Risk Factors of Emergency Hemodialysis

Abstract

Objectives: Emergency hemodialysis (HD) is a chal1en~e to patients, their families and nephrologists. The majority of previous reports focused on the prognosis of acute renal failure, but acute renal failure is not the only indication for emergency HD in the emergency department (ED): chronic renal failure accounts for the majority of HD cases. The aim of this study was to analyze the risk factors of all patients who need emergency HD in ED. Methods: We retrospectively collected 90 emergency HD cases from July 1999 to August 2000. By analyzing their basic data, vital signs and laboratory data, we were able to determine the risk factors of emergency HD. Results: The mortality rate was 24.4%. The leading causes of death were septic shock, respiratory failure, and multiple organ failure. Thirty-seven-patients had no history of hemodialysis, and they did not have significant mortality risk. Some of the indications for emergency HD did predict survival rate. For example, pulmonary edema was the benign factor but metabolic acidosis, uremic encephalopathy and intractable gastrointestinal upset were the predictors of mortality. Younger patients and those with a history of diabetes mellitus had good prognoses. Those who had received cardiopulmonary resuscitation (CPR) or mechanical ventilator therapy before emergency HD had poor prognoses. Metabolic acidosis, leukocytosis, high C-reactive protein and blood urea nitrogen levels were all poor prognostic factors. Conclusions: The main indicators of the need for patients receiving emergency HD were pulmonary edema, hyperkalemia, metabolic acidosis and uremic encephalopathy. The leading cause of death was septic shock. Risk factors of emergency HD included patients who were elderly, and those who received mechanical ventilator support and CPR; the indicators for dialysis were metabolic acidosis, uremic encephalopathy, and intractable GI upset; laboratory data indicators included leukocytosis, high C-reactive protein and blood urea nitrogen levels.