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논문분류	춘계학술대회 초록집
제목	Optimal time to start hemodialysis according to underlying kidney disease
저자	Geo Neul Park
출판정보	2023; 2023(1):
키워드
초록	Objectives: Determining when to prepare vascular access and to start dialysis in patients with chronic kidney disease (CKD) is difficult. Current study is retrospective cohort research to find out the effect of underlying kidney disease on the start of hemodialysis (HD) and to anticipate the best time of permanent vascular access preparation. Methods: Patients with CKD, who had visited nephrologist at least 1 year before the onset of HD and started maintenance HD from Jan 2011 to Dec 2021, were enrolled. Underlying kidney diseases of patients were classified into diabetic nephropathy (DN), hypertension (HTN), glomerulonephritis (GN) and polycystic kidney disease (PCKD). Patients who started HD using permanent vascular access (AVF or AVG) were grouped as Planned HD, and patients using central vein catheter were grouped as Unplanned HD. Results: Total 411 patients (244 males, mean 54.2 years old) were included. The mean period from first visit to HD start date was 61.8 months. Patients with DN, HTN, GN, and PCKD were 54.3%, 30.7%, 9%, and 5.6%, respectively. One third of all patients underwent planned HD. Patients with DN had fewer prepared access (figure 1) and the highest serum creatinine (Cr) level (mean 9.80 mg/dL) at the HD start time compared with the others (figure 2). Patients with DN had serum Cr level 5.0 mg/dL at ‘1 year to 2 years before HD start’, while others had it at ‘1 years to 3 months before HD start’. Conclusions: Among patients with CKD, more DN patients start unplanned maintenance HD despite higher serum Cr level. As vascular access is recommended to be created 6 months before HD start, it is suggested that CKD patients create permanent vascular access at the time of serum Cr level near 5.0 mg/dL, allowing DN patients to be prepared for planned HD.
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