Emergency Department Use among Patients with CKD: A Population-Based Analysis

Ronksley, Paul E.; Tonelli, Marcello; Manns, Braden; Weaver, R. W.; Thomas, Chandra; MacRae, Jennifer M.; Ravani, Pietro; Quinn, Robert R.; James, Matthew T.; Lewanczuk, Richard; Hemmelgarn, Brenda R.

doi:10.2215/cjn.06280616

Cited by 59 publications

(56 citation statements)

References 36 publications

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“…The incidence rate of healthcare use in our sample was also less compared to those reported by Ronksley et al in patients with CKD [45]. This difference may be potentially explained by the selected nature of our convenience sample at a single center, whereas Ronksley et al performed a population-based analysis.…”

Section: Discussioncontrasting

confidence: 69%

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

Zhang

El-Majzoub

et al. 2020

Renal Failure

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Context: Patients treated with maintenance hemodialysis experience significant symptom burden resulting in impaired quality of life. However, the association of patient reported symptom burden and the risk of healthcare use for patients with end stage kidney disease on hemodialysis has not been fully explored. Objectives: To investigate if higher symptom burden, assessed by the Edmonton Symptom Assessment System-revised (ESASr), is associated with increased healthcare use in patients with end stage kidney disease on hemodialysis. Methods: Prospective, single-center, study of adult patients on HD. Participants completed the ESASr questionnaire at enrollment. Baseline demographic, clinical information as well as healthcare use events during the 12-month following enrollment were extracted from medical records. The association between symptom burden and healthcare use was examined with a multivariable adjusted negative binomial model. Results: Mean (SD) age of the 80 participants was 71 (13) years, 56% diabetic, and 70% male. The median (IQR) dialysis vintage was 2 (1-4) years. In multivariable adjusted models, higher global [incident rate ratio (IRR) 1.02, 95% confidence interval (CI) 1.00-1.04, p ¼ .025] and physical symptom burden score [IRR 1.03, CI 1.00-1.05, p ¼ .034], but not emotional symptom burden score [IRR 1.05, CI 1.00-1.10, p ¼ .052] predicted higher subsequent healthcare use. Conclusions: Our preliminary evidence suggests that higher symptom burden, assessed by ESASr may predict higher risk of healthcare use amongst patients with end stage kidney disease on hemodialysis. Future studies need to confirm the findings of this preliminary study and to assess the utility of ESASr for systematic symptom screening.

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Section: Discussioncontrasting

confidence: 69%

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

Zhang

El-Majzoub

et al. 2020

Renal Failure

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“…It remains one of the leading causes of emergency department visits and hospitalisations in this population,9 which translates to poor health-related quality of life 10. Currently, 2-year survival for Medicare patients with CKD and HF is only 76% compared with 93% for those without either condition 2…”

Section: Epidemiology Of Heart Failure and Other Cardiovascular Diseamentioning

confidence: 99%

Heart failure in patients with kidney disease

Tuegel

Bansal

2017

Heart

149

120

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Heart failure (HF) is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), and the population of CKD patients with concurrent HF continues to grow. The accurate diagnosis of HF is challenging in patients with CKD in part due to a lack of validated imaging and biomarkers specifically in this population. The pathophysiology between the heart and the kidneys is complex and bidirectional. Patients with CKD have greater prevalence of traditional HF risk factors as well as unique kidney-specific risk factors including malnutrition, acid-base alterations, uraemic toxins, bone mineral changes, anemia and myocardial stunning. These risk factors also contribute to the decline of kidney function seen in patients with subclinical and clinical HF. More targeted HF therapies may improve outcomes in patients with kidney disease as current HF therapies are underutilised in this population. Further work is also needed to develop novel HF therapies for the CKD population.

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“…Heart failure accounted for over 80% of all potentially preventable emergency department visits whereas hyperkalemia accounted for almost one half (48%) of all ambulatory caresensitive conditions among patients on dialysis. 8 People with CKD have an increased burden from atrial fibrillation relative to those without CKD, and 20 The most common cause of mortality in chronic kidney disease patients was cancer (31.9%) followed by cardiovascular disease (30.2%). 21 Sodium disorder was associated with allcause mortality among CKD patients.…”

Section: Resultsmentioning

confidence: 99%

“…[5][6][7] Many of these patients present to emergency room because of complications like uncontrolled hypertension, anemia, high potassium, metabolic acidosis,pulmonary edema, cardiac failure and other cardiovascular problem. 8 Frequent emergency visit of CKD patients under maintenance hemodialysis points towards either inadequate hemodialysis or inadequate management of underlying medical conditions. Therefore, the study aims to analyses the reasons for emergency visit in chronic kidney disease cases under regular maintenance hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Clinical Presentations of Chronic Kidney Disease Patients on Regular Haemodialysis Attending in Tribhuvan University Teaching Hospital Emergency Services

Shrestha

Prasad

Bhusal³

et al. 2019

J. Karnali Acad. Health Sci.

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Background: Chronic kidney disease is increasing day by day and so is condition of renal replacement therapy mainly hemodialysis. Emergency visit of the patients under maintenance hemodialysis is frequent. The objective of the study is to study clinical parameters of these patients so that in future these deranged parameters can be focused during patient management and decrease their emergency visit. Methods: A prospective cross sectional study was conducted in emergency services of Tribhuvan University Teaching Hospital from 1st May 2018 to 31st October 2018 among the adult chronic kidney disease patients under maintenance hemodialysis. Ethical approval was taken from Institutional review board, Institute of Medicine, Tribhuvan University. Non-probability sampling method was used. Total of 300 patients were enrolled in the study. Patients’ age, sex, causes, laboratory parameter during emergency visit, need of emergency hemodialysis, and need of blood transfusion were studied. Results: Out of total 300 patients, mean age was 45.64 years (S.D =17.15). 190 (63.3 %) were male and 110(36.70%) were female. 152(50.70%) of patients had hypertension.Diabetes and Glomerulonephritis both had equal prevalence of 63(21%). Mean hemoglobin was 6.52gm% (S.D = 1.93). Mean pH was 7.17 (S.D =0.154). Mean serum potassium and creatinine level were 5.77 mEq/L (S.D =0.76) and 1076.03 mmol/l (S.D =367.25) respectively. Area under the Receiver Operating Curve was 0.660 for potassium and 0.598 for serum creatinine. Conclusion: Causes of chronic kidney disease, decreased hemoglobin level, increased serum creatinine and potassium level and metabolic acidosis are reasons of frequent emergency room visit among CKD patients. So these conditions need to be addressed to decrease emergency visit of these patients

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Emergency Department Use among Patients with CKD: A Population-Based Analysis

Cited by 59 publications

References 36 publications

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

Heart failure in patients with kidney disease

Clinical Presentations of Chronic Kidney Disease Patients on Regular Haemodialysis Attending in Tribhuvan University Teaching Hospital Emergency Services

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