Improving Patient Outcomes Through Targeted Interventions.

Statisticians from the UKKA’s Renal Registry (UKRR) have made a significant contribution to understanding unplanned dialysis initiation (UDI), highlighting new opportunities to improve care for patients with advanced CKD.

The review was led by Winnie Magadi, a PhD researcher at the University of Bristol and UKRR Senior Statistician, alongside Principal Statistician, Shalini Santhakumaran, and is now published in the Clinical Kidney Journal. 

The work shines a light on the vital role of our UK Renal Registry in advancing kidney care and research and we would like to congratulate Winnie and Shalini for their publication.

A Comprehensive Look at Risk Factors

The study analysed 17 international studies published between 2018 and 2023, updating a 2019 review by Hassan et al.

The new report identified several modifiable risk factors for UDI, including:

• Poor CKD coding in general practice records.
• Fewer nephrology visits prior to starting dialysis.
• Social factors such as living alone or reduced mobility.
• Lower health literacy and awareness.

These findings build on previously known predictors, such as cardiovascular disease, lower serum albumin and late referrals to nephrology services.

What This Means for Patients and Care

Unplanned dialysis starts are associated with worse outcomes, including higher rates of hospitalisation, morbidity and mortality. The review provides new insights into why people start dialysis in an unplanned manner, many of which are modifiable, thus contributing to efforts in reducing the rate of UDI. 

The article also emphasises the need for improved care coordination and patient education to reduce the rate of UDI. Lead author, Winnie Magadi, noted: 

“This work highlights actionable areas for improvement, such as better surveillance of at-risk patients and earlier intervention. By addressing these factors, improvements to the quality of life for patients transitioning to dialysis can be made.”

Next Steps for Research

The findings call for further research into modifiable risk factors, particularly social and psychosocial influences that have not been widely studied. The team also identified the need for standardised definitions of UDI across studies to facilitate better comparisons and data synthesis. Future research will focus on exploring these areas further, with the goal of developing interventions that can be implemented in clinical practice.

Access the Full Study

The full review, "An updated systematic review of the risk factors for unplanned dialysis initiation," is available in the Clinical Kidney Journal (2024, vol. 17, no. 12). Read it here.