Anned start and need of urgent dialysis start. Population n Cause/s for urgent dialysis start Asymptomatic + biochemistry abnormalities, n ( ) Over imposed acute kidney MLN9708 chemical information injury on CKD, n ( ) Hyperkalemia, n ( ) More than one cause at once (mix), n ( ) Other reasons, n ( ) Clinical symptoms of uremia, n ( ) Volume overload, n ( ) Unknown Reasons for becoming NP Acute factor deteriorating previous GFR, n ( ) Mix reasons, n ( ) Others, n ( ) Patient lack of compliance follow-up, n ( ) GFR loss faster than expected, n ( ) Patient related healthcare bureaucracy issues, n ( ) Non-functional vascular access at start, n ( ) Unknown 27 (9) 19 (6) 34 (12) 103 (36) 54 (19) 31 (11) 13 (10) 10 (3) 12 (12) 10 (10) 12 (12) 26 (25) 31 (30) 4 (4) 9 (9) 9 (8) 15 (9) 9 (5) 22 (12) 77 (43) 23 (13) 27 (15) 4 (2) 1 (0.4) <0.001 8 (2.5) 20 (6.3) 5 (1.5) 79 (25) 13 (4) 126 (40) 55 (17.4) 10 (3) 2 (2) 7 (7) 3 (3) 22 (21) 6 (6) 39 (27) 26 (23) 8 (7) 6 (3) 13 (6) 2 (1) 57 (28) 7 (3) 87 (43) 29 (14) 2 (0.9) 0.20 NP 316 ER+NP 113 LR+NP 203 P-valueAbbreviations: CKD, chronic kidney disease; NP, non-planned patients; ER+NP, early referral and non-planned patients; LR+NP, late referral and nonplanned patients. doi:10.1371/journal.pone.0155987.treferral nephrologists). Additionally, patients with NP start had worse clinical status at dialysis start and worse access management (Table 1 and Fig 2). Factors associated with P start were evaluated by a multivariate logistic regression analysis and are described in Table 3. Factors were adjusted for age and gender. More patients received education in the P (218/231, 94 ) than in the NP group (218/316, 69 ). At the time of modality information, P start patients had lower serum creatinine, longer predialysis follow-up and more patients were started on PD as RRT (p 0.01) (Table 4).Early ReferralsThe group of ER + NP patients showed markedly lower indicators of quality care than ER+P patients as well as less use of PD (p<0.05) [Table 4]. On the other hand, in a multivariate logistic regression analysis, the ER+P group was associated with eGFR >8.2 ml/min (OR 2.64, p = 0.001) and with information provided >2 months before initiation of dialysis (OR 38.5, p = 0.001). The final model was adjusted for age, gender, renal etiology and eGFR.PD as RRTPD was performed as first dialysis modality in 8.2 of patients (n = 45), with 5/45 as unplanned start. On the other hand, 14 NP patients who started with HD and a central venous line were switched to PD in the next six weeks reaching a final PD incidence of 59/547 (10.7 ) (Table 5 and Fig 3). PD incidence varied with age and patient subgroup (Fig 3). Patients who were not informed about RRT modalities never used PD. It is worthy to note that optimal care conditions had a big impact on the probability of PD as final RRT modality. Almost half of the PD patients (29/PLOS ONE | DOI:10.1371/journal.pone.0155987 May 26,6 /Referral, Modality and Dialysis Start in an International SettingFig 2. Type of dialysis access at first dialysis buy P144 Peptide session accordingly with different studied subgroups. Abbreviations: ER+P, early referral and planned patients; ER+NP, early referral and non-planned patients; LR+P, late referral and planned patients; LR+NP, late referral and non-planned patients. PD, peritoneal dialysis; HD, hemodialysis; AVF, arterio-venous fistula. Figure represents a diagram of bars showing the different types of accesses at first dialysis session. Accesses were as follows for the total popula.Anned start and need of urgent dialysis start. Population n Cause/s for urgent dialysis start Asymptomatic + biochemistry abnormalities, n ( ) Over imposed acute kidney injury on CKD, n ( ) Hyperkalemia, n ( ) More than one cause at once (mix), n ( ) Other reasons, n ( ) Clinical symptoms of uremia, n ( ) Volume overload, n ( ) Unknown Reasons for becoming NP Acute factor deteriorating previous GFR, n ( ) Mix reasons, n ( ) Others, n ( ) Patient lack of compliance follow-up, n ( ) GFR loss faster than expected, n ( ) Patient related healthcare bureaucracy issues, n ( ) Non-functional vascular access at start, n ( ) Unknown 27 (9) 19 (6) 34 (12) 103 (36) 54 (19) 31 (11) 13 (10) 10 (3) 12 (12) 10 (10) 12 (12) 26 (25) 31 (30) 4 (4) 9 (9) 9 (8) 15 (9) 9 (5) 22 (12) 77 (43) 23 (13) 27 (15) 4 (2) 1 (0.4) <0.001 8 (2.5) 20 (6.3) 5 (1.5) 79 (25) 13 (4) 126 (40) 55 (17.4) 10 (3) 2 (2) 7 (7) 3 (3) 22 (21) 6 (6) 39 (27) 26 (23) 8 (7) 6 (3) 13 (6) 2 (1) 57 (28) 7 (3) 87 (43) 29 (14) 2 (0.9) 0.20 NP 316 ER+NP 113 LR+NP 203 P-valueAbbreviations: CKD, chronic kidney disease; NP, non-planned patients; ER+NP, early referral and non-planned patients; LR+NP, late referral and nonplanned patients. doi:10.1371/journal.pone.0155987.treferral nephrologists). Additionally, patients with NP start had worse clinical status at dialysis start and worse access management (Table 1 and Fig 2). Factors associated with P start were evaluated by a multivariate logistic regression analysis and are described in Table 3. Factors were adjusted for age and gender. More patients received education in the P (218/231, 94 ) than in the NP group (218/316, 69 ). At the time of modality information, P start patients had lower serum creatinine, longer predialysis follow-up and more patients were started on PD as RRT (p 0.01) (Table 4).Early ReferralsThe group of ER + NP patients showed markedly lower indicators of quality care than ER+P patients as well as less use of PD (p<0.05) [Table 4]. On the other hand, in a multivariate logistic regression analysis, the ER+P group was associated with eGFR >8.2 ml/min (OR 2.64, p = 0.001) and with information provided >2 months before initiation of dialysis (OR 38.5, p = 0.001). The final model was adjusted for age, gender, renal etiology and eGFR.PD as RRTPD was performed as first dialysis modality in 8.2 of patients (n = 45), with 5/45 as unplanned start. On the other hand, 14 NP patients who started with HD and a central venous line were switched to PD in the next six weeks reaching a final PD incidence of 59/547 (10.7 ) (Table 5 and Fig 3). PD incidence varied with age and patient subgroup (Fig 3). Patients who were not informed about RRT modalities never used PD. It is worthy to note that optimal care conditions had a big impact on the probability of PD as final RRT modality. Almost half of the PD patients (29/PLOS ONE | DOI:10.1371/journal.pone.0155987 May 26,6 /Referral, Modality and Dialysis Start in an International SettingFig 2. Type of dialysis access at first dialysis session accordingly with different studied subgroups. Abbreviations: ER+P, early referral and planned patients; ER+NP, early referral and non-planned patients; LR+P, late referral and planned patients; LR+NP, late referral and non-planned patients. PD, peritoneal dialysis; HD, hemodialysis; AVF, arterio-venous fistula. Figure represents a diagram of bars showing the different types of accesses at first dialysis session. Accesses were as follows for the total popula.
