Emergency department visits in peritoneal dialysis patients: a single center study during an 8-year period

Abstract Background and Aims Peritoneal dialysis patients may present to the emergency department (ED) with infectious, mechanical and metabolic complications of dialysis, as well as non-dialysis-related problems. We planned to retrospectively analyse ED visits in PD patients. Method Study included 189 PD patients followed between December 2014 and July 2022. Patients younger than 18 years and with less than 1-month follow-up were excluded. Demographic characteristics, co-morbidities, medications, dialysis modalities, laboratory tests, presenting symptoms, diagnoses and patient endpoints were evaluated. Results There were 32 (16.9%) female and 157 (83.1%) male patients. Patients were divided into two groups as those who applied to the ED (n = 109) or not (n = 80). Median age (47 (19-80) vs 52.5 (26-77) years, p = 0.389) and dialysis duration (42 (1-248) vs 20.5 (1-217) months, p = 0.390) were similar in both groups. Most common comorbidities were anaemia (103 (94.5%) vs 75 (93.8%), p = 1,000), hypertension (90 (82.6%) vs 64 (80%), p = 0.707) and diabetes mellitus (23 (21.9%) vs 17 (21.3%), p = 1,000). While mortality (39 (35.8%) vs. 16 (20%), p = 0.013) was significantly higher in patients presenting to ED, transfer to hemodialysis (29 (26.6%) vs 33 (41.3%), p = 0.008) and transplant (4 (3.7%) vs 12 (15%), p = 0.042) were lower. There were 248 ED admissions for 109 patients during follow-up. Ninety-two (37.1%) episodes required hospitalization, whereas 156 (62.9%) episodes were treated as outpatients. Mean hospital stay was 10.5 (1-103) days. Most common reasons for admission were abdominal pain, cloudy dialysate, nausea and/or vomiting in 111 episodes (44.8%), cardiovascular symptoms in 31 episodes (12.5%) and hypervolemia in 29 episodes (11.7%). Most common diagnoses were peritonitis in 61 (24.6%), hypervolemia in 32 (12.6%), and upper respiratory tract infection in 21 (8.5%) episodes. When patients were evaluated based on hospitalization status, mean patient age was higher in hospitalized patients (55 (17-84) vs 49 (15- 87) years; p = 0.029), whereas residual renal function (RRF) was lower (150 (0-2500) vs 300 (0-9500) mL /day; p = 0.048). Laboratory data is shown in Table 1. In multivariate analysis, factors predicting hospitalization were CRP [0.991 (0.984-0.997), p = 0.003] and magnesium [5.315 (1.423-19.853), p = 0.013]. Patients presenting to ED were also evaluated based on mortality during follow-up and 39 (35.8%) out of 109 patients died. There was no difference in terms of patient age (p = 0.525), gender (p = 0.792), dialysis time (p = 0.536) or RRF (p = 0.377). However, number of ED admissions was significantly higher in patients who died (2.81±1.63 vs 1.99±1.26; p = 0.004) and the only factor predicting patient death was the number of ED admissions [1.603 (1.058-2.430) p = 0.026]. Conclusion The most common symptoms associated with ED admissions were gastrointestinal and the most common diagnosis was peritonitis. In patients presenting to the ED, more than a third required hospitalization. Factors predicting hospitalization were high CRP and low magnesium levels. The number of admissions to the ED was the only factor that predicted death during follow-up.