Emergency hemodialysis in the Joseph Raseta Befelatanana hospital, Antananarivo, Madagascar

Introduction: Initiation of emergency dialysis is a critical situation responsible for high morbidity and mortality. This study describes the characteristics of emergency hemodialysis patients in a hospital in Madagascar.

Patients and methods: It is a descriptive study over a period of 7 months, from September 1, 2018 to March 31, 2019, on emergency hemodialysis patients in the hemodialysis department of the University Hospital of Joseph Raseta Befelatanana, Antananarivo. Emergency hemodialysis was defined as dialysis performed immediately or within the first 48 hours of hospitalisation in a life-threatening situation.

Results: Among 124 haemodialysis patients, 52 patients (41.93%) had started dialysis as an emergency. The mean age of patients was 50.5 years and the sex ratio (male/female) was 1.08. Hypertension (51.92%) and diabetes (34.61%) were the main comorbidities. Chronic kidney disease was found in 82.7%. The majority of patients were unprepared and had initiated dialysis with a central venous catheter. The most frequent indication was Kussmaul's breathing (32.6%) followed by anuria (28.84%). The mortality rate was 23.08% and the prognosis was influenced by their condition on arrival.

Conclusion: The predominance of chronic kidney disease and the absence of a permanent vascular approach can be explained by the late referral to nephrologists of patients with chronic kidney disease. Efforts need to be made to increase the proportion of scheduled dialysis patients with a permanent approach.