Chronic kidney disease in the emergency centre: A prospective observational study

Area of Science:

• Nephrology
• Public Health
• Epidemiology

Background:

• Late presentation to emergency centres (EC) is common in resource-limited settings for patients with chronic kidney disease (CKD), leading to adverse outcomes.
• Understanding the patterns of EC presentation for CKD patients in Southwest Nigeria is crucial for improving care.

Purpose of the Study:

• To describe the characteristics and outcomes of adult CKD patients presenting to emergency centres in Southwest Nigeria.

Main Methods:

• A prospective observational study involving 158 adult CKD patients admitted to ECs in two Nigerian tertiary hospitals.
• Data collected included socio-demographics, reasons for EC admission, dialysis requirements and indications, and EC admission outcomes.
• Patients were followed during their EC stay to document outcomes.

Main Results:

• A significant proportion (74.1%) of CKD patients were unaware of their condition before EC admission.
• Common admission reasons included uraemia, sepsis, and hypertensive crisis, with most patients (73.4%) requiring dialysis.
• Indications for dialysis were primarily uraemia, severe azotaemia, and acute pulmonary oedema; 14% of those needing dialysis did not receive it, and 8.9% of patients died during EC admission, all previously undiagnosed.

Conclusions:

• A substantial number of individuals have undiagnosed CKD, with diagnosis often occurring only upon presentation to the EC due to complications.
• Late diagnosis of CKD is associated with significantly worse patient outcomes.