Kronik diyaliz tedavisi alan hastaların acil servise başvuru nedenleri ve klinik sonlanımları
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Diyaliz hastaları özellikle enfeksiyon, hipotansiyon ve elektrolit dengesizlikleri gibi komplikasyonlar açısından yüksek risk altındadırlar. Bu komplikasyonlar hastaneye yatışlara ve acil servis ziyaretlerine yol açabilir. Acil servise başvuran diyaliz hastalarının bu durumuna katkıda bulunan faktörleri, bu hastaların karşılaştıkları zorlukları ve bu sorunları çözmek için kullanılabilecek stratejilere ihtiyaç vardır. Bu çalışmada, kronik diyaliz hastalarının acil servise başvurularındaki klinik ve laboratuvar verileri retrospektif olarak incelenerek başvuru nedenlerinin incelenmesi ve sağkalıma etki eden faktörlerin belirlenmesi amaçlanmıştır. Materyal ve Metot: Ocak 2020 ve Aralık 2022 aralığında Ege Üniversitesi Tıp Fakültesi Erişkin Acil servise başvuran kronik diyaliz hastaları çalışmaya alınmış ve verileri retrospektif olarak değerlendirilmiştir. Bulgular: Çalışmamız 640 hastayla yapılmıştır. Hastalarımızın ortalama yaşı 65,2±15,2 idi. Hastaların 346 (%54) tanesi erkek, 294 (%46) tanesi kadın idi., erkek/kadın oranı:1,1/ 1 saptandı. Pazartesi-çarşamba-cuma diyalize giren hastalarda acil servis başvurularının en çok pazartesi günü, salı-perşembe-cumartesi günü diyalize giren hastalarda acil servis başvurularının en çok salı günü olduğu saptandı. Hastaların acil servise başvuru nedenleri incelendiğinde kardiyovasküler nedenler (hipervolemi-dispne ilişkili ve anjina ilişkili) %24,9 ile ilk sıradaydı. Enfeksiyon ilişkili nedenler %18, damaryolu sorunları %12,4, gastrointestinal sistem sorunları %11,4, pulmoner sorunlar (pnömoni ve Covid-19) %11, nörolojik sorunlar %6,4, elektrolit sorunları %2,5 diğer nedenler de %13' lük kısmı oluşturmaktaydı. Hastaların diyalize giriş damaryoluna bakıldığında, hastaların %36,9' u arteriyovenöz fistülden, %44,1' i kalıcı kataterden ve %15,6' sı geçici kataterden diyalize girmekteydi. Acil servise başvuran hastaların yıllara göre (2020-2021-2022) acil servise başvuru nedenleri incelendiğinde Covid-19 pandemisinin başladığı 2020 yılında pulmoner nedenlerle acil servis başvuruları fazla olup, 2022 yılına doğru bu başvurular azalmıştır. Kardiyovasküler nedenler ve enfeksiyon ilişkili nedenler her 3 yılda da en fazla başvuruyu oluşturmaktadır. Acil servise başvuran hastaların yıllara göre (2020-2021-2022) taburculuktaki ve günümüzdeki mortalite oranları istatistiksel olarak incelendiğinde 2020 yılında acil servise başvuran hastaların 2021 ve 2022' de başvuran hastalara göre günümüzdeki ölüm oranları istatistik verilerine bakıldığında anlamlı biçimde daha yüksek saptandı (p<0,05). Acil servise başvuran hastaların taburcu olma ve exitus durumuna göre diyaliz seans verileri istatistiksel olarak incelendiğinde acil serviste diyalize giriş süresi taburcu olanlarda (3,3 saat), exitus olanlara (3 saat) göre istatistik verilerinde anlamlı biçimde daha yüksektir (p<0,05). Diyalize giriş sistolik kan basıncı, diyalizden çıkış sistolik kan basıncı ve diyalizden çıkış diyastolik kan basıncı taburcu olanlarda exitus olanlara göre istatistiki olarak anlamlı biçimde yüksekti. (p<0,05) Acil servise başvuran hastaların taburcu olma ve exitus durumuna göre komorbidite nedenleri istatistiksel olarak incelendiğinde exitus olan hastalarda diyabet görülme sıklığı anlamlı şekilde daha yüksek saptandı (p<0,05). Exitus olanlarda taburcu olanlara göre albümin ve kreatinin değeri istatistiksel olarak anlamlı derecede daha düşük bulunurken, CRP değeri anlamlı olarak daha yüksek saptandı (p<0,05). Sonuç: Diyaliz hastalarının acil servis ziyaretlerindeki düşük albümin, kreatinin , trombosit düzeyi; yüksek CRP, lökosit ve glukoz düzeyi mortaliteyi öngörmede yardımcıdır. Ek komorbidite olarak DM' ye sahip olmak mortaliteyi artırmaktadır. Diyalize giriş damar yolu olarak katater kullanımının fistülden fazla olması da damaryolu problemleri ve katater enfeksiyonu nedeniyle acil servis başvurularını artırmaktadır. İnterdiyalitik aralıktan sonra diyaliz hastalarının acil servis başvuruları artmaktadır. Bu durum bazı hastaların ek diyaliz ihtiyacı olduğunu göstermektedir. Ayrıca 2020 yılında Covid-19' un da katkısıyla mortalite ve pulmoner nedenlerle acil servis başvuruları artmıştır. Anahtar kelimeler: Kronik diyaliz hastaları, acil servis başvuru, hipervolemi, hasta sağkalımı, mortalite
Introduction and Aim: Dialysis patients are particularly at high risk for complications such as infection, hypotension and electrolyte imbalances. These complications may lead to hospitalisations and emergency department visits. There is a need to understand the factors contributing to this situation of dialysis patients presenting to the emergency department, the difficulties faced by these patients and the strategies that can be used to solve these problems. The aim of this study was to retrospectively examine the clinical and laboratory data of chronic dialysis patients admitted to the emergency department to investigate the reasons for admission and to determine the factors affecting survival. Materyal and Method: Chronic dialysis patients admitted to Ege University Faculty of Medicine Adult Emergency Department between January 2020 and December 2022 were included in the study and their data were evaluated retrospectively. Results: Our study included 640 patients. The mean age of the patients was 65.2±15.2 years. 346 (54%) of the patients were male and 294 (46%) were female. It was determined that the most common emergency department visits in patients undergoing dialysis on Monday-Wednesday-Friday were on Monday, and the most common emergency department visits in patients undergoing dialysis on Tuesday-Thursday-Saturday were on Tuesday. When the reasons for presentation to the emergency department were analysed, cardiovascular cause (hypervolemia-dyspnea related and angina related) were in the first order with 24.9%. Infection-related causes accounted for 18%, vascular problems 12.4%, gastrointestinal system problems 11.4%, pulmonary problems (pneumonia and Covid-19) 11%, neurological problems 6.4%, electrolyte problems 2.5% and other causes 13%. Regarding the vascular access to dialysis, 36.9% of the patients were dialysed via arteriovenous fistula, 44.1% via permanent catheter and 15.6% via temporary catheter. When the reasons of the patients admitted to the emergency department according to years (2020-2021-2022) were examined, emergency department admissions due to pulmonary reasons were high in 2020, when the Covid-19 pandemic started, and these admissions decreased towards 2022. Cardiovascular causes and infection-related causes constitute the highest number of admissions in all 3 years. When the mortality rates at discharge and current mortality rates of the patients admitted to the emergency department according to the years (2020-2021-2022) were statistically analysed, it was found that the mortality rates of the patients admitted to the emergency department in 2020 were significantly higher than the patients admitted in 2021 and 2022 (p<0.05). When the dialysis session data of the patients admitted to the emergency department according to discharge and exitus status were examined statistically, the duration of dialysis in the emergency department was significantly higher in those who were discharged (3.3 hours) than those who were exitus (3 hours) (p<0.05). Dialysis entry systolic blood pressure, dialysis exit systolic blood pressure and dialysis exit diastolic blood pressure were statistically significantly higher in those who were discharged than in those who were exited (p<0.05). When the causes of comorbidity were analysed statistically according to discharge and exit status of the patients admitted to the emergency department, the incidence of diabetes was found to be significantly higher in patients with exit (p<0.05). Albumin and creatinine values were found to be statistically significantly lower and CRP values were found to be significantly higher in the exitus patients compared to the discharge patients (p<0.05). Conclusion: Low albumin, creatinine and platelet levels and high CRP, leucocyte and glucose levels in emergency department visits of dialysis patients are helpful in predicting mortality. Having DM as an additional comorbidity increases mortality. The use of catheters more than fistulas as dialysis access vascular access also increases emergency department visits due to vascular access problems and catheter infections. Emergency department admissions of dialysis patients increase after the interdialytic interval. This situation shows that some patients need additional dialysis. In addition, with the contribution of Covid-19 in 2020, mortality and emergency department admissions for pulmonary reasons increased. Key words: Chronic dialysis patients, emergency department admission, hypervolemia, patient survival, mortality
Introduction and Aim: Dialysis patients are particularly at high risk for complications such as infection, hypotension and electrolyte imbalances. These complications may lead to hospitalisations and emergency department visits. There is a need to understand the factors contributing to this situation of dialysis patients presenting to the emergency department, the difficulties faced by these patients and the strategies that can be used to solve these problems. The aim of this study was to retrospectively examine the clinical and laboratory data of chronic dialysis patients admitted to the emergency department to investigate the reasons for admission and to determine the factors affecting survival. Materyal and Method: Chronic dialysis patients admitted to Ege University Faculty of Medicine Adult Emergency Department between January 2020 and December 2022 were included in the study and their data were evaluated retrospectively. Results: Our study included 640 patients. The mean age of the patients was 65.2±15.2 years. 346 (54%) of the patients were male and 294 (46%) were female. It was determined that the most common emergency department visits in patients undergoing dialysis on Monday-Wednesday-Friday were on Monday, and the most common emergency department visits in patients undergoing dialysis on Tuesday-Thursday-Saturday were on Tuesday. When the reasons for presentation to the emergency department were analysed, cardiovascular cause (hypervolemia-dyspnea related and angina related) were in the first order with 24.9%. Infection-related causes accounted for 18%, vascular problems 12.4%, gastrointestinal system problems 11.4%, pulmonary problems (pneumonia and Covid-19) 11%, neurological problems 6.4%, electrolyte problems 2.5% and other causes 13%. Regarding the vascular access to dialysis, 36.9% of the patients were dialysed via arteriovenous fistula, 44.1% via permanent catheter and 15.6% via temporary catheter. When the reasons of the patients admitted to the emergency department according to years (2020-2021-2022) were examined, emergency department admissions due to pulmonary reasons were high in 2020, when the Covid-19 pandemic started, and these admissions decreased towards 2022. Cardiovascular causes and infection-related causes constitute the highest number of admissions in all 3 years. When the mortality rates at discharge and current mortality rates of the patients admitted to the emergency department according to the years (2020-2021-2022) were statistically analysed, it was found that the mortality rates of the patients admitted to the emergency department in 2020 were significantly higher than the patients admitted in 2021 and 2022 (p<0.05). When the dialysis session data of the patients admitted to the emergency department according to discharge and exitus status were examined statistically, the duration of dialysis in the emergency department was significantly higher in those who were discharged (3.3 hours) than those who were exitus (3 hours) (p<0.05). Dialysis entry systolic blood pressure, dialysis exit systolic blood pressure and dialysis exit diastolic blood pressure were statistically significantly higher in those who were discharged than in those who were exited (p<0.05). When the causes of comorbidity were analysed statistically according to discharge and exit status of the patients admitted to the emergency department, the incidence of diabetes was found to be significantly higher in patients with exit (p<0.05). Albumin and creatinine values were found to be statistically significantly lower and CRP values were found to be significantly higher in the exitus patients compared to the discharge patients (p<0.05). Conclusion: Low albumin, creatinine and platelet levels and high CRP, leucocyte and glucose levels in emergency department visits of dialysis patients are helpful in predicting mortality. Having DM as an additional comorbidity increases mortality. The use of catheters more than fistulas as dialysis access vascular access also increases emergency department visits due to vascular access problems and catheter infections. Emergency department admissions of dialysis patients increase after the interdialytic interval. This situation shows that some patients need additional dialysis. In addition, with the contribution of Covid-19 in 2020, mortality and emergency department admissions for pulmonary reasons increased. Key words: Chronic dialysis patients, emergency department admission, hypervolemia, patient survival, mortality
Açıklama
Anahtar Kelimeler
Nefroloji, Nephrology, Kronik diyaliz hastaları, acil servis başvuru, hipervolemi, hasta sağkalımı, mortalite
