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Retrospective Analysis of Patients with Emergency Hemodialysis Indication in the Emergency Department

Yıl 2022, Cilt: 5 Sayı: 3, 124 - 127, 30.09.2022
https://doi.org/10.54996/anatolianjem.1147015

Öz

Aim: Emergency hemodialysis is a life-saving treatment. There is a limited number of descriptive studies in the literature on patients who applied to the emergency department due to chronic renal failure or acute renal failure and then received hemodialysis with the need for urgent hemodialysis. In this study, it was aimed to determine the demographic characteristics, clinical and laboratory findings of the patients who applied to the Marmara University Faculty of Medicine Emergency Medicine Clinic with various complaints and were given an indication for emergency dialysis as a result of the tests.


Material and Methods: Patients who applied to the emergency department of our hospital and received hemodialysis after consultation after emergency medicine physician evaluation were included in this study. Demographic, clinical and laboratory data of the patients, dialysis indications and subsequent processes were collected retrospectively. The data were analyzed with the SPSS 22.0 program.


Results: A total of 380 patients were included in our study. 56.6% of the patients were male and their mean age was 63.3±17.3 years. 71.7% of the patients have known chronic renal failure and 67% of them enter the routine hemodialysis program. The most common presenting complaint is shortness of breath. 75% of the patients received hemodialysis within the first 12 hours. An emergency catheterization was required in 54.2% of the patients. Most of the patients required hospitalization in the service or intensive care unit, and 3 patients died.


Conclusion: Most of the patients who need emergency hemodialysis require hospitalization and these patients constitute the critical patient group. Larger descriptive studies are needed to better recognize these patients and to control their diseases before the emergency service process.

Kaynakça

  • Carmona-Bayonas A, Jimenez-Fonseca P, de Castro EM, et al. SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018). Clin Transl Oncol. 2019;21(1):75-86. doi:10.1007/s12094-018-1983-4
  • Baugh CW, Wang TJ, Caterino JM, et al. Emergency Department Management of Patients with Febrile Neutropenia: Guideline Concordant or Overly Aggressive? Mark Courtney D, ed. Academic Emergency Medicine. 2017;24(1):83-91. doi:10.1111/acem.13079
  • Ba Y, Shi Y, Jiang W, et al. Current management of chemotherapy-induced neutropenia in adults: key points and new challenges. Cancer Biol Med. 2020;17(4):896-909. doi:10.20892/j.issn.2095-3941.2020.0069
  • Thursky KA, Worth LJ. Can mortality of cancer patients with fever and neutropenia be improved? Current Opinion in Infectious Diseases. 2015;28(6):505-513. doi:10.1097/QCO.0000000000000202
  • Al-Tawfiq JA, Hinedi K, Khairallah H, et al. Epidemiology and source of infection in patients with febrile neutropenia: A ten-year longitudinal study. J Infect Public Health. 2019;12(3):364-366. doi:10.1016/j.jiph.2018.12.006
  • Kuo JC, De Silva M, Diwakarla C, et al. A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients. Asia-Pacific Journal of Clinical Oncology. 2017;13(3):179-184. doi:10.1111/ajco.12641
  • Baugh CW, Faridi MK, Mueller EL, et al. Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia. PLoS One. 2019;14(5):e0216835. doi:10.1371/journal.pone.0216835
  • Kochanek M, Schalk E, von Bergwelt-Baildon M, et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2019;98(5):1051-1069. doi:10.1007/s00277-019-03622-0
  • Jansma B, Vakkalanka P, Talan DA, et al. Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement? Journal of Oncology Pharmacy Practice. Published online 2020. doi:10.1177/1078155219896396
  • Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. JCO. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211
  • Daniels LM, Durani U, Barreto JN, et al. Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia. Support Care Cancer. 2019;27(11):4171-4177. doi:10.1007/s00520-019-04701-8
  • Peyrony O, Gerlier C, Barla I, et al. Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department. PLoS One. 2020;15(2):e0229828. doi:10.1371/journal.pone.0229828
  • Mhaskar R, Clark OAC, Lyman G, et al. Colony-stimulating factors for chemotherapy-induced febrile neutropenia. Cochrane Database Syst Rev. 2014;(10):CD003039. doi:10.1002/14651858.CD003039.pub2
  • Skoetz N, Bohlius J, Engert A, et al. Prophylactic antibiotics or G(M)-CSF for the prevention of infections and improvement of survival in cancer patients receiving myelotoxic chemotherapy. Cochrane Database Syst Rev. 2015;(12):CD007107. doi:10.1002/14651858.CD007107.pub3
  • van der Velden WJFM, Blijlevens NMA, Feuth T, et al. Febrile mucositis in haematopoietic SCT recipients. Bone Marrow Transplant. 2009;43(1):55-60. doi:10.1038/bmt.2008.270
  • Hatamabadi H, Arhami Dolatabadi A, Akhavan A, et al. Clinical Characteristics and Associated Factors of Mortality in Febrile Neutropenia Patients; a Cross Sectional Study. Arch Acad Emerg Med. 2019;7(1):39.
  • Aagaard T, Reekie J, Jørgensen M, et al. Mortality and admission to intensive care units after febrile neutropenia in patients with cancer. Cancer Med. 2020;9(9):3033-3042. doi:10.1002/cam4.2955

Acil Serviste Acil Hemodiyaliz Endikasyonu Konulan Hastaların Retrospektif Analizi

Yıl 2022, Cilt: 5 Sayı: 3, 124 - 127, 30.09.2022
https://doi.org/10.54996/anatolianjem.1147015

Öz

Amaç: Acil hemodiyaliz hayat kurtarıcı bir tedavidir. Literatürde kronik böbrek yetmezliği ya da akut böbrek yetmezliği nedeniyle acil servise başvuran ve sonrasında acil hemodiyaliz ihtiyacı ile hemodiyalize alınan hastalarla ilgili tanımlayıcı çalışma sınırlı sayıdadır. Bu çalışmada Marmara Üniversitesi Tıp Fakültesi Acil Tıp Kliniğine çeşitli şikâyetlerle başvuran ve yapılan tetkikleri neticesinde acil diyaliz endikasyonu konulan hastaların demografik özellikleri, klinik ve laboratuvar bulgularının belirlenmesi amaçlandı.


Gereç ve Yöntemler: Bu çalışmaya hastanemiz acil servisine başvuran, acil tıp hekimi değerlendirmesinin ardından konsültasyon sonrası hemodiyalize alınan hastalar dahil edildi. Hastaların demografik, klinik ve laboratuvar verileri, diyaliz endikasyonları ve sonraki süreçleri retrospektif olarak toplandı. Veriler SPSS 22.0 programı ile analiz edildi.


Bulgular: Çalışmamıza toplam 380 hasta alınmıştır. Hastaların %56,6’sı erkek olup yaş ortalamaları 63,3±17,3’dir. Hastaların %71,7’sinin bilinen kronik böbrek yetmezliği olup %67’si rutin hemodiyaliz programına girmektedir. En sık başvuru şikayeti nefes darlığıdır. Hastaların %75’i ilk 12 saat içinde hemodiyalize alınmıştır. %54,2 hastaya acil kateter takılması gerekmiştir. Hastaların büyük çoğunluğuna servis ya da yoğun bakım yatışı gerekmiş olup 3 hasta exitus olmuştur.


Sonuç: Acil hemodiyalize alınması gereken hastaların çoğunluğuna yatış gerekmekte olup bu hastalar kritik hasta grubunu oluşturmaktadır. Bu hastaların daha iyi tanınması ve acil servis süreci öncesi hastalıklarının kontrol altına alınması için daha geniş tanımlayıcı çalışmalara ihtiyaç vardır.

Kaynakça

  • Carmona-Bayonas A, Jimenez-Fonseca P, de Castro EM, et al. SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018). Clin Transl Oncol. 2019;21(1):75-86. doi:10.1007/s12094-018-1983-4
  • Baugh CW, Wang TJ, Caterino JM, et al. Emergency Department Management of Patients with Febrile Neutropenia: Guideline Concordant or Overly Aggressive? Mark Courtney D, ed. Academic Emergency Medicine. 2017;24(1):83-91. doi:10.1111/acem.13079
  • Ba Y, Shi Y, Jiang W, et al. Current management of chemotherapy-induced neutropenia in adults: key points and new challenges. Cancer Biol Med. 2020;17(4):896-909. doi:10.20892/j.issn.2095-3941.2020.0069
  • Thursky KA, Worth LJ. Can mortality of cancer patients with fever and neutropenia be improved? Current Opinion in Infectious Diseases. 2015;28(6):505-513. doi:10.1097/QCO.0000000000000202
  • Al-Tawfiq JA, Hinedi K, Khairallah H, et al. Epidemiology and source of infection in patients with febrile neutropenia: A ten-year longitudinal study. J Infect Public Health. 2019;12(3):364-366. doi:10.1016/j.jiph.2018.12.006
  • Kuo JC, De Silva M, Diwakarla C, et al. A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients. Asia-Pacific Journal of Clinical Oncology. 2017;13(3):179-184. doi:10.1111/ajco.12641
  • Baugh CW, Faridi MK, Mueller EL, et al. Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia. PLoS One. 2019;14(5):e0216835. doi:10.1371/journal.pone.0216835
  • Kochanek M, Schalk E, von Bergwelt-Baildon M, et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2019;98(5):1051-1069. doi:10.1007/s00277-019-03622-0
  • Jansma B, Vakkalanka P, Talan DA, et al. Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement? Journal of Oncology Pharmacy Practice. Published online 2020. doi:10.1177/1078155219896396
  • Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. JCO. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211
  • Daniels LM, Durani U, Barreto JN, et al. Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia. Support Care Cancer. 2019;27(11):4171-4177. doi:10.1007/s00520-019-04701-8
  • Peyrony O, Gerlier C, Barla I, et al. Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department. PLoS One. 2020;15(2):e0229828. doi:10.1371/journal.pone.0229828
  • Mhaskar R, Clark OAC, Lyman G, et al. Colony-stimulating factors for chemotherapy-induced febrile neutropenia. Cochrane Database Syst Rev. 2014;(10):CD003039. doi:10.1002/14651858.CD003039.pub2
  • Skoetz N, Bohlius J, Engert A, et al. Prophylactic antibiotics or G(M)-CSF for the prevention of infections and improvement of survival in cancer patients receiving myelotoxic chemotherapy. Cochrane Database Syst Rev. 2015;(12):CD007107. doi:10.1002/14651858.CD007107.pub3
  • van der Velden WJFM, Blijlevens NMA, Feuth T, et al. Febrile mucositis in haematopoietic SCT recipients. Bone Marrow Transplant. 2009;43(1):55-60. doi:10.1038/bmt.2008.270
  • Hatamabadi H, Arhami Dolatabadi A, Akhavan A, et al. Clinical Characteristics and Associated Factors of Mortality in Febrile Neutropenia Patients; a Cross Sectional Study. Arch Acad Emerg Med. 2019;7(1):39.
  • Aagaard T, Reekie J, Jørgensen M, et al. Mortality and admission to intensive care units after febrile neutropenia in patients with cancer. Cancer Med. 2020;9(9):3033-3042. doi:10.1002/cam4.2955
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Çalışma
Yazarlar

Çiğdem Özpolat 0000-0002-9747-4661

Erhan Altunbaş 0000-0002-5075-739X

Yayımlanma Tarihi 30 Eylül 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 5 Sayı: 3

Kaynak Göster

AMA Özpolat Ç, Altunbaş E. Acil Serviste Acil Hemodiyaliz Endikasyonu Konulan Hastaların Retrospektif Analizi. Anatolian J Emerg Med. Eylül 2022;5(3):124-127. doi:10.54996/anatolianjem.1147015