Epidemiological, Clinical and Evolutionary Profiles of Patients Admitted in a Dialytic Emergency Situation at the University Hospital of Brazzaville

Abstract

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.