Abstract
The unplanned initiation of hemodialysis is a prognostic risk factor for survival in maintenance hemodialysis patients. We examined the nutritional challenges associated with the unplanned initiation of hemodialysis. The study subjects comprised patients who were started on maintenance hemodialysis within 1 year from April 2017. The planned initiation group included patients who had a vascular access point before their admission and were considered to have undergone a scheduled admission. The remaining patients were included in the unplanned group. We compared the two groups and retrospectively collected information on primary disease, age, length of hospitalization, complications, outcomes, nutritional management, nutrition support team activity, the rehabilitation intervention rate, blood test results, and activities of daily living（ADL）. Eighty‒one patients were included in this study. Among them, the unplanned initiation group comprised 26 patients（32％）（median［IQR］age： 76（70‒82）years）. The median length of hospitalization was 48（32‒64）days. Forty‒six percent and 77％ of patients were complicated by heart failure and infectious diseases, respectively. The unplanned initiation group had significantly more difficulties, according to the results of the nutritional status assessment, and lower serum albumin levels than the planned initiation group; however, they exhibited better dietary intake. In addition, the unplanned initiation group exhibited poor nutritional index values and ADL recovery and a high hospital transfer rate. Our findings suggest that among patients subjected to the unplanned initiation of hemodialysis nutritional status and poor ADL recovery at the initiation of maintenance hemodialysis might be related to a poor prognosis.
