Why hemodialysis outpatients come to hospital emergency departments?

An important number of Hospital admissions (HA) occurs through Hospital Eme rgency Departments (HED). This is a indicator of quality and have to be low er than 50%. However there are almost no data available on the causes of em ergency consultation by outpatient hemodialysis patients (HD). For this rea son, we prospectively examined a population of 83 outpatient HD patients di alyzed in a peripheral unit under the surveillance of a University Hospital . Objectives: 1) To know the diagnosis of HED and days of hospitalization f or which HD patients came to the HED in 1998. 2) To know the possible risk factors associated with the patients with frequent assistance in HED. 3) To compare the number and causes of emergency consultation in 1998 with a gro up of patients treated in the same Unit in 1991 (n = 39). Results: The percentage of patients who used the HED in 1998 was 66,3% (55/ 83). The total number of emergency episodies in 1998 was 118 (mean of 55 pa tients 2,27 +/- 1,51). Fifty one percent of the emergency episodes were due to patients initiative. The 4 more frequent diagnoses of HED in 1998 were infectious, 19.5% (23/118); traumatologic emergencies, 15.3% (18/118); dige stive disease 15.3% (18/118); relationed problem vascular access, 11.9% (14 /118). Thirty percent (36/118) of the emergency consultations needed HA lea ding to a mean hospitalitaiton of 10.2 +/- 9.3 days. The infectious disease were the highest percentage of HA (36.1%) and the longest days of hospital itation (12.7 +/- 71.2 days). The risk factors for repeated emergency consu ltation (more than 3 times) were: age (68.9 vs 61.4), lower hematocrit (31. 6 vs 34.4%), lower hemoglobin (10.2 vs 11), high EPO dose (166.3 vs 109.7 u nit/kg/week) and lower Kt/V (0.99 vs 1.11). If we compare these results wit h 1991 the percentage that used the HED was similar 66.2% (pNS); the number of emergency episodes was higher (mean 2.99 +/- 1.96) than 1998 (p < 0.006 ) and there are a significant differences in the diagnoses of HED between 1 998 and 1991: acute pulmonary edema 1.7 vs 11.2% (p < 0.003); hyperkalemia 0.8 vs 7.9% (p < 0.009); gastrointestinal disease 15.3% vs 4.5% (p < 0.008) and infectious 19.5% vs 7.9% (p < 0.01). In conclusion our study provides data previously not available on the epide miology of Emergency Consultation by outpatient HD patients treated in the same peripheral unit. The data obtained albeit limited because of the numbe r provide information of potential protocol usefulness for the possible red uction in the frequency of Hospital Emergency Consultations by outpatient H D patients.