engleski

Emergency department visits of hemodialysis patients

Chronic kidney disease (CKD) is one of the leading public health problem with significant increase in patient number each year. Kidney disease can progress to CKD through several stages until it reaches the end-stage renal disease (ESRD) when is necessary to replace kidney function by methods such as hemodialysis, peritoneal dialysis and eventually kidney transplantation. The primary endpoint of this studywas to describe the emergency department (ED) presentation and management of chronic dialysis patients in the acute care setting. This was a retrospective study of ED visits and inpatient admissions of the adult dialysis population, age >18 years old, in the Emergency Department of Clinical Hospital „Sveti Duh“, Croatia, between January 1, 2010 and December 31, 2016. Of the total number of ED visits (133.697), we identified 482 (0, 4%) patients on chronic dialysis, 265 men (55, 02%) ; 217 women (44, 98%) ; mean(SD) age 68 (13, 53) years ; 68, 29% older than 65 year old. Nearly half (45, 02%) of the patients have been sent in ED by the institution where dialysis is conducted, 33, 18% were sent by the family doctor or had transported via emergency medical services. The most frequently diagnosed comorbid conditions were hypertension (192 (31, 91%)), diabetes mellitus (107 (17, 76%)), congestive heart failure (96 (15, 96%)), coronary disease (71 (11.84%)), cerebrovascular disease (31 (5, 15%)) and chronic obstructive pulmonary disease (16 (2, 57%)). 21, 43% of all patients with ESRD visited the ED during their first year of dialysis, 14, 29% during second, 19, 64% during third and 44, 64% after four or more years of dialysis. More then one third (36, 97%) of ED visits by patients with ESRD resulted in hospital admission, accounting for 178 admissions during the study period, and HD was performed earlier than scheduled in 50 patients (10, 43%). The majority of hospitalizations were related to coronary disease and cardiac decompensation (31, 1%), afunctio A-V fistula and hemodialysis catheter (14, 4%), infections (13, 60%), volume overload (13, 60%), abdominal pain (10, 4%), hyperkalemia (4, 0%), wounds and injuries (1, 4%), and other (11, 5%). The most common reasons for coming to the ED among non- hospitalized patients were: respiratory infections (32, 05%), hypertension (21, 79%), chronic pulmonary obstructive disease (7, 69%), fever (5, 13%) and abdominal pain (10, 26%). In documented patients, 85, 2% of hemodialysis were performed via an AV fistula, 9, 4% through the hemodialysis catheter and in 5, 4% were performed like peritoneal dialysis. The hospitalization rate via ED of all patients was 0, 28 hospitalizations per patient and were slightly higher in older patients. In documented patients, 68% of hemodialysis recipients had their index hospitalization in the same facility as their dialysis unit. Our results suggest that patients in earlier stages of ESRD could be targeted to potentially reduce the risk of ED encounters for hypertension, hyperkalemia, heart failure, volume overload, vascular access and abdominal infections for patients on peritoneal dialysis. Focusing on modifiable factors associated with ED use, such as ensuring that patients with chronic kidney disease have early access to nephrology and cardiology care and early placement of fistulas, could lead to improved care for patients with ESRD and decreased costs for health systems.

emergency department, chronic kidney disease, dialysis

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