PATHWAYS AND INDICATIONS OF CHRONIC HAEMODIALYSIS COMMENCEMENT IN A TERTIARY NEPHROLOGY CENTRE IN PERTH, WESTERN AUSTRALIA.
Dr Ben Tomlinson1, Dr Abu Abraham1, Dr Ramyasuda Swaminathan1
1Fiona Stanley Hospital, Murdoch, Australia
Aim: To elucidate the pathways and indications for initiation of chronic haemodialysis (CHx) in a local cohort of patients.
Background: Trends in estimated glomerular filtration rate around time of haemodialysis initiation are well characterised. Patients initiate CHx through a range of pathways. The exact indications and trends in initiation have not been well studied.
Methods: A retrospective cohort analysis of single tertiary centre data using the electronic medical record between 1 January 2022 and 30 November 2022 for all new-start haemodialysis patients (excluding home haemodialysis).
Results: 175 patients initiated haemodialysis during the study period. 146 patients characterised as CHx were included in the study with 29 patients coming off renal replacement. Baseline characteristics include: mean age 60 years, 89% male, and 37% Aboriginal and Torres Strait Islander. 97 patients (67.1%) initiated CHx during an inpatient admission with 12 patients (8.2%) commencing therapy in the intensive care unit (ICU). 13 patients (8.9%) required CHx following an acute kidney injury without prior renal impairment greater than Chronic Kidney Disease (CKD) stage II, 69 patients (47.3%) due to acute on chronic renal impairment with background CKD IIIa or greater, and 64 patients (43.8%) as a result of progressive CKD.
Indications for initiation of CHx included hypervolaemia (25.7%), transition from peritoneal dialysis (17.8%), uraemic symptoms (11.6%), metabolic acidosis (9.6%), refractory hyperkalaemia (5.5%), failed renal transplant (5.5%), transfer from another service (1.4%), hyperphosphataemia (0.58%), and unspecified (20.6%).
Conclusion: Most patients initiated CHx as an inpatient, with a significant proportion commencing therapy in the ICU. Abrupt transition from lower stages of CKD to CHx is under recognised in dialysis initiation with potential significant implications for patients.