Study of clinical characteristics of patients initiating hemodialysis as initial renal replacement therapy,

The prevalence of end-stage renal disease (ESRD) is increasing. Hemodialysis (HD) is the most commonly applied renal replacement therapy (RRT) in ESRD worldwide and in our country. There is an increasing trend in urgent initiation in patients starting HD as the initial RRT. Parallel to this, the use of arteriovenous fistula (AVF) is decreasing, and catheter use is increasing. In this study, we aimed to evaluate the clinical and demographic characteristics of patients initiating HD as the initial RRT. A total of 136 patients with ESRD who were hospitalized or referred to our nephrology clinic between January 2021 and December 2023 and initiated HD as the initial RRT were included. Laboratory parameters at the initiation of HD (creatinine, estimated glomerular filtration rate (eGFR), hemoglobin (Hgb), pH, bicarbonate (HCO3), transferrin saturation, ferritin, parathyroid hormone, albumin, uric acid, potassium, phosphorus, calcium, cholesterol) were evaluated. The etiology of ESRD, vascular access route, how HD initiation occurred (urgent or scheduled), medications used, and whether they received predialysis erythropoiesis-stimulating agents (ESA) and iron therapy were evaluated. The data obtained were compared with the United States Renal Data System (USRDS) and Turkish Society of Nephrology registry data. Patients' data were obtained from the hospital automation system and patient records. eGFR was calculated according to the CKD-EPI (2021) creatinine equation. The mean age of patients at the initiation of HD was 59,6±15,7 years. HD was initiated urgently in 75,7% of patients. Non-tunnelled central venous catheter was predominantly used as the vascular access route (78,7%). The number of patients with Hgb <10 g/dL at the initiation of HD was 90 (66,2%). The use of predialysis ESA was 14%. Diabetes mellitus (DM) was the leading cause of ESRD at 39%, followed by hypertension (HT) at 16,9%. The majority of patients initiated HD urgently with non-tunnelled central venous catheter. Despite the frequency of anemia, ESA utilization was low. Close monitoring during the predialysis period is important for the initiation of HD with AVF and the management of complications associated with ESRD. The limited number of expert physicians in the nephrology and cardiovascular surgery departments in our hospital, low socioeconomic status, and advanced age can be considered among the other causes of urgent initiation in our center.