Emergency Medicine Sun 02 August 2020 To study the clinical profile and pattern of complications related to chronic kidney disease among patients visiting emergency department
Researcher : Bhushan vidhya
Research Guide : Aggarwal praveen
Institution Name : All india institute of medical sciences new delhi


Background: a significant proportion of emergency patients are from patients with complications related to CKD. Management of complications related to CKD in emergency is very challenging. Objective: To study the pattern of complications related to chronic kidney disease among patients visiting emergency department. To correlate the complications with stages of chronic kidney disease as defined by Kidney Disease Improving Global Outcomes Method: To determine prospective observational study (February 2018 to July 2019) was performed among adult population (>18 year) with CKD, presenting to emergency department. Data on patients included demographic profile, associated symptoms and comorbidities, primary survey, general physical examination and relevant systemic examination, laboratory parameters, imaging impressions, emergency disposition, final diagnosis and outcome. Results: Total of 260 cases .45.7% of cases age 18-40 years. F>M with a sex ratio of 1.7:1. Majority of cases presented with symptom of shortness of breath (76%). Common comorbidities associated were hypertension (62.7%%) and diabetes (37.3%). 212 patients (81%) were in CKD stage 5, out of which 74 patients were not on dialysis and 138 were on dialysis. 12% of patients required Endotracheal intubation for threatened airway or for severe respiratory distress. 188 patients (72%) had diagnosis of CKD within last one year. In 66% of patient’s respiratory rate was > 22/min, in 164 patients blood pressure was > 140 mmHg. Among the lab investigations, 236 cases had haemoglobin < 10g/dl and 21 patients had sodium level < 120 mEq/L. The complications of CKD were, anemia 226 patients , Electrolyte imbalance 211 patients, pneumonia 122 patient which is 3nd most common complication in CKD patients, Fluid overload in 115 patients, hyperkalemia was present in 103 patients, HTN in 96 patients, sepsis in 40 patients, uremic encephalopathy in 18 patients, pleural effusion in 17 patients, hypokalemia in 14 patients, stroke in 8 patients, heart failure in 5 patients and IHD in 3 patients. The overall mortality was 19.6%. 33 cases (12.7%) were discharged from emergency after initial work up and management. 221 cases (85%) who required admission only 101 admitted for further work up and management and 120 patients were referred to other hospital due to non-availability of beds. Conclusion: In our study, we found that anemia, electrolyte imbalance, pneumonia, HTN, hyperkalemia, fluid overload, sepsis were important complications related to CKD. Shortness of breath as a symptom was present in majority of patients (76%). The common and important diagnosis requires timely diagnosis and intervention.

DOI: 1596385269   Year of publication: 2019

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