Profile and outcome of patients with emergency complications of renal failure presenting to an urban emergency department of a tertiary hospital in Tanzania

Autor: Said S. Kilindimo, Erasto Sylvanus, Ellen J. Weber, Juma A. Mfinanga, Biita Muhanuzi, Hendry R. Sawe, Elly M. Mulesi
Rok vydání: 2019
Předmět:
Male
Kidney Disease
Hyperkalemia
medicine.medical_treatment
Logistic regression
Tanzania
Emergency Care
Insurance Coverage
Tertiary Care Centers
0302 clinical medicine
Hospitals
Urban
Risk Factors
030212 general & internal medicine
Hospital Mortality
Prospective Studies
Renal Insufficiency
Prospective cohort study
Brain Diseases
Emergency Service
biology
lcsh:RC952-1245
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Age Factors
Middle Aged
Health Services
Hospitals
Treatment Outcome
Health
Creatinine
Emergency Medicine
Female
medicine.symptom
Emergency Service
Hospital
Research Article
Adult
medicine.medical_specialty
Renal failure
Emergency complications
Vomiting
lcsh:Special situations and conditions
Clinical Sciences
Oliguria
Renal and urogenital
Pulmonary Edema
Lower risk
03 medical and health sciences
Hospital
Insurance
Sex Factors
Renal Dialysis
Clinical Research
medicine
Humans
Urban
Developing Countries
Dialysis
Aged
Insurance
Health
business.industry
Emergency department
030208 emergency & critical care medicine
lcsh:RC86-88.9
biology.organism_classification
Emergency & Critical Care Medicine
Dyspnea
Good Health and Well Being
Public hospital
Emergency medicine
business
Zdroj: BMC emergency medicine, vol 19, iss 1
Sylvanus, Erasto; Sawe, Hendry R; Muhanuzi, Biita; Mulesi, Elly; Mfinanga, Juma A; Weber, Ellen J; et al.(2019). Profile and outcome of patients with emergency complications of renal failure presenting to an urban emergency department of a tertiary hospital in Tanzania.. BMC emergency medicine, 19(1), 11. doi: 10.1186/s12873-019-0229-2. UCSF: Retrieved from: http://www.escholarship.org/uc/item/1bf41963
BMC Emergency Medicine
BMC Emergency Medicine, Vol 19, Iss 1, Pp 1-8 (2019)
DOI: 10.1186/s12873-019-0229-2.
Popis: Background Renal failure carries high mortality even in high-resource countries. Little attention has been paid to renal failure patients presenting acutely in emergency care settings in low-to-middle income countries (LMIC). Our aim was to describe the profile, management strategies and outcome of renal failure patients presenting with indications for emergent dialysis to an urban Emergency Department (ED) in a tertiary public hospital in Tanzania. Methods This was a prospective cohort study of consecutive patients (age ≥ 15 yrs) presenting to the Emergency Medicine Department of Muhimbili National Hospital from September 2017 to February 2018. All patients with renal failure and complications requiring acute dialysis were included. A structured data collection sheet was used to gather demographics, clinical presentation, management strategies and outcomes. Data were summarized with descriptive statistics. Logistic regressions were performed to determine factors associated with receiving dialysis and with mortality. Results We enrolled 146 patients, median age was 49 years (IQR 32–66 years), and 110 (75.3%) were male. Shortness of breath 67 (45.9%) and reduced urine output 58 (39.7%) were the most common presenting complaints. The most common complications were hyperkalemia 77 (53%), uremic encephalopathy 66 (45%) and pulmonary edema 54 (37%). All patients were hospitalized, and 61 (42%) received dialysis. Overall mortality was 39% (57 patients); the mortality in non-dialysed patients was 53% vs. 20% (p 1200umol/L (OR = 5.0 95%CI: 1.4–18.2), and not receiving dialysis (OR = 8.0, CI: 2.7–23.5). Female sex had a lower risk of dying (OR = 0.13, CI: 0.03–0.5). Conclusions In this ED in LIC, acute complications of renal failure created a need for ED stabilization and emergent dialysis. Overall in-hospital mortality was high; significantly higher in undialysed patients. Future studies in LICs should focus on identification of categories of patients that will do well with conservative therapy.
Databáze: OpenAIRE
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