Clinical characteristics of end stage renal disease patients at hemodialysis initiation
The starting time of renal replacement therapy (RRT) is a complicated issue, which is based on multiple factors including clinical, social and laboratory parameters. To help make decision on when to start hemodialysis in impending end stage renal disease (ESRD) patients, we investigated the clinical features of ESRD patients at the start of hemodialysis at a university hospital center in Korea. We retrospectively analyzed 409 ESRD patients who were newly started on hemodialysis treatment between January 2010 and December 2012. The most common cause of ESRD was diabetic nephropathy (48.7%), followed by biopsy-proven glomerulonephritis (11.7%). The mean eGFR at the start of hemodialysis, ranging between 5.59 – 7.82 ml/min/1.73m2 (except Nankivell equation), were significantly different according to different equations. The modified Cockcroft-Gault, the MDRD and the CKD-EPI equations showed significant correlations with all categories of chronic kidney disease complications. The main reasons to start hemodialysis were fluid overload (38.4%) and uremic symptoms (35.0%). DM patents were older and started dialysis at higher eGFR levels than non-DM patients (mean eGFR by the MDRD equation, 6.92 ± 3.63 vs 5.41 ± 2.91, p < 0.001). Hemodialysis was started in 59.2% patents through outpatient clinic or admission after outpatient clinic (OPD group), and in the remaining 40.8% patients via emergency department (ER group). In the ER group, hyperkalemia and metabolic acidosis were significantly more severe than the OPD group. We hope our study will provide valuable information on the clinical and laboratory characteristics of the patients at the time of hemodialysis initiation in our current practices.
End stage renal disease, hemodialysis, estimated glomerular filtration rate
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