGFR 4.6÷6.3 ml/min isn`t associated with increased risk compared higher eGFR levels.

гемодиализ, перитонеальный диализ, выживаемость, начало диализа, регистр ЗПТ, hemodialysis, peritoneal dialysis, survival, dialysis initiation timing, RRT register

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