Hemodialysis in emergency situation in a Hemodialysis Center in Dakar : A prospective study about 81 cases

Abstract

Introduction: Hemodialysis is a renal replacement technique that uses extracorporeal blood circulation (ECC) to purge the blood of patients with renal failure. It is used urgently in severe acute kidney injury (AKI) and complicated end stage renal disease (ESRD). The objective of this work was to determine the prevalence of each indication of emergency hemodialysis and its prognosis. Methods: We conducted a prospective, mono-centric study of descriptive and analytical type over a period of 6 months at the hemodialysis center of Aristide Le Dantec University Hospital. All patients with acute or chronic renal failure who underwent hemodialysis during an emergency were included. These emergencies were for the AKI or Chronic Kidney disease (CKD) the existence of one or more severity criteria: pulmonary œdema, hyperkalemia, severe metabolic acidosis, poorly tolerated uremia, persistent anuria and / or symptomatic hyponatraemia. Results: Eighty-one emergency hemodialysis patients were received during the study period out of a total of 660 hemodialysis patients serving a hospital prevalence of 12.2%. The mean age of the patients was 39.31 ± 18.78 years with a sex ratio of 1.02. The first indication of emergency hemodialysis was poorly tolerated uremia in 46 patients (56.7%) followed by threatening hyperkalemia with 43.2%. The evolution was highlighted by a complete recovery in 53% of patients with AKI whereas for patients with ESRD lifting the emergency was the rule. Fifteen patients (18.50%) had died, including 12 patients (14.80%) outside dialysis and 3 patients (3.75%) on dialysis. The occurrence of death was statistically correlated with hyperkalemia (p = 0.003) and metabolic acidosis (p = 0.001). Conclusion: Hemodialysis was performed urgently in 12.2% of cases. Poorly tolerated urine was the most common indication (56.7%). In the majority of cases we noted a good evolution with the emergency lifting. However we noted 15 deaths (18.5%).