Outcome of End-Stage Renal Disease Patients with Advanced Uremia and Acidemia

Objective: To determine the outcome of End-Stage Renal Disease (ESRD) patients presenting with advanced uremia and acidemia requiring hemodialysis and adverse events seen within 72 hours of admission. Study Design: Cross-sectional study. Place and Duration of Study: Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from October 2010 to March 2011. Methodology: ESRD patients with advanced uremia and acidemia were included in the study. History, physical examination, complete blood count, serum urea, creatinine, electrolytes, arterial blood gases analysis, and ultrasound of kidneys were done in each patient. Adverse events and outcome were recorded for the next 72 hours. Data was analyzed by SPSS version (10). Mean value and standard deviation of quantitative measurements were calculated and statistical significance computed by t-test. A p-value 0.05 was taken as significant. Statistical significance of categorical variables was determined by chi-square test. Results: Out of the 194 ESRD patients (mean age 46.54 ±14.07 years), 28 (14 percentage) expired and 166 (86 percentage) survived within 72 hours of admission. Hypotension requiring inotropic support was the commonest adverse event observed in 40 (20.6 percentage) cases followed by fits in 31 (16 percentage); and 25 (12.9 percentage) patients required ventilatory support. Mortality was high in patients above 50 years of age. There was no statistically significant difference between two genders regarding adverse events and mortality. Conclusion: The morbidity and mortality of patients with ESRD are serious concerns. Early referral of patients with ESRD, before they develop severe acidosis, can prevent significant morbidity and mortality. (author)