{"id":22124,"date":"2025-07-21T09:10:04","date_gmt":"2025-07-21T13:10:04","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=22124"},"modified":"2025-07-22T09:14:15","modified_gmt":"2025-07-22T13:14:15","slug":"risk-factors-for-suboptimal-dialysis-initiation","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/risk-factors-for-suboptimal-dialysis-initiation\/","title":{"rendered":"Risk factors for suboptimal dialysis initiation: a prospective cohort study"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 Suboptimal dialysis initiation is common and is associated with increased morbidity and mortality. We sought to determine risk factors for suboptimal dialysis among patients with advanced CKD.<\/p>\n<p><strong>Methods<\/strong> \u2014\u00a0Prospective cohort study that enrolled English speaking patients without cognitive impairment followed in multidisciplinary kidney clinics across four regional kidney programs in Ontario, Canada. Patients completed a 6-month follow-up visit with further follow-up using healthcare administrative data. The primary outcome was suboptimal dialysis initiation defined by dialysis initiation during a hospitalization or with a central venous catheter in patients &lt;75 years old. Adjusted cause specific hazard models were used to examine the association of pre-specified characteristics with suboptimal dialysis.<\/p>\n<p><strong>Results<\/strong> \u2014 366 patients were included, 122 (33%) patients had a suboptimal dialysis start (69% of dialysis starts) over a median follow up of 1.9 (IQR 0.7-2.5) years. Higher hemoglobin (time-varying) was associated with a lower risk of suboptimal dialysis initiation (adjusted hazard ratio (aHR) 0.96, 95% CI 0.95-0.98). The mean (SD) hemoglobin in those with suboptimal dialysis initiation was 10.7 (1.5) g\/dL. Higher comorbidity index and greater number of nephrologist visits within the past 6 months were associated with a higher risk of suboptimal dialysis initiation (aHR 1.17, 95% CI 1.01-1.35 and 1.70, 95% CI 1.39-2.08, respectively). Measures of health literacy, kidney disease knowledge and influenza vaccination were not associated with suboptimal dialysis initiation. A secondary analysis defining suboptimal dialysis initiation by dialysis initiation during a hospitalization showed similar results.<\/p>\n<p><strong>Conclusions<\/strong> \u2014 Suboptimal dialysis initiation was common despite established nephrology follow-up. Our study did not find readily modifiable patient-related risk factors for suboptimal dialysis initiation.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 Suboptimal dialysis initiation is common and is associated with increased morbidity and mortality. We sought to determine risk factors for suboptimal dialysis among patients with advanced CKD. Methods \u2014\u00a0Prospective cohort study that enrolled English speaking patients without cognitive impairment followed in multidisciplinary kidney clinics across four regional kidney programs in Ontario, Canada. Patients [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[49],"migration-helper-qa-sample-set":[],"class_list":["post-22124","journal_article","type-journal_article","status-publish","hentry","topic-kidney-disease"],"acf":{"citation":"Molnar AO, Brimble KS, Bota SE, Kang Y, Harmon JP, Hiremath S, Brown PA, Silver SA, Akbari A. <em>Kidney360<\/em>. 2025 Jul 21 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.34067\/kid.0000000895","ices_scientist":[1316,1357],"site":[6739],"research_program":[6743],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Risk factors for suboptimal dialysis initiation: a prospective cohort study<\/title>\n<meta name=\"description\" content=\"Background \u2014 Suboptimal dialysis initiation is common and is associated with increased morbidity and mortality. 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