{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T01:39:36Z","timestamp":1768009176515,"version":"3.49.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T00:00:00Z","timestamp":1587081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Baxter Healthcare","award":["15002474"],"award-info":[{"award-number":["15002474"]}]},{"name":"Baxter Healthcare"},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In the \u2018Peridialysis\u2019 study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>SDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfaa041","type":"journal-article","created":{"date-parts":[[2020,3,15]],"date-time":"2020-03-15T20:26:33Z","timestamp":1584303993000},"page":"933-942","source":"Crossref","is-referenced-by-count":11,"title":["Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate"],"prefix":"10.1093","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3715-3388","authenticated-orcid":false,"given":"James","family":"Heaf","sequence":"first","affiliation":[{"name":"Department of Medicine, Zealand University Hospital, Roskilde, Denmark"},{"name":"Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maija","family":"Heiro","sequence":"additional","affiliation":[{"name":"Turku University Hospital, Turku, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aivars","family":"Petersons","sequence":"additional","affiliation":[{"name":"P. Stradins University Hospital, Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baiba","family":"Vernere","sequence":"additional","affiliation":[{"name":"P. Stradins University Hospital, Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan V","family":"Povlsen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anette Bagger","family":"S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Clyne","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Clinical Sciences Lund, Lund University and Sk\u00e5ne University Hospital, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inga","family":"Bumblyte","sequence":"additional","affiliation":[{"name":"Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alanta","family":"Zilinskiene","sequence":"additional","affiliation":[{"name":"Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Else","family":"Randers","sequence":"additional","affiliation":[{"name":"Department of Medicine, Viborg Regional Hospital, Viborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"L\u00f8kkegaard","sequence":"additional","affiliation":[{"name":"Department of Medicine, Holbaek Hospital, Holbaek, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai","family":"Ots-Rosenberg","sequence":"additional","affiliation":[{"name":"University Hospital of Tartu, University of Tartu, Tartu, Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stig","family":"Kjellevold","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vestfold Hospital, T\u00f8nsberg, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Dominik","family":"Kampmann","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital of Southern Jutland, Soenderborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bj\u00f6rn","family":"Rogland","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inger","family":"Lagreid","sequence":"additional","affiliation":[{"name":"Department of Medicine, St Olav University Hospital, Trondheim, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olof","family":"Heimburger","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bengt","family":"Lindholm","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,4,17]]},"reference":[{"key":"2021032313064413600_sfaa041-B1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1471-2369-10-22","article-title":"An integrated review of \u201cunplanned\u201d dialysis initiation: reframing the terminology to \u201csuboptimal\u201d initiation","volume":"10","author":"Mendelssohn","year":"2009","journal-title":"BMC Nephrol"},{"key":"2021032313064413600_sfaa041-B2","doi-asserted-by":"crossref","first-page":"e0130080","DOI":"10.1371\/journal.pone.0130080","article-title":"Factors associated with unplanned dialysis starts in patients followed by nephrologists: a retrospective cohort study","volume":"10","author":"Brown","year":"2015","journal-title":"PLoS One"},{"key":"2021032313064413600_sfaa041-B3","doi-asserted-by":"crossref","first-page":"2959","DOI":"10.1093\/ndt\/gfq843","article-title":"Suboptimal initiation of dialysis with and without early referral to a nephrologist","volume":"26","author":"Mendelssohn","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"2021032313064413600_sfaa041-B4","first-page":"445","article-title":"The start of renal replacement therapy in a Spanish department","volume":"26","author":"Castellano","year":"2006","journal-title":"Nefrologia"},{"key":"2021032313064413600_sfaa041-B5","first-page":"49","article-title":"Prognostic significance of programmed dialysis in patients who initiate renal substitutive treatment. 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