Risk factors for hospital death of patients with end-stage renal disease without previous diagnosis of severe chronic renal failure arriving in an emergency situation at the hospital.
OBJECTIVE
Many end stage renal disease (ESRD) patients get their first nephrologic care under critical clinical conditions and without previous diagnosis of chronic renal failure (CRF), a situation even worse than the late referral of CRF patients for nephrologic treatment. Data on these "nonreferred" patients are scarce. The objectives of this study were to assess clinical and laboratory features, the reasons for coming to the hospital and the factors associated with death in nonreferred ESRD patients first seen by a nephrologist in an emergency situation.


METHODS
Retrospective study (April 1996-March 2000) using the medical records of patients diagnosed with ESRD at the nephrologic emergency visit in a university tertiary hospital. Clinical and laboratory parameters were reviewed. Patients were divided into two groups according to hospital outcome: survivors or nonsurvivors.


RESULTS
There were 414 patients (12% of all nephrologic emergency visits), aged 49 +/- 17 years, 266 males (64%) and 208 (55%) hypertensive. Mortality rate was 13.7% (54/393). When compared to nonsurvivors were older, used mechanical ventilation and vasoactive drugs more frequently, presented higher infection rate, and showed lower plasma creatinine. Multivariate logistic regression showed as factors independently associated with death: first nephrologic visit at intensive care unit, infection as cause for seeking medical care, and increasing age. Plasma creatinine above 10 mg/dL was a protective factor for death.


CONCLUSIONS
ESRD patients reaching dialysis in a nephrologic emergency situation presented high hospital mortality, which was mostly associated with their poor clinical condition at admission.
Abdulkader
Regina C R M
RC
Hospital das Clinicas, Nephrology Division, University of São Paulo Medical School, São Paulo, SP, Brazil. kader@usp.br
Zanetta
Dirce M T
DM
Oliveira
Gláucia M
GM
Burdmann
Emmanuel A
EA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000401:mortality; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011188:Potassium / Q000097:blood; D015995:Prevalence; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
D001639:Bicarbonates; D015415:Biomarkers; D006454:Hemoglobins; D014508:Urea; D003404:Creatinine; D011188:Potassium