{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T05:07:57Z","timestamp":1790485677219,"version":"4.1.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-IA-COH-2012\/3731"],"award-info":[{"award-number":["ANR-IA-COH-2012\/3731"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The lack of a well-designed prospective study of the determinants of urgent dialysis start led us to investigate its individual- and provider-related factors in patients seeing nephrologists.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study that included 3033 patients with CKD [mean age 67\u2009years, 65% men, mean estimated glomerular filtration rate (eGFR) 32\u2009mL\/min\/1.73\u2009m2] from 40 nationally representative nephrology clinics from 2013 to 2016 who were followed annually through 2020. Urgent-start dialysis was defined as that \u2018initiated imminently or &amp;lt;48\u2009hours after presentation to correct life-threatening manifestations\u2019 according to the Kidney Disease: Improving Global Outcomes 2018 definition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over a 4-year (interquartile range 3.0\u20134.8) median follow-up, 541 patients initiated dialysis with a known start status and 86 (16%) were identified with urgent starts. The 5-year risks for the competing events of urgent and non-urgent dialysis start, pre-emptive transplantation and death were 4, 17, 3 and 15%, respectively. Fluid overload, electrolytic disorders, acute kidney injury and post-surgery kidney function worsening were the reasons most frequently reported for urgent-start dialysis. Adjusted odds ratios for urgent start were significantly higher in patients living alone {2.14 [95% confidence interval (CI) 1.08\u20134.25] or with low health literacy [2.22 (95% CI 1.28\u20133.84)], heart failure [2.60 (95% CI 1.47\u20134.57)] or hyperpolypharmacy [taking &amp;gt;10 drugs; 2.14 (95% CI 1.17\u20133.90)], but not with age or lower eGFR at initiation. They were lower in patients with planned dialysis modality [0.46 (95% CI 0.19\u20131.10)] and more nephrologist visits in the 12\u2009months before dialysis [0.81 (95% CI 0.70\u20130.94)] for each visit.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study highlights several patient- and provider-level factors that are important to address to reduce the burden of urgent-start dialysis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ndt\/gfab170","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T19:25:38Z","timestamp":1620069938000},"page":"1500-1510","source":"Crossref","is-referenced-by-count":17,"title":["Urgent-start dialysis in patients referred early to a nephrologist\u2014the CKD-REIN prospective cohort 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