Epidemiological, Clinical and Evolutionary Profiles of Patients Admitted in a Dialytic Emergency Situation at the University Hospital of Brazzaville
Asian Journal of Research in Nephrology,
Introduction: Emergency dialyses often require some timely extrarenal purification procedures. In addition, the vital and functional prognosis could be jeopardized.
Objective of this study was to study the epidemiological, etiological and prognostic aspects of emergency dialysis at the University Hospital of Brazzaville.
Patients and Methods: We conducted a cross-sectional, descriptive and analytical study, with prospective data collection, over a period of one year (from September 01, 2019 to August 30, 2020), carried out at the University Hospital of Brazzaville. Patients of any age with acute or chronic renal failure requiring emergency dialysis for the first time were included.
Results: The incidence of emergency dialyses was 31.33%. The average age was 48 ± 17 years. Men were the most represented in this study with 64 cases (68%) and the female sex 30 cases (32%) for a sex ratio was 2.13. Acute renal failure (ARF) was the predominant type of renal failure in 61 patients (64.89%) with the most common etiology being acute tubular necrosis in 16 patients (17.1%). Chronic renal failure (CRF) was found in 33 patients (35.11%). The most common indications for emergency hemodialysis were major uremic syndrome in 48 patients (51.07%) followed by acute pulmonary edema in 21 patients (22.34%). An extrarenal purification therapy was done in emergency in 46 patients admitted in the department of nephrology, i.e. 48.94%. The procedure of choice was intermittent hemodialysis with a synthetic membrane. The mean duration of the first hemodialysis session was 3 hours ± 49 minutes and an average ultrafiltration of 1106 ± 759 ml in 28 patients. The other patients had dialysis without ultrafiltration. The vascular access was exclusively a femoral catheter. An anticoagulant was used in 37 patients each dialyses, ie 80.34%. Eight patients (17.39%) had died on post dialysis. On the other hand, for ARF, renal function recovery was complete in 39.13% of cases, partial in 17.39%. 17.39% of CRF patients had a favorable course and 8.7% a course to CRF. The univariate analysis showed diabetes, hypertension, underlying nephropathy, heart disease, and type of renal failure are risk factors for unfavorable development and mortality.
Conclusion: In the Republic of Congo, patients are generally admitted in late stages of renal failure which, moreover, aggravates the already difficulty of access to an eventual extrarenal purification therapy and increases cases of emergency dialyses with a significant morbidity and mortality.
- Emergency dialysis
- renal failure
How to Cite
Saha M, Allon M. Diagnosis, treatment, and prevention of hemodialysis emergencies. Clin J Am SOC Nephrol. 2017;12 (2):357-9.
Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, et al. haemodialysis for acute renal failure in patients with multipleorgan dysfunction syndrome: A multicenter randomized trial. Lancet. 2012;368: 379-85.
Diawara M, Kane Y, Cisse M.M, Lemrabott A.T, Faye M, Bop M.C, et al. Hemodialysis in Emergency Situations: A Study of 107 Cases at the Hemodialysis Center of the CHR in Thiès (Senegal). Health Sciences and Diseases March. 2020;21(3):49.
Kellum JA, Ravindra LM, Angus DC, Palevsky P, Ronco C. for the ADQI Workgroup. The first international consensus conference on continuous renal replacement therapy. Kidney Int. 2002;62: 1853–63.
Gibney N, Hoste E, Burdmann EA, Bunchman T, Kher V, Viswanathan R, Mehta RL, Ronco C. Clin J Am Soc Nephrol. Timing of initiation and discontinuation of renal replacement therapy in AKI: unanswered key questions. 2008;3:876-80
Phu NH, Hien TT, Mai NT, Chau TT, Chuong LV, Loc PP, et al. Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med. 2002;347:895-96.
Koroma M. Thesis: The indications for hemodialysis in an emergency situation in Dakar. 2013;25.
Sane FG. Hemodialysis in emergency situations at the CHU Le Dantec in Dakar. Health Sci. Say. 2019;(21): 25-34.
Bourquia A. Current status of IRC processing in Morocco. Nephrol. 1999;20: 75-80.
Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multipleorgan dysfunction syndrome: a multicenter randomized trial. Lancet. 2006;368:379-85.
Lengani A, Kargougou D, Fogazzi G.B, Laville M. Acute renal failure in Burkina Faso. Nephron. 2009 ;07 :013.
D. Payen, C. Berton. Acute renal failure: epidemiology, incidence and risk factors. French Annals of Anesthesia and Resuscitation. 2005;24:134-139.
O’Callaghan. C.A, Vinsonneau. C, Benyamina. M. What techniques for the treatment of acute renal failure in intensive care Resuscitation. 2009;18;397—406.
Schaefer JH, Jochimsen F, Keller F, Wegscheider K, Distler A. Outcome of acuterenal failure in medical intensive care. Intensive Care Med. 1991;17: 19–24.
Chew SL, Lins RL, Daelemans R, de Broe ME. Outcome in acute renal failure. Nephrol Dial Transplant. 1993;8:101 –7.
De Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–21.
Brivet FG, Kleinknech D, Loirat P, Landais PJM, the French Study Group on Acute Renal Failure. Acute renal failure in intensive care units. Causes, outcome, and prognostic factors of hospital mortality: a prospective multicenter study. Crit Care Med. 1996;24:192-8.
Bagshaw AM, Cruz DN, Noel RT et al. Proposed algorithm for initiation of renal replacement therapy in adult critically ill patients. Crit Care. 2009;13:317.
Mehta RL, Pascual MT, Gruta CG, Zhuang S, Chertow CM. Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol. 2002;13:1350–7.
Bellomo R, Kellum JA, Ronco C. Acute kidney injury. The Lancet. 2012;380 (9843):756-66.
Li P, Burdmann E, Mehta R. Acute kidney injury: global health alert. Kidney Int. 2013; 83(3):372-6.
Schissler MM, Zaidi S, Kumar H, Deo D, Brier ME, McLeish KR. Characteristics and outcomes in community acquired versus hospital-acquired acute kidney injury. Nephrology (Calton) 2013;18:183 -87.
Finlay S, Bray B, Lewington AJ, et al. Identification of risk factors associated with acute kidney injury in patients admitted to acute medical units. Clin Med. 2013;13: 233-38.
Idrissi Z. Acute renal failure in a multipurpose emergency medicine department: prevalence, characteristics and prognosis. Thesis; 2016 (Rabat-Morocco).
Man N, Touam M, Jungers P. Emergency hemodialysis. Flammarion; Medicine-Science. 2010;2(4):55.
Guérin C, Girard R, Selli JM, Perdrix JP, Ayzac L, for the Rhône-Alpes area study group on acute renal failure. Initial versus delayed acute renal failure in the intensive care unit. Am J Respir Crit Care Med. 2000;161:872–79.
Tall A. Contribution to the study of postpartum ARI. These Med, No. 162, 2011. Dakar
Maaroufi C, Lazrak MA, El Youbi R et al. Hemodialysis in an emergency. Rev Epidemiol Sante Publique. 2009;57S:S3-S59.
Khellaf G, Cholghoum S, Missoum S. et al. Chronic renal failure in nephrology: etiology and prognosis. Nephrol Ther. 2011;7:301-43.
Guérin C, Girard R, Selli JM, et al. Initial versus delayed acute renal failure in the intensive care unit. Am J Resp Crit Care Med. 2000;161:872-79.
128. Uchino S, Bellomo R, Morimatsu H, et al. External validation of severity scoring systems for acute renal failure using a multinational database. Crit Care Med. 2005;33:1961-67.
Lazral et al. Hemodialysis in an emergency about 207 cases. Nephrol Ther. 2011(7): 341
Abstract View: 55 times
PDF Download: 21 times