Abstract
Abstract Background and Aims Dialysis can be either programmed or performed in an emergency context, which complicates the management of patients. Our objective was to study the indications as well as the epidemiological, clinical and biological elements of dialysis emergencies. Method This is a retrospective study conducted over a period of 5 months from March 2022 to September 2022 in the nephrology department of the Mongi Slim Hospital La Marsa including patients having had emergency hemodialysis sessions Results We collected a total of 32 cases with an average age of 65 years, ranging from 30 years to 93 years and a sex ratio at 1.06. The majority of patients were transferred from the emergency department (69%) and secondarily from the nephrology (6%) and cardiology (6%) departments. Sixty-five percent of the patients had arterial hypertension, 53% were diabetic, 37% had chronic kidney disease, 28% had cardiovascular complications, and 41% had an active infection with a biological inflammatory syndrome. Emergency hemodialysis was indicated for severe metabolic acidosis in 50% of the cases, threatening hyperkalemia in 41% of the cases, uremic syndrome in 28% of cases, anuria in 28% of cases, and acute lung edema resistant to medical treatment in 19% of cases. Indeed, 47% of the patients had a single dialysis emergency and 53% of them were dialyzed for several interrelated indications. The vascular approach was mainly femoral catheter in 84% of the cases followed by arteriovenous fistula in 13% and jugular catheter in 3%. The average session duration was 3.5 hours with good hemodynamic tolerance for the majority of patients. Five patients required a blood transfusion. Conclusion Severe metabolic acidosis and threatening hyperkalemia were the main indications for emergency hemodialysis. Unfortunately, the majority of our patients were dialyzed via a femoral catheter. It is therefore recommended to insist on the necessity of early preparation of patients for dialysis as early as stage 4 of chronic kidney disease if the patient obviously chooses hemodialysis as the preferred method of epuration.
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