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Abstract
In Taiwan, most first-time dialysis was started without the creation of an arteriovenous shunt. Here, we aimed to elucidate the transitions of dialysis status in the unplanned first dialysis patients and determine factors associated with their outcomes. A total of 50,315 unplanned first dialysis patients aged more than 18 years were identified from the National Health Insurance Dataset in Taiwan between 2001 and 2012. All patients were followed for 5 years for the transitions in dialysis status, including robust (dialysis-free), sporadic dialysis, continued dialysis, and death. Furthermore, factors associated with the development of continued dialysis and death were examined by the Cox proportional hazard models. After 5 years after the first dialysis occurrence, there were 5.39% with robust status, 1.67% with sporadic dialysis, 8.45% with continued dialysis, and 84.48% with death. Notably, we have identified common risk factors for developing maintenance dialysis and deaths, including male gender, older age, diabetes, coronary heart disease, stroke, heart failure, sepsis, and surgery. There was an extremely high mortality rate among the first unplanned dialysis patients in Taiwan. Less than 10% of these patients underwent continued dialysis during the 5-year follow-up period. This study highlighted the urgent need for interventions to improve patient outcomes.
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1 Shuang Ho Hospital, Taipei Medical University, Division of Nephrology, Department of Internal Medicine, New Taipei City, Taiwan (GRID:grid.412896.0) (ISNI:0000 0000 9337 0481); Taipei Medical University, Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei, Taiwan (GRID:grid.412896.0) (ISNI:0000 0000 9337 0481); Taipei Medical University, TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei, Taiwan (GRID:grid.412896.0) (ISNI:0000 0000 9337 0481)
2 National Health Research Institutes, Institute of Population Health Sciences, Zhunan, Taiwan (GRID:grid.59784.37) (ISNI:0000 0004 0622 9172)
3 Shuang Ho Hospital, Taipei Medical University, Division of Nephrology, Department of Internal Medicine, New Taipei City, Taiwan (GRID:grid.412896.0) (ISNI:0000 0000 9337 0481); Taipei Medical University, Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei, Taiwan (GRID:grid.412896.0) (ISNI:0000 0000 9337 0481); Taipei Medical University, TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei, Taiwan (GRID:grid.412896.0) (ISNI:0000 0000 9337 0481); Hsin Kuo Min Hospital, Taipei Medical University, Division of Nephrology, Department of Internal Medicine, Taoyuan City, Taiwan (GRID:grid.412896.0) (ISNI:0000 0000 9337 0481)
4 National Health Research Institutes, Institute of Population Health Sciences, Zhunan, Taiwan (GRID:grid.59784.37) (ISNI:0000 0004 0622 9172); National Health Research Institutes, National Center for Geriatrics and Welfare Research, Yunlin, Taiwan (GRID:grid.59784.37) (ISNI:0000 0004 0622 9172)