PATIENT SAFETY ON HEMODIALYSIS: CARDIAC ARRESTS DURING A HEMODIALYSIS SESSION IN A LARGE DIALYSIS NETWORK OVER 46 MONTHS – A DESCRIPTIVE STUDY

Introduction:

Patient safety is an important aspect of hemodialysis delivery. Among sentinel events used to measure patient safety, cardiac arrests are of the highest impact. Patient safety has not been well studied in the context of rapidly evolving end-stage kidney disease care in lower-middle-income countries. Hence, we reviewed cardiac arrests among patients on hemodialysis to understand rate, timing, patient and dialysis characteristics and outcome.

Methods:

All cardiac arrests that occurred over 46 months from July 2019 to April 2023, which included 8,392,241 million hemodialysis sessions in centres that provide hemodialysis services under a single large private dialysis network in India were included in the study. Age, gender, cause of chronic disease, dialysis characteristics including vascular access, weekly dialysis frequency, haemoglobin (as g/dl), adequacy and ultrafiltration rate as ml/kg/hour were analyzed. Survival after resuscitation, hospitalization and outcome were reviewed. Data is presented in proportions.

Results:

A total of 227 cardiac arrests occurred during the study period. The monthly rate of cardiac arrests ranges from 0.2 to 1.15 per 10,000 sessions during the study period (Figure 1 - data presented quarterly). The patient characteristics are as follows: 41% belonged to the age group of 61 - 80 years, 45% were 41 - 60 years and 14% were 18 – 40 years. 74% were male. 44% were diabetics and 28% had ischaemic heart disease. 60% were on AVF/AVG and 40% on catheters. 47% on once-weekly dialysis sessions, 21% on twice-weekly and 15% on thrice-weekly sessions. 4% had haemoglobin level of > 12g/dl,15%, 10-12g/dl, 40%, 8 – 9.9g/dl and 34%, <8g/dl. 58% had dialysis adequacy of ≥1.2 and 16% had < 1.2. 27% had ultrafiltration of >13ml/kg/hr, 29% had 7 - 13ml/kg/hr and 21% had < 7 ml/kg/hr. 24% had an arrest within an hour of a hemodialysis session,18% - within 1 to 3 hours, 28% - after 3 hours, 9% before a session and 21% immediately after a session. 58% expired due to cardiac arrest, 44% were hospitalized to undergo treatment for cardiac arrest and 16% survived overall.

Conclusions:

Despite the structured reporting policy in place, there is underreporting of cardiac arrests in hemodialysis centres. Patients who suffer cardiac arrests are a high proportion of elderly, on temporary catheters, with low hemodialysis frequency, severe anaemia and high ultrafiltration rate. Patient survival remains poor. Early lessons show significant gaps in our understanding of the background and trigger factors leading to cardiac arrests, resuscitation interventions and post-arrest care which are essential to prevent cardiac arrests and improve outcome.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.