Factors contributing to unplanned initiation of dialysis in chronic kidney disease patients: A prospective analysis.

Abstract

Objective: To determining risk factors for unplanned initiation of dialysis in advanced chronic kidney disease (CKD) patients. Study Design: Prospective Observational study. Setting: The Kidney Center, Karachi, Pakistan. Period: September 2024 to May 2025. Methods: Adults (≥18 years) with stage 5 CKD initiating maintenance haemodialysis were analyzed. Planned dialysis was defined as elective initiation via arteriovenous fistula (AVF) / arteriovenous graft (AVG), or planned catheter, while unplanned initiation referred to urgent inpatient dialysis. Demographic, clinical, laboratory, and vascular access data were recorded. Statistical analyses was performed taking p<0.05 as significant. Results: Of 73 patients, 23 (31.5%) initiated dialysis electively, and 50 (68.5%) unplanned. Overall, the mean age was 53.9±14.6 years, and 39 (53.4%) were male. Diabetes mellitus was significantly more frequent in unplanned dialysis patients (60.0% vs 30.4%, p=0.019). Late referral (<1 month) was significantly associated with unplanned dialysis (p<0.001). Unplanned dialysis patients had lower albumin (p=0.024), and higher potassium (p=0.001) levels. AVF use was 82.6% in elective vs none in unplanned dialysis patients (p<0.001). Logistic regression identified diabetes (OR 3.4), late referral (OR 2.9), hyperkalaemia (OR 2.4), volume overload (OR 7.7), and AKI on CKD (OR 42.7) as major risk factors for unplanned dialysis. Conclusion: The unplanned initiation of dialysis in advanced CKD is strongly associated with diabetes mellitus, late referral, inadequate dialysis education, hypoalbuminaemia, hyperkalaemia, metabolic acidosis, volume overload, and acute kidney injury on CKD.