Examining factors associated with catheter-defined unplanned dialysis initiation: a UK Renal Registry analysis

In the UK, nearly half of patients with end stage kidney disease (ESKD) who initiate dialysis do so in an unplanned manner. A reduced quality of life, increased number of hospitalisations, and higher rates of mortality are just a few of the consequences of unplanned dialysis initiation (UDI). Our study examined factors associated with UDI in patients with ESKD in England, focusing on the effects of ethnicity and late presentation (LP).

We conducted a retrospective cohort study using data from the UK Renal Registry on 26 512 adult patients initiating dialysis between 2019 and 2023. UDI was defined as starting dialysis via a tunnelled or non-tunnelled line. We ran univariable and multivariable (multilevel) logistic regression analyses to examine risk factors of UDI, then tested for interactions between ethnicity and other key risk factors.

Just under half of the population had a UDI (49%), with Black and 'Other' patients having increased odds (1.36 and 1.29, respectively) of having a UDI than White patients, after adjusting for age. Unsurprisingly, the age-adjusted analyses also showed that LP and UDI were strongly associated (odds ratio (OR) 8.03, 95% confidence interval (CI) 7.38-8.74). Among late presenters, Asians had lower odds of UDI (OR 0.77, 95% CI 0.61-0.99) than Whites. For non-late presenters, the odds of UDI were higher in Asians (OR 1.18, 95% CI 1.09-1.28), Blacks (OR 1.47, 95% CI 1.32-1.64), and 'Other' (OR 1.30, 95% CI 1.08-1.57) compared to Whites (ethnicity and LP interaction P < 0.001). UDI was also associated with being more deprived, having an acute kidney injury, diabetes, higher comorbidity burden and history of cancer, heart failure, myocardial infarction, and minimal engagement with outpatient services before starting dialysis.

Our study highlighted ethnicity as an important risk factor for UDI. Further, timing of presentation appears to alter ethnic differences in UDI.