Effect of preparedness of emergency equipment on patient survival in hemodialysis facilities: a Korean nationwide cohort study.

Abstract

Background: Intradialytic cardiac arrest is a serious complication of hemodialysis (HD) in patients with end-stage kidney disease. Therefore, appropriate emergency equipment should be prepared before the initiation of HD. However, little is known about the effects of preparedness of emergency equipment on the outcomes of patients undergoing HD. We aimed to evaluate the effects of preparedness of emergency equipment on mortality in Korean patients undergoing maintenance HD.

Methods: Data from HD quality assessment and National Health Service claims between October and December 2015 were used. In total, 34,950 patients were categorized into two groups based on the availability of emergency equipment in the HD facilities. Cox proportional hazards models were used to assess the impact of preparedness of emergency equipment on patient mortality over a mean follow-up period of 53.7 ± 23.0 months.

Results: The proportions of patients in the groups with and without emergency equipment were 95.2% (n = 33,267) and 4.8% (n = 1,683), respectively. Serum calcium and phosphorus levels, as well as systolic and diastolic blood pressures, were lower, whereas single-pool Kt/V was higher, in the group with emergency equipment than in the group without. After adjustment for demographic and clinical parameters, preparedness of emergency equipment was observed to be an independent risk factor for patient mortality (hazard ratio, 0.87; 95% confidence interval, 0.79-0.96; p = 0.004).

Conclusion: Preparedness of emergency equipment was associated with decreased mortality among patients undergoing HD. A well-equipped HD unit can help increase patient survival.