Kidney pathology constitutes a major public health problem in the world due to its frequency, high mortality rate and the costs of its treatment [1] [2].

Nephrological emergencies are not so frequent but they most often deal with management problems [3]. Their treatment often calls for hemodialysis, which can supplement the functions of cleaning uremic toxins and fluid and electrolytes balance, thereby improving their prognosis [4]. Despite these therapeutic advances made over the past 50 years, the mortality of patients with kidney impairment requiring emergency dialysis remains high [5] [6].

In 2010, replacement therapy ensured the survival of nearly 3 million patients worldwide, 78% of whom were on dialysis [7]. The incidence of acute kidney injury requiring hemodialysis is increasing and associated with high mortality [8].

In France, the 2011 REIN report estimated the incidence of dialysis patients at 144/million inhabitants [9]. In the United States of America, the rate of acute renal damage requiring extrarenal purification increased from 3227/million peope/year in 1996 to 5224/million people/year in 2003. In Canada, it increased from 0.8% to 3% from 1996 to 2010 [6].

In Senegal in 2016, a hospital study noted that 84.7% of patients in a hemodialysis center had received emergency sessions and that 34.2% of these patients had acute renal failure [10].

Data on emergency dialysis patients are scarce in our practice setting. Our work aims to study the profile of patients who have benefited from a first emergency hemodialysis session in order to facilitate decision-making for their management.

During the study period, 213 patients received emergency dialysis in the ward. Of these, 146 met the inclusion criteria. The patients’ medium age was 39.80 ± 14.55 years with the extremes of 13 and 85 years. The age group of [35 – 65] years was the most represented with 54.7%. We observed 59.5% of male subjects and 40.4% of female subjects.

Patients’ medical history was dominated by hypertension (63.9%), CKD (23.9%) and HIV-infection (8.2%). The main clinical signs were hypertensive surge (64.3%), edema (44.5%) and coma (30.1%) (Table 1). This hypertension was grade 3 in 42.5% of cases.

Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. The other laboratory abnormalities were hyperkalemia (28%), hypocalcemia (70.1%), hyponatremia (68.7%) and elevated C Reactive Protein (CRP) (93.3%) (Table 1).

Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%).

The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute lung edema (19.8%), persistent anuria (11.6%) and hyperkalaemia (5.4%).

The vascular access was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8%) and an arteriovenous fistula in 2.7%.

The outcome was favorable in 82.2% and death observed in 17.8%. Kidney function stabilized in 71.9% and normalized in 10.2%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute acute kidney injury (p = 0.02) were associated with the risk of death (Table 1).

In multivariate analysis, only coma seemed to be associated with the risk of mortality in our patients (Table 2).

This work describes the profile of patients undergoing their first hemodialysis session in an emergency situation. The majority of these were young adults. Our results are similar to those found by Yaya Kane et al. in Senegal [10] who noted an average age of 41.3 years. On the other hand, our patients seemed younger than those of Dali Youcef et al. in Algeria [11] who had found a medium age of 57.8 ± 16 years. This difference could be explained by the difference in life expectancy which seems to be higher in Maghreb.

The male predominance observed in our work is found in all the African series [11] [12]. This could be explained by the predominance of Kidney disease in men.

The comorbidities were dominated by hypertension found in one out of ten patients, followed by HIV infection. Fayrouz Zemed et al observed hypertension in 46% of cases in Morocco in 2017 [13]. In our context, hypertension followed by HIV infection is the two main risk factors for chronic renal failure [14].

Almost one in four patients (24%) had a known CKD. The fact that the latter begin their hemodialysis sessions under emergency conditions could be explained by the high cost of treatment and/or the availability of centers. This would be added the refusal to accept the disease in some cases.

The clinical signs vary according to the departments in which the studies are carried out. Thus, the hypertensive surge observed in six out of ten patients in our study is a common situation in nephrology. In intensive care settings, neurological disorders are frequent and may affect eight out of ten patients as observed by Fayrouz Zemed et al. [12].

CKD was predominant and found in over two-thirds of our patients. In Algeria, Dali Youcef [11] noted a predominance of AKIs with 65%. This difference could be explained by the difficulty of access to hemodialysis by patients in our context. This difficulty could be attributable not only to the high cost of dialysis in private centers but also to the availability of public centers, which remains limited.

The probable etiologies of CKD were dominated by CGN with 70.91% of cases. Our results corroborate with those of the numerous studies that show a high proportion of CGN in the aetiologies of especially in our context [14].

In our study, the indications for hemodialysis were dominated by uremic encephalopathy and severe uremia. Other authors [11] [15] have reported hyperkalemia and anuria as the main indications for emergency dialysis. This difference could be explained by the predominance of CKD cases in our study versus a predominance of AKIs in these studies.

The catheter is the main vascular access for emergency hemodialysis, as reported by various authors [11] [12] [13] [15]. The installation site varies according to the habits of the services. Thus, the femoral catheter was the most used followed by the jugular catheter in our patients. Dali Youcef et al. [11] reported the femoral catheter in 72.5%, the site in 15% and the AVF in 12.5%.

The mortality of 17.80% in our series was lower than that observed in the Moroccan series, respectively 32.2% [13] and 70% [15].

The high proportion of CKD cases in our work and the comorbidities of the patients could explain this difference. When analyzing the cases of AKI in our patients, mortality was in the order of 30.55%. In the sub-Saharan African series, mortality varies between 34.1% [16] and 42.1% [10] in the event of AKI. Globally, AKI-related mortality can reach 50% according to some meta-analyzes and this mortality could be higher in the absence of hemodialysis [6] [17].

On univariate analysis, age > 65 years, coma, and AKI appeared to be risk factors for mortality. But in multivariate analysis, only coma was significantly linked to death. Talbi Sofia et al. [13] reported that hyperkalaemia was significantly associated with death in emergency hemodialysis AKIs. In the study by Suter Mendonça et al. [18], age ≥ 65 years was a risk factor for death in AKI.

Hemodialysis in an emergency is a common practice at the Yopougon University Hospital. Our patients were predominantly young with a predominance of men. Almost all of the patients were hospitalized for various reasons dominated by neurological disorders and edema. The main physical signs were hypertension, edema and coma. Apart from very high urea levels and serum creatinine, anemia and inflammatory syndrome were found in almost all of our patients.

CKD cases were predominant and found in three out of four patients with CGN as the main initial nephropathy. Uremic encephalopathy dominated the indications for the hemodialysis session. The femoral catheter was the most widely used vascular access.

Mortality was 17.80% and higher in AKI cases. Coma seems to be a factor of poor prognosis.

It turns out that emergency hemodialysis is a critical situation especially for AKI cases. It is therefore imperative to be prompt in performing hemodialysis.

Our study had limitations due to its retrospective nature. The information sought in the clinical records of patients was sometimes not complete.

The authors declare no conflicts of interest regarding the publication of this paper.

Didier, K.S., François, K.P., Cyr, G.M., Patrick, D.S., Astrid, A.J. and Hubert, Y.K. (2020) First Emergency Hemodialysis Session at the Nephrology Department of the Teaching Hospital of Yopougon: About 146 Cases. Open Journal of Nephrology, 10, 338-347. https://doi.org/10.4236/ojneph.2020.104033

Hospitalization file number: …………………………………………

1) DEMOGRAPHIC DATA

Age: …. Years Sex: M □ F □

Level of study: primary □ secondary □ University□ lliterate □

Profession: ……………

2) CLINICS

Reason for admission ……………………………………………………………….

Antecedents

Hypertension: Yes □ No □

Diabetes: Yes □ No □; CKD: Yes □ No □; HIV: Yes □ No □

Taking toxic substances: Tobacco: Yes □ No □; alcohol: Yes □ No □;

Traditional medicines: Yes □ No □; NSAIDs: Yes □ No □,

Exams

State of consciousness: …………… .. State of hydration: …………………………

Blood pressure: ………….mmHg

3) BLOOD BIOLOGY

WBC ……. /mm³, Hb: …… g/dL, Platelets: …. ×10³/mm³, Urea ……… g/L Creatinine …..mg/L, CRP: …..mg/L, Na⁺: ……MEq/L, Ca2⁺: ….mg/L, K⁺: …..mEq/L

4) DIAGNOSTIC

Acute Kidney Injury: Yes □ No □ if yes type: ………………………...

Chronic Kidney Desease: Yes □ No □ if yes type: ……………………

5) TREATMENT

Hemodialysis

HD indication: ………………………………………………………

Vascular access: ………………………………………………………….…

Number of sessions: …………………………………………………………….

Other treatments

Blood Transfusion: Yes □ No □

Antibiotic therapy: Yes □ No □

6) EVOLUTION

Healing: Yes □ No □

Stabilization: Yes □ No □

Death: Yes □ No □ if Yes cause: …………………………………

Duration of hospitalization: ………………………………………