Barzilai University Medical Center

23 Research Day 2020 Barzilai University Medical Center 12 INDICATIONS FOR INITIATING HEMODIALYSIS IN A HOSPITAL- BASED DIALYSIS UNIT Marina Sapojnikov, Alexander Wechsler, Larissa Lebedev, Ronen Levi-Varadi and Yoram Yagil Hemodialysis Unit, Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. Background : KDIGO guidelines suggest that dialysis should be initiated when kidneys fail and when life-threatening conditions occur and/or in the presence of uremic signs or symptoms, but not in the asymptomatic patient with low glomerular filtration rate. Objectives Explore the reasoning that lead nephrologists to initiate dialysis and determine whether the stated indications comply with KDIGO guidelines. Methods We prospectively assembled data over 4 years from one hospital-based dialysis unit in the acute (AKI) and chronic (CKD) settings. Attending nephrologists were requested to fill in a form that incorporates a list of 12 clinical indications for initiating dialysis in each of their patients. Results Data were obtained from 234 initiations of dialysis, 126 (64 males and 62 females, aged 24-90) in the setting of AKI and 108 (64 males and 44 females, aged 20-93) in patients with CKD starting chronic hemodialysis. Dialysis was initiated in AKI because of low GFR without any other symptoms or signs in 11.1% of cases and in CKD in 15.7%. Other causes for initiating dialysis during AKI were anuria (29.4%), volume overload (29.4%), pulmonary congestion/edema (23.0%), hyperkalemia (16.7%), uremic encephalopathy (15.1%), metformin-associated lactic acidosis (4.0%), metabolic acidosis (1.6%) and uremic pericarditis (0.8%). In advanced CKD, dialysis was initiated also because of uremic symptoms (30.6%), hyperkalemia (29.6%), volume overload (19.4%), pulmonary congestion/ edema (18.5%), uremic encephalopathy (14.8%), metabolic acidosis (1.9%) and pericardial effusion (1.9%). Conclusions The findings indicate overall adherence to KDIGO guidelines in the timing of initiation of dialysis. In a substantial number of patients, however, “late” initiation of dialysis was associated with development of life-threatening complications, including pulmonary edema, uremic encephalopathy, uremic pericarditis, which might have been averted had dialysis been initiated earlier. We suggest that guidelines for timing initiation of dialysis need to be reevaluated, possibly prompting “early” initiation of dialysis.