Evaluation of Urgent Hemodialysis in Maintenance Hemodialysis Patients: A 2-Year Retrospective Single Center Study

OBJECTIVE: Receiving urgent hemodialysis (HD) in end-stage renal disease (ESRD) patients significantly increases morbidity and mortality. We aimed to explore the factors involved in the development of urgent hemodialysis in patients on maintenance HD and to compare clinical differences between patients with arteriovenous fistula (AVF) and permanent tunelled catheter.

MATERIAL and METHODS: We retrospectively studied 242 ESRD patients over 18 years old who required urgent hemodialysis after presentation to the emergency department between November 2013 and November 2015. We excluded referrals from another hospital, drug overdose or toxic substance intake and patients in the intensive care unit.

RESULTS: We analyzed retrospective (2013-2015) data obtained from 242 patients. Participants’ mean age was 61.4 years; 120 (49.6%) were female and 122 (50,4%) were male; 45.5% had diabetes and 65% had hypertension. The mean duration of renal replacement therapy was 37.6 months. Of these, 55% underwent HD through an autologous AVF and 45% had a permanent tunelled catheter. Emergency service complaints were shortness of breath (38.2%), nausea and vomiting (20.2%), cerebrovascular event (7%), catheter-related problems (6,2%), and others. Immediate HD indications of the patients according to the order of frequency were hypervolemia (33.9%), hyperkalemia (24%), metabolic acidosis (21.9%), and uremic symptoms (20.2%). Permanent tunnelled catheter use was found to increase with age (p<0,01). HD duration was statisticaly significant longer in patients with AVF (p<0.01).

CONCLUSION: The rate of emergency department visits in patients undergoing HD is significantly high around our hospital. The use of catheters in patients undergoing emergency HD is significantly higher than all HD patients. Routine assessment of dialysis effectiveness, questioning vascular access problems, and regular follow-up of these patients by a nephrologist is very important. More detailed and prospective studies are needed to assess the emergency hemodialysis requirements in patients on maintenance HD.