![]() For patient characteristics that are continuous variables (i.e., age), the mean (SD) or median (IQR) values for the crash and non-crash or unplanned and planned dialysis groups will be included along with the reported p values. All criteria used to define crash or unplanned dialysis starts and all reported patient characteristics/risk factors (i.e., age, reason for starting dialysis, blood test results) will be included. ![]() A number of variables related to study identification (author, number and location of centers, year of study, year of data collection), and study design (type of study, sample size, included patients) will be included. The systematic review will be conducted in accordance with recommendations from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement (see Additional file 1: PRISMA-P + checklist.docx).ĭata will be extracted by two independent reviewers using a standard data abstraction form. As well, consensus definitions are needed to help with the conduct of future studies. This will hopefully help clinicians better detect at-risk patients and help to design strategies with the aim of minimizing the incidence of crash and unplanned dialysis starts. Given the high prevalence and poor outcomes associated with crash and unplanned dialysis starts, we plan to conduct a systematic review with the objective of determining patient risk factors. Crash or unplanned dialysis starts are both associated with increased patient morbidity and mortality and lower quality-of-life scores. Studies have found that 23 to 38 % of patients “crash” onto dialysis, and 33 to 63 % of patients initiate dialysis in an unplanned fashion. The prevalence of crash or unplanned dialysis starts varies somewhat in the literature, likely in large part due to inconsistent definitions across studies, but overall, the prevalence is high. The criteria used to define an unplanned dialysis initiation also differ across studies. Certain studies have also used a definition that includes the number of nephrologist visits in the year prior to dialysis initiation. Various studies have used different time cutoffs, ranging from referral to a nephrologist within 90 days to 12 months of dialysis initiation. Unfortunately, there is no consensus definition on the exact timing of referral that qualifies a patient as “crashing” onto dialysis. An unplanned dialysis start is when a patient does not start dialysis using his or her chosen modality, starts dialysis during a hospitalization or, in certain studies, starts dialysis with a central venous catheter (CVC) as opposed to a permanent access (arteriovenous fistula (AVF), arteriovenous graft (AVG), or peritoneal dialysis catheter). Unfortunately, many patients will “crash” onto dialysis or initiate dialysis in an unplanned fashion.Ī patient is labeled as having a crash dialysis start when he or she is referred late to a nephrologist and therefore has minimal or no nephrology care prior to starting dialysis. ![]() Although showing signs of stabilization, the annual growth of dialysis programs worldwide over the past two decades has ranged between 6 and 12 %. Studies show that the prevalence of CKD in the USA and Canada has increased over the past decade, likely due to a higher prevalence of risk factors for CKD, such as diabetes and hypertension, and an aging population. However, this figure is much higher (18.6 %) when restricted to Canadian adults ≥65 years. The estimated prevalence among Canadian adults is lower at 3.1 % (0.73 million adults). Data will be pooled in meta-analysis if deemed appropriate.Ĭhronic kidney disease (CKD) defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m 2 affects 8.1 % of the American adult population (approximately 16.2 million people). Observational studies will be evaluated using the Newcastle-Ottawa Scale. If there are any eligible randomized controlled trials, quality assessment will be performed using the Cochrane Risk of Bias Assessment Tool. ![]() We will also extract from included studies the criteria used to define crash and unplanned dialysis starts. non-crash dialysis starts or unplanned vs. ![]() We will search MEDLINE, EMBASE and Cochrane Library from inception to the present date for all studies that report the characteristics and outcomes of patients who have crash vs. Secondary objectives will be to determine the most common criteria used to define both crash and unplanned dialysis starts and to determine outcomes associated with crash and unplanned dialysis starts. The first objective will be to determine patient risk factors for crash and unplanned dialysis starts. We will conduct a systematic review and meta-analysis with a focus on both crash and unplanned dialysis starts. ![]()
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