[Why do ambulatory hemodialysis patients go to hospital emergency services?

An important number of Hospital admissions (HA) occurs through Hospital Emergency Departments (HED). This is a indicator of quality and have to be lower than 50%. However there are almost no data available on the causes of emergency consultation by outpatient hemodialysis patients (HD). For this reason, we prospectively examined a population of 83 outpatient HD patients dialyzed in a peripheral unit under the surveillance of a University Hospital.

1) To know the diagnosis of HED and days of hospitalization for 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 group of patients treated in the same Unit in 1991 (n = 39).

The percentage of patients who used the HED in 1998 was 66.3% (55/83). The total number of emergency episodes in 1998 was 118 (mean of 55 patients 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); digestive disease 15.3% (18/118); relationed problem vascular access, 11.9% (14/118). Thirty percent (36/118) of the emergency consultations needed HA leading to a mean hospitalitation of 10.2 +/- 9.3 days. The infectious disease were the highest percentage of HA (36.1%) and the longest days of hospitalitation (12.7 +/- 11.2 days). The risk factors for repeated emergency consultation (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 unit/kg/week) and lower Kt/V (0.99 vs 1.11). If we compare these results with 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 1998 and 1991: acute pulmonary edema 1.7 vs 11.2% (p < 0.003); hiperkalemia 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 epidemiology of Emergency Consultation by outpatient HD patients treated in the same peripheral unit. The data obtained albeit limited because of the number provide information of potential protocol usefulness for the possible reduction in the frequency of Hospital Emergency Consultations by outpatient HD patients.