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Kidney disease is a syndrome characterized by decreased glomerular filtration, which causes the kidney's inability to excrete nitrogenous products and to maintain fluid and electrolyte homeostasis. It is associated with a high risk of death and/or major complications, in addition to the high cost it generates for health services. The criteria for starting renal replacement therapy in patients with dialysis emergency are widely documented in international literature, however, at the ISSSTE Morelia Hospital they are affected by various factors, mainly: lack of supplies and lack of personnel and this is reflected in the morbidity and mortality of patients.
Observational, analytical, cross-sectional, retrospective study. Adult patients with chronic kidney disease who meet the criteria for dialysis urgency. Age between 18-65 years, both genders.
In the period from July 1, 2022 to April 30, 2023, 59 cases with dialytic urgency were documented, of which 21 patients received peritoneal dialysis and 38 patients received hemodialysis. Of the 21 peritoneal dialysis patients, 15 were admitted to peritoneal dialysis mainly due to cardiac complications and in the morning shift (shift in which percutaneous catheters for peritoneal dialysis are placed) the rest received peritoneal dialysis after 12 hours and up to 26 hours after admission, for lack of surgical space and refractory shock that contraindicated hemodialysis. Of the 38 patients who were admitted to hemodialysis: 27 of them had therapy started within the first 6 hours of their admission, 7 had the temporary catheter placed between 4 and 6 hours after their admission and the hemodialysis session was delayed. more than 12 hrs due to lack of space in the unit; For the remaining 4, the placement of the catheter was delayed from 6 to 8:30 hours, this was observed on the weekend night shift, with this the hemodialysis session was delayed from 15 hours 30 minutes to 19 hours from their admission to the emergency room.
The average hospital stay of patients treated within the first 6 hours was 2. Those replaced after 12 hours had an average stay of 5 days, which increases the risk of nosocomial infections and morbidity; On the other hand, it exponentially increases costs to the health system. Regarding mortality, there was no statistical significance, possibly due to the sample size.