SP629FIRST DIALYSIS SESSION FOR ESRD : PLANNED OR EMERGENCY

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INTRODUCTION AND AIMS: Starting dialysis therapy for End Stage Renal Disease should be ideally a planned process, following a period of Nephrologist medical care, often long, including information, education, and creation of a primary vascular access. However, according to the French register REIN and EDTA, a third of patients initiate their dialysis (from 24 to 49%), importantly, there is no notable progress in these rates of emergency dialysis initiation in Europe. Those “emergency” cares are known to increase morbidity and mortality, length of hospitalization and finally cost. The aim of this study is to describe circumstances of first dialysis session and outline some predictive factors for emergency unplanned first session. METHODS: This is a retrospective monocentric cohort study that includes 104 patients who initiated chronic hemodialysis treatment in our unit between January 2015 and December 2016. Acute renal failures were excluded from this study. They were separated into two groups: “Planned” and “Emergency” 1st dialysis session for ESRD. The biological parameters, such as renal function, hemoglobin level, inflammatory syndrome and metabolic balance, were studied as well as patient’s medical history and the existence of a nephrologist follow-up. The final evaluation was based on the survival eight months after the end of the inclusion period. RESULTS: Out of all the patients included in this study, there were 21.15%(n=22) who started the treatment in emergency. There were no significant differences between the two groups regarding mean age ( 68.4+/-16) , sex ratio((M/F)1.47), mean BMI : (28.4+/-6.1), history of diabetes (53%), high blood pressure ( 94%) and diagnosis of nephropathy. The main circumstances for the initiation of dialysis in emergency were pulmonary edema (14%) fluid overload (32%) acidosis (27%) high blood pressure (9%) symptoms of uremia (5%) post-surgical evolution (4%). “Emergency” patients had higher serum creatinin levels as well as serum urea levels. Anemia was significantly more severe in this group. The initiation of dialysis for ESRD in emergency was correlated with higher mortality and low rate of functional vascular access. CONCLUSIONS: Emergency situation at the initiation of hemodialysis occurs in one fifth of patients in our unit and is associated with higher mortality and morbidity. Besides standard biological parameters that were significantly different, low rate follow-up by the nephrologist is correlated with high probability of a first dialysis session in emergency. Thus a frequent and careful clinical and biological follow-up should be proposed to the patient months before starting dialysis. During this period primary vascular access should be provided.

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