Introduction:
The high prevalence of diabetes in Guyana has resulted in a significant burden of chronic kidney disease resulting in a rapidly growing hemodialysis (HD) population estimated of 400 patients. The Georgetown Public Hospital Corporation (GPHC) is the main hospital in Guyana that is responsible for most of the hospital admissions amongst people receiving HD. We sought to describe the clinical and demographic characteristics of HD patients that present to the Emergency Department (ED) in Georgetown and require hospital admission.
Methods:
Retrospective chart review on individuals receiving maintenance HD who presented to the GPHC ED in need of hospital admission between March 5 – July 5, 2024. Descriptive statistics (frequency, mean or median) were used to characterize patients, comorbidities and laboratory values at the time of admission. The primary outcome was to identify the main reasons for hospital admission.
Results:
During the 4-month study period, 110 patients were admitted to GPHC representing 27.5% of the Guyana HD population. The average age was 51 ± 13.9 years, with 54% male and 46% female. Comorbidities included: hypertension (84%), diabetes mellitus (61%) and cardiovascular disease (8.2%). The majority, 53%, received twice per week dialysis. The mean hemoglobin was 7.9 ± 2.1 g/dl, blood urea nitrogen 62.4 ± 31.4 mg/dl and potassium 5.1 ± 1.1 mmol/l. There were 228 reasons for admission, most patients had more than one reason for admission. The most common reason for admission to the ED was anemia (25.4%), followed by volume overload (16.7%), catheter related issues (infection, dysfunction) (13.6%) and hyperkalemia (11.8%). 21 (19.1%) of the patients had repeated visits during this time period; these patients were younger, 47 ± 13.7 years and had similar comorbidities and lab values at presentation. The most common reasons for admission for the repeat visits included anemia (23.3%), volume overload (18.7%), hyperkalemia (13.6%) and catheter related issues (12.1%).
Conclusions:
In Guyana, the proportion of individuals receiving HD who require admission to hospital is very high. The most common reasons for admission are potentially modifiable. Analyzing this data is the first crucial step toward the creation of targeted strategies to decrease the number of preventable admissions to GPHC and ultimately lower health care costs associated with hospitalization.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.