Abstract
BackgroundRenal failure carries high mortality even in high-resource countries. Little attention has been paid to renal failure patients presenting acutely in emergency care settings in low-to-middle income countries (LMIC). Our aim was to describe the profile, management strategies and outcome of renal failure patients presenting with indications for emergent dialysis to an urban Emergency Department (ED) in a tertiary public hospital in Tanzania.MethodsThis was a prospective cohort study of consecutive patients (age ≥ 15 yrs) presenting to the Emergency Medicine Department of Muhimbili National Hospital from September 2017 to February 2018. All patients with renal failure and complications requiring acute dialysis were included. A structured data collection sheet was used to gather demographics, clinical presentation, management strategies and outcomes. Data were summarized with descriptive statistics. Logistic regressions were performed to determine factors associated with receiving dialysis and with mortality.ResultsWe enrolled 146 patients, median age was 49 years (IQR 32–66 years), and 110 (75.3%) were male. Shortness of breath 67 (45.9%) and reduced urine output 58 (39.7%) were the most common presenting complaints. The most common complications were hyperkalemia 77 (53%), uremic encephalopathy 66 (45%) and pulmonary edema 54 (37%). All patients were hospitalized, and 61 (42%) received dialysis. Overall mortality was 39% (57 patients); the mortality in non-dialysed patients was 53% vs. 20% (p < 0.0005) in those receiving dialysis. 54% of patients with health insurance were dialyzed, compared to 39% who paid out of pocket (adjusted OR = 0.3, 95%CI: 0.1–0.9). Patients (≥55 years) were less likely to be dialysed (adjusted OR = 0.2 [0.1–0.9]). Independent predictors of mortality were vomiting (OR = 6.2, 95%CI: 1.8–22.2), oliguria (OR = 3.4, 95%CI: 1.2–9.5), pulmonary edema (OR = 4.6, 95%CI: 1.6–14.3), creatinine level > 1200umol/L (OR = 5.0 95%CI: 1.4–18.2), and not receiving dialysis (OR = 8.0, CI: 2.7–23.5). Female sex had a lower risk of dying (OR = 0.13, CI: 0.03–0.5).ConclusionsIn this ED in LIC, acute complications of renal failure created a need for ED stabilization and emergent dialysis. Overall in-hospital mortality was high; significantly higher in undialysed patients. Future studies in LICs should focus on identification of categories of patients that will do well with conservative therapy.
Highlights
Renal failure carries high mortality even in high-resource countries
Sylvanus et al BMC Emergency Medicine (2019) 19:11 (Continued from previous page). In this Emergency Department (ED) in Low Income Countries (LIC), acute complications of renal failure created a need for ED stabilization and emergent dialysis
Future studies in LICs should focus on identification of categories of patients that will do well with conservative therapy
Summary
Renal failure carries high mortality even in high-resource countries. Little attention has been paid to renal failure patients presenting acutely in emergency care settings in low-to-middle income countries (LMIC). Renal failure carries a high mortality rate in both high and low resource countries [4]. Emergency departments are frequently the first site of care for patients who develop acute kidney injury and those who develop complications from chronic kidney disease. Appropriate management of these patients can be life-saving. Poor access to care for some of these diseases (e.g. hypertension) result in earlier onset of CKD than in high resource countries and late presentation and financial inability to access advanced care such as dialysis and renal transplant contribute to higher mortality rates from renal disease [4]
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