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Acil Serviste Hemodiyaliz Endikasyonu Konulan Hastaların Analizi

Year 2020, Volume: 2 Issue: 3, 145 - 151, 01.11.2020
https://doi.org/10.38175/phnx.790591

Abstract

Amaç: Acil hemodiyaliz akut böbrek yetmezliği oluşan hastalarda hayat kurtarıcı bir tedavidir. Çalışmamızda acil serviste ilk kez hemodiyaliz tedavisi gören hastaların demografik ve klinik özellikleri ile beraber mortalitelerini etkileyen faktörlerin incelenmesi amaçlandı.
Gereç ve Yöntem: Retrospektif olarak yapılan bu çalışmaya hastanemiz acil servisine başvuran ve hemodiyaliz ünitesinde, 1.1.2017 ile 1.1.2018 tarihleri arasında ilk kez hemodiyalize alınan 95 hasta alındı. Hastalar demografik, klinik ve laboratuvar verileri, diyaliz endikasyonları, 30 günlük sağ kalımları, yaşayan hastaların renal durumları, ölen hastaların ölüm sebepleri açısından değerlendirildi.
Bulgular: Hastaların %62.1’i erkek, %37.9’u kadın, yaş ortalaması 62.28 yıl saptandı. Hastaların en sık diyalize alınma sebepleri metabolik asidoz ve kreatinin yüksekliği (%75) idi. Hastaların %41.1’ inin 30 gün içerisinde öldüğü görüldü. En sık ölüm sebebinin %64.1 malignite gibi altta yatan hastalıklara bağlı komplikasyonlar olduğu görüldü. Hastaların %7.4 ü tam iyileşme, %28.4 ü diyalize ihtiyaç duymayan kronik böbrek hastalığı, %64.2’si diyaliz hastası olarak taburcu olmuştur.
Sonuç: Acil servise başvuran ve akut böbrek hasarı saptanan pek çok hasta anüri, hipervolemi, hiperpotasemi ve üremik bulgular nedeniyle hemodiyalize alınmaktadır. Bu hastaların otuz günlük mortalite oranları yüksektir ve en sık mortalite sebebi malignite gibi altta yatan hastalıklara bağlı komplikasyonlardır.

References

  • Akpolat T, Utaş C. Hemodiyaliz hekimi el kitabı, Anadolu Yayıncılık, Kayseri, 2001. s. 15-34.
  • Kramer A, Pippias M, Noordzij M, Stel VS, Afentakis N, Ambühl PM, et al. The European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015: a summary. Clinical kidney journal. 2018;11(1):108-22.
  • Seyhani N, Ates K, Süleymanlar G. Türkiye’de renal replasman tedavilerinin güncel durumu: Türk Nefroloji Derneği Kayıt Sistemi 2016 Yılı Özet Raporu. Turk Neph Dial Transpl 2018;27(2):133-139.
  • Singbartl K, Joannidis M. Short-term effects of acute kidney injury. Crit Care Clin. 2015;31(4):751-62.
  • Li PK, Burdmann EA, Mehta RL; World Kidney Day Steering Committee 2013. Acute kidney injury: global health alert. Kidney Int. 2013;83(3):372-6.
  • Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury, Kidney Int. 2009;76(4):422-7.7.
  • Hoste EAJ, et al. "Global epidemiology and outcomes of acute kidney injury." Nat Rev Nephrol. 2018;14(10): 607-625.
  • Süleymanlar, G. Registry of Nefrology, Dialysis and Transplantation in Turkey.Ministry of Health and Turkish Society of Nephrology Joint Report. 2017.
  • Harrison's Principles Of Internal Medicine, , Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J,(editors),18th ed. Chapter. 280:2308-2331.
  • Koç Y, Abdulkadir Ünsal A, Hasan Kayabaşlı H, Akgün AO, Ahbap E, Mürvet Yılmaz M. Ve ark, İlk Kez Hemodiyaliz Tedavisine Alınan Hastaların Geriye Dönük Olarak Değerlendirilmesi. Ş.E.E.A.H. Tıp Bülteni. 2009:43;169-173.
  • Gong Y, Xu H, Zhang F, Hao C. Comparison of prognostic value of two kinds of severity scoring systems for hospital mortality prediction of elderly patients with acute kidney injury. Aging Clin Exp Res. 2012;24:74-78.
  • Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A. et al. Continuous vs. intermittent dialysis for acute renal failure in the ICU: Results from a randomized multicenter trial, Kidney Int. 2001;60(3):1154-63.
  • Morgera S, Kraft AK, Siebert G, Luft FC. Neumayer HH, Long-Term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis. 2002;40(2):275-9.
  • Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int. 2008;73(5):538-46.
  • Çeliker H. Akut böbrek yetmezliği epidemiyolojisi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi. 2006;15: 1-4.
  • Bhandarı S. Turney Jh, Survivors Of Acute Renal Failure Who Do Not Recover Renal Function. Q J Med. 1996;89:415-421.
  • Hsu CY, Chertow GM, McCulloch CE, Fan D, Ordoñez JD, Go AS. Nonrecovery of kidney function and death after acute on chronic renal failure. CJASN. 2009;4(5):891-898.
  • Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006;17(4):1143-50.
  • Süleymanlar G, Serdengeçti K, Erek E. Türkiye’de nefroloji– diyaliz ve transplantasyon registry 2007. 1.Baskı, İstanbul: Yorum Danışmanlık. 2008. s: 3-23.
  • Cervantes L, O’Hare A, Chonchol M, Hull M, Bockern JV, Thomson M, et al. Circumstances of death among undocumented ımmigrants who rely on emergency-only hemodialysis. Clin J Am Soc Nephrol. 2018;13:1405-1406.
  • Bagshaw SM, Laupland KB, Doig CJ, Mortis G. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: Population-based study. Crit Care. 2005;9:700-709.
  • Mehta RL, Kellum JA, Shah SV, Molitoris BA. Acute kidney injury network:acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:31.
  • Wang JH, Joslin J, Jenkins R, Sharpe CG. Outcomes of elderly patients with acute kidney injury on a renal high dependency unit. int. J. Clin Pract. 2015;69:1209-1210.
  • Kane-Gill SL, Sileanu FE, Murugan R, Trietley GS. Risk Factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2015;65:860-869.
  • Silveira Santos CG, Romani RF, Benvenutti R, Ribas Zahdi JO, Riella MC, Mazza do Nascimento M. Acute kidney injury in elderly population: a prospective observational study, Nephron Clinical Practice. 2018;138:104-112.
  • Pascual J, Liona F. Causes and prognosis of acute renal failure in the very old. madrid acute renal failure study group. J Am Geriatr Soc. 1998;46:721-725.
  • Chertow GM, Soroko SH, Paganini EP, Cho KC, Himmelfarb J, Ikizler TA, Mehta R. Mortality after acute renal failure: models for prognostic stratification and risk adjustment, Kidney Int. 2006;70(6):1120-6.

Analysis of Patients Who Underwent Hemodialysis in the Emergency Department

Year 2020, Volume: 2 Issue: 3, 145 - 151, 01.11.2020
https://doi.org/10.38175/phnx.790591

Abstract

Objectives: Hemodialysis is a life-saving treatment in patients with acute kidney injury. We aimed to compare the etiologic, laboratory, and clinical status and mortality rates of patients who underwent hemodialysis for the first time, as well as to determine the factors impacting mortality.
Material and Method: 95 patients who apply to the emergency room and underwent hemodialysis for the first time in our hemodialysis unit between 1.1.2017 and 1.1.2018 were enrolled in this retrospective study. The patients were evaluated in terms of demographic, clinical, and laboratory data, dialysis indications, the mortality rate for 30 days, kidney disease status, and causes of death.
Results: %62.1 of patients were male and 37.9% were female and the mean age was 62.28 years. Metabolic acidosis and creatinine increase (75%) were the most cause of dialysis. 41.1% of patients died in 30 days. The most common cause of death was complications due to underlining concomitant illnesses like malignancy (64.1%). 7.4% of patients were recovered completely, 28.4% of patients had chronic renal disease without any renal replacement therapy, 64.2% of patients were dialysis patients at the discharge from the hospital.
Conclusion: Most of the patients who access the emergency room, because of anuria, hypervolemia, hyperpotasemia, and uremic symptoms, is taken to hemodialysis. These patients have approximately 40% mortality rate in 30 days of survival, and the primary cause of mortality is complications due to underlining concomitant diseases.

References

  • Akpolat T, Utaş C. Hemodiyaliz hekimi el kitabı, Anadolu Yayıncılık, Kayseri, 2001. s. 15-34.
  • Kramer A, Pippias M, Noordzij M, Stel VS, Afentakis N, Ambühl PM, et al. The European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015: a summary. Clinical kidney journal. 2018;11(1):108-22.
  • Seyhani N, Ates K, Süleymanlar G. Türkiye’de renal replasman tedavilerinin güncel durumu: Türk Nefroloji Derneği Kayıt Sistemi 2016 Yılı Özet Raporu. Turk Neph Dial Transpl 2018;27(2):133-139.
  • Singbartl K, Joannidis M. Short-term effects of acute kidney injury. Crit Care Clin. 2015;31(4):751-62.
  • Li PK, Burdmann EA, Mehta RL; World Kidney Day Steering Committee 2013. Acute kidney injury: global health alert. Kidney Int. 2013;83(3):372-6.
  • Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury, Kidney Int. 2009;76(4):422-7.7.
  • Hoste EAJ, et al. "Global epidemiology and outcomes of acute kidney injury." Nat Rev Nephrol. 2018;14(10): 607-625.
  • Süleymanlar, G. Registry of Nefrology, Dialysis and Transplantation in Turkey.Ministry of Health and Turkish Society of Nephrology Joint Report. 2017.
  • Harrison's Principles Of Internal Medicine, , Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J,(editors),18th ed. Chapter. 280:2308-2331.
  • Koç Y, Abdulkadir Ünsal A, Hasan Kayabaşlı H, Akgün AO, Ahbap E, Mürvet Yılmaz M. Ve ark, İlk Kez Hemodiyaliz Tedavisine Alınan Hastaların Geriye Dönük Olarak Değerlendirilmesi. Ş.E.E.A.H. Tıp Bülteni. 2009:43;169-173.
  • Gong Y, Xu H, Zhang F, Hao C. Comparison of prognostic value of two kinds of severity scoring systems for hospital mortality prediction of elderly patients with acute kidney injury. Aging Clin Exp Res. 2012;24:74-78.
  • Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A. et al. Continuous vs. intermittent dialysis for acute renal failure in the ICU: Results from a randomized multicenter trial, Kidney Int. 2001;60(3):1154-63.
  • Morgera S, Kraft AK, Siebert G, Luft FC. Neumayer HH, Long-Term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis. 2002;40(2):275-9.
  • Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int. 2008;73(5):538-46.
  • Çeliker H. Akut böbrek yetmezliği epidemiyolojisi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi. 2006;15: 1-4.
  • Bhandarı S. Turney Jh, Survivors Of Acute Renal Failure Who Do Not Recover Renal Function. Q J Med. 1996;89:415-421.
  • Hsu CY, Chertow GM, McCulloch CE, Fan D, Ordoñez JD, Go AS. Nonrecovery of kidney function and death after acute on chronic renal failure. CJASN. 2009;4(5):891-898.
  • Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006;17(4):1143-50.
  • Süleymanlar G, Serdengeçti K, Erek E. Türkiye’de nefroloji– diyaliz ve transplantasyon registry 2007. 1.Baskı, İstanbul: Yorum Danışmanlık. 2008. s: 3-23.
  • Cervantes L, O’Hare A, Chonchol M, Hull M, Bockern JV, Thomson M, et al. Circumstances of death among undocumented ımmigrants who rely on emergency-only hemodialysis. Clin J Am Soc Nephrol. 2018;13:1405-1406.
  • Bagshaw SM, Laupland KB, Doig CJ, Mortis G. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: Population-based study. Crit Care. 2005;9:700-709.
  • Mehta RL, Kellum JA, Shah SV, Molitoris BA. Acute kidney injury network:acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:31.
  • Wang JH, Joslin J, Jenkins R, Sharpe CG. Outcomes of elderly patients with acute kidney injury on a renal high dependency unit. int. J. Clin Pract. 2015;69:1209-1210.
  • Kane-Gill SL, Sileanu FE, Murugan R, Trietley GS. Risk Factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2015;65:860-869.
  • Silveira Santos CG, Romani RF, Benvenutti R, Ribas Zahdi JO, Riella MC, Mazza do Nascimento M. Acute kidney injury in elderly population: a prospective observational study, Nephron Clinical Practice. 2018;138:104-112.
  • Pascual J, Liona F. Causes and prognosis of acute renal failure in the very old. madrid acute renal failure study group. J Am Geriatr Soc. 1998;46:721-725.
  • Chertow GM, Soroko SH, Paganini EP, Cho KC, Himmelfarb J, Ikizler TA, Mehta R. Mortality after acute renal failure: models for prognostic stratification and risk adjustment, Kidney Int. 2006;70(6):1120-6.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Emergency Medicine
Journal Section Research Articles
Authors

Melek Aktepe 0000-0003-0909-3701

Yonca Senem Akdeniz 0000-0002-4843-1155

Afşın İpekci 0000-0001-6125-4061

Fatih Çakmak 0000-0002-8813-4139

Mehmet Rıza Altıparmak 0000-0002-3579-1100

İbrahim İkizceli 0000-0002-9825-4716

Publication Date November 1, 2020
Submission Date September 8, 2020
Acceptance Date October 16, 2020
Published in Issue Year 2020 Volume: 2 Issue: 3

Cite

Vancouver Aktepe M, Akdeniz YS, İpekci A, Çakmak F, Altıparmak MR, İkizceli İ. Acil Serviste Hemodiyaliz Endikasyonu Konulan Hastaların Analizi. Phnx Med J. 2020;2(3):145-51.

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