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Many patients with End Stage Renal Disease (ESRD) required urgent initiation of dialysis without preestablished access or PD catheter. This trial aimed to assess the safety and feasibility of using dexmedetomidine for procedural sedation and analgesia during urgent percutaneous placement of peritoneal dialysis (PD) catheters and hemodialysis (HD) initiation in patients with end-stage renal disease (ESRD). Due to a lack of resources, the study implemented local anesthesia for catheter placement
Prospective, open clinical trial performed among adult patient (>18y) with End stage renal disease, since july 2022 to august 2023 at the Nephrology of the Hospital Civil de Guadalajara Fray Antonio Alcalde, a tertiary care center for uninsured people in western Mexico. During this period, we included all patients who needs dialysis start in emergency due to a vital risk: uremic syndrome with overload, metabolic acidosis, hemorragic diathesis or encephalopathy with agitation or anxiety, requiring procedural sedation and analgesia. All patients were monitored and received dexmedetomidine doses, calculated for weight, infusion or bolus administration. Patient were grouped according to development of adverse events during procedure, to compared characteristics between the two group. Each patient was followed for at least discharged at hospital.
All results are expressed as the mean-SD for normally distributed data, median (range) for non normally distributed data and frequencies (percentages) for categorical data. Differences between groups were assessed using a T-test or Mann-Whitney. Categorical data were analyzed using Chi-square test or Pearson correlation. All statistical analysese were conducted using SPSS for apple. A p-value <0.05 was considered statistically significant.
A total of 97 patients were included in the analysis (60% male), the mean age was 42.37 years, presence of diabetes in 27.8%,. Biochemical parameters at the beginning, Hemoglobin were 8.5 g/dL, serum albumin 3.2g/dL, creatinine 11.8mg/dL, eGFR 5.8 ml/min, and the mean urea was 229mg/dL. Time procedure was 38.72 minutes (15-105), only 1 patient was adverse event with lidocaine.
The administration of different doses of dexmedetomidine or route of administration (bolus or infusion) did not show a statistically significant difference between the groups. The adverse event were bradycardia, hypotension, hypopnea or need of Oxigen supplementation (see table)
There was no significant difference respect to patient survival between groups (only 1 vs 2 patients dying during the hospitalization).
The procedure time was 38.72 minutes (15-105), 65% was teckhoff catheters implanted using modified Seldinger technique and 35% were tunneled vascular catheters. When we compared patients with AE vs without, there were no significant differences in age, primary renal disease, comorbidities and other laboratory characteristics. There was no significant difference respect to patient survival between groups (only 1 vs 2 patients dying during the hospitalization) Table 1. Our intervention did not prolong hospital stay.
This is the first study realized in patients with urgent start PD or HD, we evaluated the safe of dexmedetomidine to procedure sedation. Dexmedetimidine is a safe and feasible alternative to procedure sedation an analgesia in patients with uremic syndrome. We need more studies to validate the dose and other administration routes.