P1537HEMODIALYSIS EMERENGIES IN A NEPHROLOGY DEPARTEMENT : ABOUT 117 CASES
Authors: Triqui Chifaa 
Published: June 2020

Abstract

Background and Aims
Hemodialysis (HD) emergencies in nephrology are very common. Prompt diagnosis and management are needed as it can be life-threatening. We aim to determine epidemiological, clinical, biological aspects as well as the etiological profile of our population.

Method
We conducted a cross-sectional study during 3 months (February, March and April 2019) collecting patients who underwent at least one session of HD at our nephrology department. Were included patients aged over 18 years old. Were excluded chronic dialysis patients presenting for their usual session. Data collection was conducted from HD registers. We collected the following parameters: age, gender, comorbidities, initial nephropathy, clinical data(blood pressure, pulmonary auscultation, diuresis, oxygen saturation),the current treatment and biological data( creatinin, kalemia, hemoglobin, and gasometry).
Data were entered and analyzed using SPSS software. Chi-squared test with a level of significance of 0.05 was used for the qualitative variables.

Results
A total of 117 patients were included, mean aged 60.71 years old (range:28-90) with a sex ratio M/F at 1.3. Our population consists in 42 chronic HD patients(37.9%), 34 Patients with moderate to severe renal failure(RF) (29.9%) and 41 patients with acute kidney injury (AKI) (35%). Initial nephropathy causes were vascular in (40%), glomerular in(25%) and undetermined in(35%) of cases. Our patients had hypertension, diabetes, dyslipidemia in respectively (58%),(45%) and (7.6%). Twenty two chronic HD patients were anuric (48.8%). Seventy-nine patients were admitted from the emergency department(68%), 21 patients from the surgical and urology departments(18.4%),8 patients from the intensive care unit (7.6%) and 4 patients from other departments(4.2%). HD indications were acute pulmonary edema in (41.8%), metabolic acidosis in (41.8%), hyperkalemia in (37.6%), Uremic signs in (22.2%). Inadequate hyperkalaemic treatment was noted in( 22.7% )of cases. Conventional HD was performed with mean session duration of 3 hours.
Ultrafiltration was required in 46 cases (36.8%) with an average of 1860ml(range:500-4000).
Perdialytic complications were observed in(12.5%)of cases. Hypotension was the most common complication which leads to the interruption of the session in(5.9%)of cases. Disequilibrium syndrome was observed in 2 patients. Arrhythmia and acute cardiac failure were noted in 2 patients. Death occurred in 1 case caused by arrhythmia.
Advanced age, anuria and underlying RF were independent risk factors of emergency dialysis with respectively (p=0.02, p=0.01 and p=0.05).
Conclusion:
Dialysis emergencies remain frequent in our country. Acute Pulmonary edema and metabolic acidosis were the main indications followed by hyperkalemia and anuria. Poor and delayed chronic renal failure management could explain the frequent use of emergency HD. The analysis of the causes and dialysis modalities in emergency situations, contributes to adopt a preventive strategy in order to identify high-risk patients and to optimize treatment protocols.