POS-112 HEMODIALYSIS EMERGENCIES : A MONOCLONAL EXPERIENCE

Abstract

Hemodialysis emergencies in nephrology are frequent. Prompt diagnosis and management are needed to save life and enhance prognosis. The aim of this work was to determine the hemodialysis’ prevalence in emergency situations, its indications, the clinical, paraclinical and evolutionary profiles and to describe the parameters of the session as well as the per-dialytic incidents and their impacts on patient mortality. It is a retrospective monocentric descriptive study during 3 months (July, August, and September 2020) carried out in the nephrology department of the University teaching hospital of Sousse. We collect patients who underwent at least one session of HD. We included 61 patients who underwent emergency hemodialysis. The average age of our patients was 58±17 years (17- 95) and the sex ratio was 1,5. Our patients have hypertension and diabetes in respectively 56,1% and 34,4% of cases. 42,6% of patients were admitted from the emergency department, 27,9% of patients from the surgical and urology department, 18% of patients from nephrology departments and 11,5% of patients from other departments. Our population consists in chronic HD patients in 34,5%. Chronic renal failure was noted in 43,6% with diabetic nephropathy as the most primary cause (44,1%). Acute renal failure was found in 18.2% with Obstructive nephropathy (66,1%) as the main etiology.two patients were transplanted (3,3%). HD indications were hyperkalemia in 30%, acute pulmonary edema in 25% and metabolic acidosis in 23,3% of cases. Conventional HD was performed with mean session duration of 3,4 hours. Ultrafiltration was required in 73,8% with an average of 1800ml (range: 500-4000).The most frequently used approach was the femoral route in 54,1% followed by arterioveinous fistula in 24,6%. Transfusion was required in 26,2% of cases. Perdialytic complications were observed in 29,5% of cases. Hypotension was the most common complication present in 13,1% of case ; which leads to the interruption of the session in 4.9% of cases ; followed by agitation in 4,9% of case. The renal evolution of our population was hemodialysis dependence in 35,6%, back to basic level in13,3%chronic kidney disease in4,4% and recovery in 2,2%. Death occurred in 5 cases including 3 patients outside dialysis and 2 patients on dialysis. Infection by SARS covid 19 was the cause of death in 1 patient. Extra-renal purification (REE) is sometimes essential in an emergency situation in the management of severe ARI or terminal CKD. Early diagnosis and relevant treatment will enhance the prognosis of patients in the short and medium term.