At the end of 2014, 20,690 Canadians were receiving chronic dialysis. Unfortunately, many of these patients started dialysis sub-optimally. There are various definitions for a sub-optimal dialysis start, but most include the criteria of dialysis initiation during a hospitalization and/or with a central venous catheter (CVC).

Patients with a sub-optimal dialysis start have increased morbidity and mortality. As well, patients who start dialysis without appropriate preparation have likely been denied the opportunity to make an informed decision with respect to their end stage renal disease (ESRD) care.

There is also the important consideration of cost. It is estimated that preventing one sub-optimal dialysis start could save the Canadian Healthcare System $20,275 in hospital costs. The first step towards reducing the incidence of sub-optimal dialysis initiation is to identify important risk factors.

Our study will be the first to prospectively examine actionable and modifiable risk factors for sub-optimal dialysis initiation among patients with advanced chronic kidney disease (CKD) followed in multi-care kidney clinics (MCKC). MCKCs are multi-disciplinary clinics wherein patients are prepared for renal replacement therapy (RRT).

We are investigating if reduced health literacy (HL) is associated with an increased risk of hospitalizations, medication non-adherence, and patient related delayed decision-making with respect to RRT preparation, and determining patient perspectives regarding RRT preparation.

The results will help inform the design of a multi-faceted intervention to be tested in a cluster randomized clinical trial with the ultimate aim of reducing the incidence of sub-optimal dialysis starts.

Risk Factors for Suboptimal Dialysis Initiation - Download PDF
Study Type


Study Design

Prospective observational study

NO. of Countries


NO. of Sites


NO. of Participants


Study Period

2019 - 2021



Kidney Foundation of Canada grant

St. Joseph's Healthcare

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