Abstract: 【Abstract】Objective To evaluate the advantages of pre-dialysis management in chronic kidney disease (CKD) outpatient clinic in maintenance hemodialysis (MHD) patients and to provide the bases for CKD patient treatment in outpatient clinic. Methods This was a retrospective single center study, which enrolled 39 initial hemodialysis patients managed in our CKD outpatient clinic (management group, group M) and 142 initial hemodialysis patients without management in CKD outpatient clinic (non-management group, group NM) in the period from March 2015 to June 2017. Their vascular access methods and laboratory indices at the beginning of hemodialysis were compared. Results A total of 181 patients were enrolled in this study. The mean age was 60.6±15.3 years and 111 patients (61.3%) were male. There were no significant differences in gender, age, cause of CKD, and comorbidities between the two groups. At the initiation of hemodialysis, lower blood pressure [(146.1±14.2) mmHg vs. (160.3±28.8) mmHg, t=4.297, P＜0.001), serum phosphorus [(1.7±0.4) mmol/L vs. (2.0±0.6) ml/min, t=3.486, P=0.010] and iPTH [(270.7±157.1) pg/ml vs. (342.7±286.4) pg/ml, t=2.070, P=0.040], and higher hemoglobin [(88.8±17.2) g/L vs. (75.5±17.3) g/L, t=-4.253, P＜0.001] and eGFR [(7.0±2.3) ml/min vs. (5.5±3.1) ml/min, t=0.906, P =0.020] were found in group M as compared with those in group NM. Five patients (3.5%) used arteriovenous fistula (AVF) and 137 (96.5%) patients used central venous catheter (CVC) as the blood access in group NM, while 29 patients (74.4%) used AVF, 2 patients (5.1%) used tunneled cuffed catheter and 8 patients (20.5%) used CVC as the blood access in group M. The blood access methods were significantly different between the two groups (χ2=110.815, P＜0.001). Conclusions Pre-dialysis management for CKD patients improved their blood pressure, anemia, and renal bone disease at the initiation of hemodialysis, resulting in a better status at the time when hemodialysis was initiated. Pre- dialysis management also increased the use of planned blood access methods and decreased the use of
temporary catheterization for blood access.

Key words: Chronic kidney disease, Clinical management, Hemodialysis, Effect