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Risk Factors for Suboptimal Dialysis Initiation: A Prospective Cohort Study
Amber O Molnar1,2,3, K Scott Brimble1, Sarah E Bota3,4
1Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Kidney360
|July 21, 2025
Summary
Suboptimal dialysis initiation is frequent in advanced chronic kidney disease (CKD) patients. Higher hemoglobin levels reduced risk, while comorbidity and more nephrologist visits increased risk, but no modifiable patient factors were found.
Area of Science:
- Nephrology
- Public Health
Background:
- Suboptimal dialysis initiation is a prevalent issue in advanced chronic kidney disease (CKD).
- It is linked to increased patient morbidity and mortality.
- Identifying risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify risk factors for suboptimal dialysis initiation in patients with advanced CKD.
- To analyze associations between patient characteristics and suboptimal dialysis start.
Main Methods:
- Prospective cohort study of English-speaking patients without cognitive impairment in multidisciplinary kidney clinics.
- Follow-up included a 6-month visit and healthcare administrative data.
- Suboptimal dialysis initiation defined as initiation during hospitalization or with a central venous catheter in patients <75 years old.
- Adjusted cause-specific hazard models were used.
Main Results:
- 33% of 366 patients experienced suboptimal dialysis initiation.
- Higher time-varying hemoglobin was associated with lower risk (aHR 0.96).
- Higher comorbidity index and more nephrologist visits (within 6 months) were associated with higher risk (aHR 1.17 and 1.70, respectively).
- Health literacy, kidney disease knowledge, and influenza vaccination were not associated with suboptimal initiation.
Conclusions:
- Suboptimal dialysis initiation remains common even with established nephrology care.
- No readily modifiable patient-related risk factors were identified in this study.
- Further research may be needed to explore other contributing factors.
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