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Background In a previous study, patients who underwent unplanned hemodialysis initiation did not have improved nutritional status and activities of daily living (ADL) at discharge compared with patients whose initiation of hemodialysis was planned. Therefore, the aim of this study was to analyze the factors that delayed or made it difficult to improve nutritional status and ADL in patients undergoing unplanned hemodialysis initiation. Methods Participants were patients with end-stage kidney disease who experienced unplanned initiation of new maintenance hemodialysis between April 2017 and March 2020. Patients were divided into two groups: a group who required assistance with ADL at discharge (assistance group) and a group who did not require assistance (independence group). Patient characteristics, nutritional management, and blood tests data obtained from medical records were retrospectively analyzed using univariate and multivariate analyses. Results In total, 95 patients who experienced unplanned dialysis initiation were included in the analysis. Of these, 55 (58%) patients were in the assistance group and 40 (42%) were in the independence group. The assistance group was significantly older than the independence group and contained significantly fewer male patients. In the assistance group, energy intake on admission and serum albumin at discharge were significantly lower, and C-reactive protein was significantly higher, than in the independence group. The multivariate analysis showed that age, sex, and energy intake on admission were associated with requirement for assistance with ADL at discharge. Conclusions Inadequate energy intake on admission was associated with requirement for assistance with ADL at discharge for patients who experienced unplanned hemodialysis initiation. This suggests that active nutritional management from the time of admission could reduce the requirement for assistance with ADL and could increase independence.

renal replacement therapy

Association of inadequate energy intake on admission with activities of daily living at discharge in patients undergoing unplanned hemodialysis initiation: a retrospective case-series study