#2473 Renal failure in the emergency department: indications for emergency hemodialysis

Background and Aims kidney failure is a frequent reason for emergency department (ED) visits. Patients may require emergency hemodialysis and this situation may increases mortality risk. We set out to study the clinical relevance and biological characteristics of patients with renal failure presenting to the emergency department with an indication for emergency hemodialysis. Method A prospective observational study conducted in ED conducted over a 6-month period. Patients were included if they were 18 years or older and suffering from acute or chronic renal insufficiency defined by creatinine clearance (CrCL) calculated by MDRD<60 ml/min. Information is recorded on demographics, clinical profile, clinical presentation, laboratory, causes of for emergency hemodialysis and in-hospital complications. Results Eighty one patients were enrolled, among them 61.7% patients had an indication for emergency hemodialysis. Mean age was 61± 12, sex-ratio=1,7. Sixty seven patients (82.7%) were known to have a chronic kidney failure and 17.3 % were discovered at the emergency department at the same hospitalisation period. Clinical profile (%): Anuric patients (11.1), preserved diuresis (40.7). Clinical presentation (%): deterioration of general condition (35.8), dyspnea and chest pain (21) and fever (17.3). Clinical examination showed a peripheral oxygen saturation between 70 and 100% with a mean of 94.81, a respiratory rhythm mean of 20 cycles/min, a systolic blood pressure mean of 134.61 mmHg and a diastolic blood pressure mean of 70 mmHg. biological exams showed that kalemia was between 2.4 and 8.6 and 45 of those patients had kalemia more or equal to 5.5. Twelve per cent of these patients had hyperkalemia signs on the electrocardiogram. The average were 28 mmol/l with a maximum of 83.3 mmol/l. Creatinine values were between 185 et 2620 μmol/l with a median of 81. The value of Ph was between 7.04 and 7.53 with a median of 7.29 mm Hg. The value of HCO3- value was between 4.6 and 28.4 with a median of 14.2. Causes of emergency hemodialysis were acidosis in 12 cases, severe anemia with blood transfusion in 4 cases, hyperkalemia in 10 cases, acute pulmonary oedema in 5 cases and acute renal failure in 6 cases .the evolution of the patients was marked by improvement of 61.7% of the patients, only 3 of the 81 patients died during the hospitalization. Conclusion This study showed that the causes of emergency dialysis can be avoided by improving care and educating patients to improve the prognosis.