ISN Western Europe Regional Board Webinar: Reducing the Rates of Unplanned starts on Dialysis: Challenges and Solutions

Unplanned initiation of dialysis remains a significant challenge globally, adversely affecting patient outcomes and straining healthcare systems. This webinar explores the multifaceted issues surrounding “late presenters” to dialysis—patients who commence dialysis without prior planning—and discusses evidence-based strategies to mitigate these rates. 

An overview of the objectives will set the context for the webinar, highlighting the importance of addressing this critical issue. 

The first segment will present an overview of the current global and Western European scenario of late dialysis presenters. Using recent data, the discussion will focus on regional variations in unplanned start rates and the persistent issue of acute presentations despite established chronic kidney disease (CKD) management programs. The clinical and quality-of-life impacts of late presentation will also be emphasized. 

The second segment will explore the risk factors and barriers associated with unplanned dialysis starts. Common contributors, such as socioeconomic disparities, gaps in health literacy, and delays in referral to nephrology services, will be examined. Barriers within healthcare systems, such as limited access to care and inadequate CKD education, will be analyzed, complemented by insights from qualitative studies and patient experiences. 

The final segment will highlight practical strategies to reduce the rates of unplanned dialysis starts. Key approaches will include early CKD identification, structured pre-dialysis care programs, and the integration of multidisciplinary teams. Examples of successful interventions from various countries, such as telehealth initiatives and policy reforms to address disparities in access to care, will be shared. 

The webinar will conclude with a Q&A session, offering attendees the opportunity to discuss region-specific challenges and solutions. A wrap-up will summarize the key points discussed and emphasize actionable takeaways for improving patient care. 

Learning objectives:

- Raise awareness about the high rates of unplanned dialysis initiation and its consequences. 
- Identify key risk factors and barriers that lead to late presentation.
- Share evidence-based approaches and best practices to reduce these rates, improving patient outcomes 

Further reading:

- Dialysis education and options for late presenters-An ongoing dilemma. Zhang Y, Baharani J.Hemodial Int. 2023 Jul;27(3):224-230. doi: 10.1111/hdi.13082. Epub 2023 Apr 3.
- Winnie Magadi, Kate Birnie, Shalini Santhakumaran, Fergus J Caskey, Yoav Ben-Shlomo, An updated systematic review of the risk factors for unplanned dialysis initiation, Clinical Kidney Journal, 2024;, sfae333, https://doi.org/10.1093/ckj/sfae333 
- Machowska A, Alscher MD, Vanga SR, Koch M, Aarup M, Qureshi AR, Lindholm B, Rutherford P. Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective. BMC Nephrol. 2017 Jan 13;18(1):18. doi: 10.1186/s12882-016-0419-z. PMID: 28086826; PMCID: PMC5237347.