Causes of Emergency Department Visits Among End-Stage Kidney Disease Patients on Maintenance Hemodialysis in Pakistan: A Single-Center Study.

Abstract

Background In this study, we aimed to determine the causes of emergency department (ED) visits by end-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) in Karachi, Pakistan. Methodology We conducted a cross-sectional study that included 194 visits of ESKD patients on MHD aged ≥18 years of both genders presenting at the ED ofThe Kidney Centre Postgraduate Training Institute, Karachi, Pakistan between February 2021 and May 2021. The study investigated the causes behind ED visits. Frequencies were calculated for categorical variables, and a bar graph was used for the graphical representation of the causes. Results In total, 194 visits included 151 patients of whom 88 (58.3%) were males while 63 (41.7%) were females, with a mean age of 51.68 ± 15.8 years. The most common comorbidity among the ED visits was hypertension 182 (93.8%). The majority of the visits 129 (66.5%) were undergoing regular three dialysis sessions per week, 101 (52.1%) were registered for MHD at our Institute, and 69.1% of visits reported arteriovenous fistula (AVF)as the current access for hemodialysis. Around 111 (57.2%) of the visits had infection-related complications, followed by electrolyte abnormalities 74 (38.1%), cardiovascular 53 (27.3%), and pulmonary complications 41 (21.1%). Overall, 19 (9.8%), 16 (8.2%), and 14 (7.2%) patients reported access-related, neurological, and gastrointestinal complications, respectively. Conclusions Infection-related complications are a significant cause of ED visits among ESKD patients, followed by electrolyte abnormalities and systemic complications, many of which are related to the existing comorbid conditions. Risk identification of preventable causes and surveillance of existing comorbidities would help mitigate ED visits among ESKD patients.