Frequency of ED visits and mortality among the adults with ESRD on twice-weekly maintenance hemodialysis at tertiary care hospital in Bhutan.

Background: The burden of end-stage renal disease (ESRD) is increasing in Bhutan but there is limited data on the emergency department (ED) visits among ESRD patients. This study aims to study the frequency of ED visits and one-year mortality among ESRD patients on twice-weekly maintenance haemodialysis (HD).

Methods: A prospective cohort study was conducted over the span of year from 1st October 2021 to 30th September 2022 at emergency department of national referral hospital of Bhutan. The ESRD patients were approached for enrollment upon presentation to the ED and followed to hospital discharge or until the end of the study period.

Results: There was a total of 633 ED visits among the 193 ESRD patients, resulting in an overall mean of 3.3 ED visits per year. The reasons for ED visit were due to renal emergencies in 48.0%, non-renal medical illnesses in 41.2%, and both in 10.8%. Out of the 633 ED visits, 46.4% required emergent HD. The majority (80.4%) of the patients were discharged from the ED after receiving various treatments, including emergent HD. Only 17.4% required admission to the ward or intensive care unit. During the one-year follow-up of the 193 ESRD patients, there were 18 deaths resulting in a one-year mortality rate of 9.3% of which out-of-hospital cardiac arrest (OHCA) accounted for 44.4% (n = 8).

Conclusion: There was high frequency of ED visits due to renal emergencies among ESRD patients undergoing twice-weekly HD at our tertiary care hospital. Additionally, there was high one-year mortality rate and incidence of OHCA among ERSD patients.