Starting chronic dialysis treatment in an emergency. What morbidity and mortality?

F. El Mazani[1], A. Adnouni[1a], W. Fadili1 Mr. Sebbani[2], Mr. Amine[2a], I. Laouad[1b]
Page no.142-150

Objective: To evaluate the morbidity and mortality of patients with end stage renal disease ( ESRD)
initiating chronic dialysis treatment in an emergency.
Population and methods: From the register of nephrology emergencies were included in the study
230 patients who started first dialysis treatment for ESRD emergency and that during the study
period between January 2010 and December 2013. clinical and biological characteristics and the
initial outcome of these patients were studied.
Results: During these 4 years , 510 patients were treated in emergency hemodialysis including 230
patients 45 % had ESRD , never initiated dialysis . A very rapid increase in the frequency of
incident cases was observed as 9 % of cases were recorded in 2010 , 16 % in 2011 , 33 % in 2012
and 42 % in 2013. 43.4 % of cases were seen during the 3 months summer. The average age of our
patients was 48 + / - 18 years with a slight male predominance of 54.3 %. Diabetes (29.6%) ,
hypertension (23.5%) and heart disease (16.5%) were most associated with ESRD comorbidities.
The IRC was known and followed prior to admission to the emergency room only in 30.1% ; among
these patients followed , 11% of them have been sent to a nephrologist. The reason for admission to
the emergency room was dominated by dyspnea (25% ), vomiting (22 %) and impaired
consciousness (14.3 %). Biologically , the mean creatinine was 154.40 + / -91 mg / l with a mean
creatinine clearance of 4.7 + / -2.9 ml/min/1.73m2 . Hyponatremia was prevalent in 89.3 % and
symptomatic deep and in 12.3%. Greater than 6.5 mmol severe hyperkalemia / l was observed in
17.32 % of patients. Deep acidosis least 10 mmol / l was seen in 58 % . Anemia was almost
constant with an average of 6.9 mg hemoglobin / dl and 44.2 % had urgent transfusion
requirements . Acute pancreatitis was associated with ESRD in 13 %. Clinical and biological
infectious syndrom e was noted in 29.5 % of cases. 15.6% of patients required an initial
hospitalization in intensive care (SSI) . Indications for taking emergency dialysis were represented
by threatening hyperkalemia ( 23.4%), a major uremia (22.6%) , acute edema of the lung (17.4 %).
The incision was a temporary catheter in 224 patients ( 97.4 %). During the first hemodialysis ,
22.2% of patients had hypotension, 16 patients or 7% a cardiac arrest . A death rate of 18.3% or 42
patients was recorded during the first hospitalization. Predictors of mortality found in the bivariate
study are: disorders of consciousness ( p < 0.0001) , dyspnea ( 0.004) , the least severe anemia
7g/dl (p : 0.005) , infection ( P: 0.0012 ) , acidosis (p < 0.0001) , a higher rate of urea has 3g / l
and hospitalization for SSI (p : 0.005). The multivariate analysis retained all these factors as
independent mortality factors except dyspnea