The clinical profile, management, and outcome of Patients presenting with emergency complications of Renal failure at emergency department of Muhimbili National Hospital

Abstract

Background: Renal failure carries high mortality rates even in high-resourced countries, however, early recognition of acute presentations and appropriate interventions including dialysis, is known to reduce mortality and long-term morbidity. In Tanzania, the overall prevalence of renal failure is around 7%. However, little is known about the clinical profile and outcomes of patients with acute complications of renal failure that present to Emergency Medicine Department (ED) in need of dialysis. Aim: The aim of the study was to describe the profile, management strategies and outcome of patients presenting with emergency complications of renal failure at ED of Muhimbili National Hospital (MNH) in need of dialysis. Material and Methods: This was a prospective cohort study of adult patients with renal failure presenting to ED-MNH between September 2017 and February 2018. A structured data collection sheet was used to gather demographic information, clinical presentation, management strategies, and outcomes. Data summarized with descriptive statistics including mean, median, and frequencies were reported. Logistic and linear regressions were done to determine factors associated with mortality and access to dialysis respectively. Results: Total of 775 (5.3%) out of 14,487 patients who presented to ED during the study period had renal disease. We enrolled 146/775 (18.8%) patients with acute symptoms of renal failure requiring emergent dialysis. The median age was 49 years (interquartile range 32 to 66 years), and 110 (75.3%) were male. Shortness of breath 67(45.9%) and reduced urine output 58 (39.7%) were the top presenting complications. Majority of patients 85(58%) were managed conservatively while 61(42%) were dialyzed. The overall mortality was 57 (39%). The mortality in non-dialysed patients vs. dialysed patients was 53% (45/85) vs. 20% (12/61) (p<0.0005) respectively. Predictors of mortality were vomiting (OR=6.23), oliguria (OR=3.4), pulmonary edema (OR=4.6), or creatinine levels >1200umol/L (OR=5.02), and not receiving dialysis (OR=8.02). Female sex had lower odds of dying (OR=0.13). The independent predictor of dialysis was having health insurance. 54% of patients with health insurance were dialyzed, compared to 39% who paid out of pocket (OR= 0.3). Conclusion: In a cohort of patients with renal disease presenting to ED, acute complications of renal failure necessitate a significant need for emergent dialysis. The overall in-hospital mortality was 39%, and patients who received conservative care had a significantly higher mortality compared to dialyzed patients.