Factors Contributing to Emergency Department Visits among Patients Initiating Intermittent Hemodialysis: A Retrospective Cohort Study in Regina, Saskatchewan, Canada

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Abstract Title *

Factors Contributing to Emergency Department Visits among Patients Initiating Intermittent Hemodialysis: A Retrospective Cohort Study in Regina, Saskatchewan, Canada

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Co-author 1

Bhanu Prasad bprasad@sasktel.net University of Saskatchewan Medicine Regina Canada *

Co-author 2

Peter Smylie ebq571@mail.usask.ca University of Saskatchewan Medicine Regina Canada -

Co-author 3

Aarti Garg research1.drprasad@sasktel.net University of Regina Biology Regina Canada -

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Arghya Podder aap659@usask.ca University of Saskatchewan Medicine Regina Canada -

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Introduction

The cost of care for hemodialysis (HD) is around $1.9 billion per year in Canada, according to data from dialysis statistics in 2014. This accounts for 1.1% of total health expenditure, placing an additional burden on taxpayers. It is widely recognized that dialysis patients impose a disproportionate burden on emergency departments (ED), contributing to ED congestion, wait times, and expenditures. This study aims to identify the factors contributing to ED visits among patients recently initiated on intermittent HD in Regina, Saskatchewan.

Methods

We conducted a retrospective cohort study of 360 patients who newly started intermittent HD between 2018 and 2022 at the main dialysis unit, Regina General Hospital, Saskatchewan, Canada. Patients younger than 18 years and < 90 days of HD were excluded. Demographic characteristics, medical comorbidities, laboratory parameters, the number of ED visits, and the reasons for hospital visits were evaluated.

Results

Among the 360 adult patients initiating HD, 50% had at least one ED visit. There were no significant sex differences in ED use, although females were slightly more represented overall (60.6% vs. 39.4% males, p = 0.753). A total of 453 ED visits were analyzed. The most frequent reasons for presentation were gastrointestinal-related issues (64, 14.1%), fluid imbalance (52, 11.5%), cardiovascular causes (38, 8.3%), infections (38, 8.3%), and syncopal episodes or vertigo (36, 7.9%). (Table 1). Highly compliant patients (n=287,80.2%) were less likely to visit the ED. Conversely, patients with suboptimal compliance (n = 71, 19.8%) had significantly higher rates of ED use, including >3 visits (18, 46.2%, p < 0.001).

Conclusion

Approximately one-third (31.4%) of the patients had more than one ED visit in the first year of HD initiation. GI-related complaints were the leading cause of ED visits. Encouraging better adherence to the dialysis schedule may reduce these visits and improve the patient’s well-being.

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