Abstract: TH-PO1151
Unplanned Initiation of Maintenance Hemodialysis: Patient Background and Survival in Pre- and Post-COVID-19 Emerging
Session Information
- COVID-19
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Kitamura, Mineaki, Nagasaki Daigaku Byoin, Nagasaki, Japan
- Nishino, Tomoya, Nagasaki Daigaku Byoin, Nagasaki, Nagasaki, Japan
Background
The initiation of hemodialysis, especially when unplanned, often leads to a decline in functional status and an increased risk of cardiovascular diseases, malnutrition, and infections. Several factors associated with unplanned dialysis have been reported; however, patient background differences between pre-and post-COVID-19 emerging have not been elucidated. We aimed to identify factors contributing to unplanned hemodialysis and evaluate patient prognosis in collaboration with maintenance hemodialysis centers.
Methods
We analyzed patients initiating hemodialysis at our facility between 2016 and 2023, stratified by pre-April 2020 and post-April 2020 periods based on the declaration of a state of emergency from the Japanese Government. Unplanned hemodialysis was defined as initiation during emergency admission, regardless of arteriovenous fistula presence. Data on patient demographics, comorbidities, and clinical course were collected. Multivariable logistic and Cox regression models assessed factors associated with unplanned hemodialysis initiation and patient mortality, respectively.
Results
We included 290 patients (age:71±12 years old, 64% male) and divided them into the groups pre-(n=149) and post-April 2020 (n=141). Unplanned hemodialysis was initiated in 77 (55%), and 69 (46%) patients in both periods. The prevalence of any infections was higher in patients initiating unplanned dialysis (P<0.001). Multivariable logistic regression analysis indicated that unplanned dialysis initiation throughout the entire period was significantly associated with infections (OR: 15.79, 95% CI: 5.45-45.75, P<0.001). This trend was almost similar in pre- and post-April 2020. Notably, the prevalence of pneumonia in the post-April 2020 group was lower (n=13, 8%) than that in the pre-April 2020 group (n=25, 17%) (P=0.02). During the follow-up period (median 766 days), 89 patients died, and infections were the most prevalent cause of death (34%). Unplanned hemodialysis was an independent risk factor of death (HR:1.96, 95%CI:1.20-3.18, P=0.007)
Conclusion
As patients with renal failure are susceptible to infections, special attention should be paid even after the post-COVID-19 pandemic. Increased awareness of hygiene practices can improve prognosis in patients with renal failure.