Evaluation of patients receiving hemodialysis in an emergency service

Abstract

Aim: Acute kidney injury (ARH) is an important emergency with high mortality and morbidity depending on patient characteristics, comorbidity and clinical situation. Rapid recognition of acute renal failure (ARF) and initiation of renal replacement therapy (RRT) is one of the most important factors determining the survival of these patients. The initiation of RTT in the emergency department depends on the correct indications in the critical patient, the correct use of resources and effective nephrological follow-up. This study aims to determine the hemodialysis indications of patients undergoing hemodialysis for the first time in the emergency service and to investigate the effect of this application on routine hemodialysis and survival. Methods: We carried out a retrospective cohort study with patients who underwent hemodialysis for the first time by central venous catheterization in the emergency service between January 01, 2019 and December 31, 2019. Age, gender, presence of chronic disease, symptoms and laboratory values of the patients were recorded from the patient files in the hospital automation system. Data regarding the hospitalization or discharge of the patients after emergency hemodialysis were collected. Patient follow-up was carried out from the patient records, and the nephrology follow-ups were examined for 3 months after emergency hemodialysis. Their routine hemodialysis and 28-day mortality were evaluated. Results: A total of 185 patients were included in the study. 55.1% of the patients (n=102) were male and the mean age was 65.63 (15.92) years. While 49.2% (n=91) of the patients were included in the routine hemodialysis program, mortality developed in 22.7% (n=42) on the 28th day. No statistically significant relationship was found between the current systemic diseases, hemodialysis indications and undergoing routine hemodialysis program (P=0.327, P=0.45). Conclusion: Although there was no statistically significant relationship between the dialysis indications of the patients and their inclusion in the routine dialysis program, emergency hemodialysis is an important procedure. The clinical condition and laboratory values of the patients should be evaluated synchronously. Physicians should not be late in initiating hemodialysis in the follow-up and treatment of electrolyte disorders and intoxications; the treatment of the patient should be decided as quickly as possible.