Abstract: 【Abstract】Objective To investigate the differences of clinical characteristics at the initiation of hemodialysis of end-stage renal disease (ESRD) patients in order to obtain the information relating to continuous improvement of management of pre- dialysis chronic kidney disease (CKD) patients. Methods This was a retrospective single center study. A total of 272 ESRD patients beginning hemodialysis at the Affiliated Hospital of Jiangsu University between March 2015 and August 2018 were recruited. They were divided into diabetic nephropathy group (DN group, n=120) and non-DN group (n=152). The main cause directly leading to dialysis, vascular access and laboratory parameters were compared between the two groups. Results Before dialysis, more outpatients were found in DN group than in non-DN group (P＜0.001). The main cause directly leading to the initiation of hemodialysis was heart failure/edema in DN group and was uremic symptoms in non-DN group. In DN group, hemoglobin and eGFR were higher than in non-DN group (t=3.190 and 7.155; P=0.002 and ＜0.001), and blood urea nitrogen, serum creatinine, serum phosphorus and iPTH were lower than in non-DN group (t=- 5.736, - 8.231, - 3.785 and - 3.116 respectively; P=＜0.001, ＜0.001, ＜0.001 and 0.002 respectively). The implement of blood access was significant different between the two groups (χ²=
4.917, P=0.027). Conclusions DN was the first primary cause for initiating hemodialysis in ESRD patients in the past 3 years. DN patients initiated hemodialysis earlier and often due to refractory heart failure. The use of central vein catheterization for blood access was higher during the initiation of hemodialysis. Therefore, clinical management of CKD patients at the outpatient department should be reinforced. In addition, arteriovenous fistula operation should be considered before initiating hemodialysis to decrease the temporary vascular catheterization.

Key words: diabetic nephropathy, initiating hemodialysis, chronic kidney disease