Circumstances of Initiation of Hemodialysis: Importance of Nephrological Follow-Up

Abstract

Introduction: The timing of initiation of renal replacement therapy (RRT) depends not only on the level of residual renal function, estimated by calculating glomerular filtration rate (GFR), but also on patients’ clinical condition and local medical practices. The aim of this study was to investigate the value of early nephrological follow-up for patients during and after initiation of hemodialysis. Patients and Methods : prospective descriptive and analytical study lasting 3 months, from September 01 to November 30, 2022, on chronic hemodialysis patients at Donka National Hemodialysis Center. Two groups were included, according to the period of follow-up prior to initiation of hemodialysis: the first, known as “early referral”, included patients who had been followed for a minimum of six months prior to initiation of “planned hemodialysis”; the second, known as “late referral”, included patients who had had less than six months of nephrological follow-up prior to initiation of “emergency hemodialysis”. Results-Discussion: We noted 70 cases of CKD. The mean age was 46.43 ± 14.7 years, with extremes of 17 and 75 years. Females were predominant, with a sex ratio M/F = 0.7. Clinical signs on admission were dominated by anemia syndrome (100%) and uremic syndrome (74.3%). Mean creatinine clearance was 5.475 ± 3.4 ml/min/1.73 m 2 . The majority of our patients had been referred late (81.4%), while 18.6% had been referred early before being placed on hemodialysis. Apart from six cases of permanent central catheterization, all our patients (91.4%) had started their iterative hemodialysis on a temporary central catheter (femoral or jugular). After bivariate analysis, we found that late referral was significantly linked to certain factors, such as diabetes comorbidity (p = 0.02), uremic intoxication (p = 0.02), and temporary central catheterization (femoral with p = 0.001 and jugular with p = 0.013). Permanent or tunneled central catheterization was also significant, with identical rates in both groups. Mean creatinine levels were significantly higher in the early referral group (198.270 ± 101.2 mg/L; p = 0.020). However, the late referral group was more prone to excess mortality during the first three months of dialysis initiation, although there was no statistically established link between referral mode and mortality. Conclusion: Early nephrological referral is still beneficial for a better quality of life in iterative hemodialysis.