Profile of Hemodialyzed Patients with Renal Insufficiency at Bab el Oued University Hospital

Abstract

Hemodialysis emergencies are common and pose a threat to the prognosis of patients. We receive patients with acute renal failure requiring dialysis sessions daily at the Bab el Oued University Hospital Center. Through this study, we aimed to delineate the clinical, biological, etiological, and evolutionary profile of these patients in order to adapt and improve their management in collaboration with various stakeholders. This was a longitudinal, descriptive study conducted at the hemodialysis center of the Bab el Oued University Hospital, between December 2018 and November 2019, including patients with acute renal failure requiring one or more hemodialysis sessions. In addition to demographic data, the collected information included: source institution, medical history, acute or chronic renal involvement and its etiology, indication for dialysis, vascular access, and evolution.During this period, we provided 1621 hemodialysis sessions involving 250 patients, 162 with acute renal failure (ARF) and 88 with chronic renal failure (CRF). We included the 88 patients with ARF and excluded those with CRF. The mean age was 59 years with a range of 10 to 94 years. There were 66% males and 34% females, with a male-to-female ratio of 1.93. Approximately 39% of patients were hypertensive, 32% were diabetic, and 26% had mainly urological neoplasms. Our patients came from various departments of the Bab el Oued University Hospital in 66% of cases and from other institutions in 34% of cases. As for etiologies, we identified 68% tubulointerstitial nephropathies, 17% obstructive nephropathies, 10% glomerular nephropathies, and 5% vascular nephropathies. Regarding dialysis indications, uremic syndrome accounted for 39% of cases, hyperkalemia for 33%, acute pulmonary edema for 14%, acidosis for 11%, and urgent transfusion for 3% of cases. Vascular access consisted of femoral catheters in 77% and jugular catheters in 23% of cases. The outcomes were complete recovery in 14%, partial recovery in 20%, transfer to chronic dialysis in 8%, death in 35%, and loss to follow-up in 23%. The morbidity and mortality among patients undergoing emergency dialysis remain high despite the availability of dialysis and improvements in renal failure management in Algeria. We should work more collaboratively with various stakeholders and strive to computerize patient records to be more responsive and better track and manage these patients with high morbidity and mortality.