Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review

2002 ◽

Vol 13 (3) ◽

pp. 708-714

Author(s):

Jean-Marc Hurot ◽

Michel Cucherat ◽

Margaret Haugh ◽

Denis Fouque

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Exercise Capacity ◽

Muscle Function ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Serum Triglycerides ◽

Anemia Management ◽

Maintenance Hemodialysis Patients

ABSTRACT. There are many causes for carnitine depletion during maintenance hemodialysis. Supplementation with l-carnitine in animals has been associated with improvement in some abnormalities also present in chronic renal failure. However, it is still controversial whether restoring plasma or tissue carnitine will correct clinical or biologic symptoms observed in maintenance hemodialysis. A systematic review is here performed to determine the effects of l-carnitine in maintenance hemodialysis patients. Eighty-three prospective trials were identified from 1978 to 1999 in which l-carnitine was randomly allocated in 21 trials. Change in serum triglycerides, cholesterol fractions, hemoglobin levels, erythropoietin dose, and other symptoms (muscle function, exercise capacity, and quality of life) were examined. A total of 482 patients in 18 trials were considered for analysis. There was no effect of l-carnitine on triglycerides, total cholesterol, or any of its fractions. Before the erythropoietin (EPO) era, l-carnitine treatment was associated with improved hemoglobin (P < 0.01) and with a decreased EPO dose (P < 0.01) and improved resistance to EPO when patients routinely received EPO. Muscle function, exercise capacity, and quality of life could not be reliably assessed because of the noncombinable nature of end points and the limited number of trials. In conclusion, l-carnitine cannot be recommended for treating the dyslipidemia of maintenance hemodialysis patients. By contrast, this review suggests a promising effect of l-carnitine on anemia management. The route of l-carnitine administration should be evaluated because there is no evidence as to the most efficient method of administration in maintenance hemodialysis.

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Derivation and Internal Validation of a Clinical Risk Prediction Tool for Hyperkalemia-Related Emergency Department Encounters Among Hemodialysis Patients

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120953287 ◽

2020 ◽

Vol 7 ◽

pp. 205435812095328

Author(s):

Paul E. Ronksley ◽

James P. Wick ◽

Meghan J. Elliott ◽

Robert G. Weaver ◽

Brenda R. Hemmelgarn ◽

...

Keyword(s):

Emergency Department ◽

Hemodialysis Patients ◽

Regression Coefficients ◽

Maintenance Hemodialysis ◽

Model Discrimination ◽

C Statistic ◽

Increased Risk ◽

Dialysis Vintage ◽

Ed Visits ◽

Maintenance Hemodialysis Patients

Background: Approximately 10% of emergency department (ED) visits among dialysis patients are for conditions that could potentially be managed in outpatient settings, such as hyperkalemia. Objective: Using population-based data, we derived and internally validated a risk score to identify hemodialysis patients at increased risk of hyperkalemia-related ED events. Design: Retrospective cohort study. Setting: Ten in-center hemodialysis sites in southern Alberta, Canada. Patients: All maintenance hemodialysis patients (≥18 years) between March 2009 and March 2017. Measurements: Predictors of hyperkalemia-related ED events included patient demographics, comorbidities, health-system use, laboratory measurements, and dialysis information. The outcome of interest (hyperkalemia-related ED events) was defined by International Classification of Diseases (10th Revision; ICD-10) codes and/or serum potassium [K+] ≥6 mmol/L. Methods: Bootstrapped logistic regression was used to derive and internally validate a model of important predictors of hyperkalemia-related ED events. A point system was created based on regression coefficients. Model discrimination was assessed by an optimism-adjusted C-statistic and calibration by deciles of risk and calibration slope. Results: Of the 1533 maintenance hemodialysis patients in our cohort, 331 (21.6%) presented to the ED with 615 hyperkalemia-related ED events. A 9-point scale for risk of a hyperkalemia-related ED event was created with points assigned to 5 strong predictors based on their regression coefficients: ≥1 laboratory measurement of serum K+ ≥6 mmol/L in the prior 6 months (3 points); ≥1 Hemoglobin A1C [HbA1C] measurement ≥8% in the prior 12 months (1 point); mean ultrafiltration of ≥10 mL/kg/h over the preceding 2 weeks (2 points); ≥25 hours of cumulative time dialyzing over the preceding 2 weeks (1 point); and dialysis vintage of ≥2 years (2 points). Model discrimination (C-statistic: 0.75) and calibration were good. Limitations: Measures related to health behaviors, social determinants of health, and residual kidney function were not available for inclusion as potential predictors. Conclusions: While this tool requires external validation, it may help identify high-risk patients and allow for preventative strategies to avoid unnecessary ED visits and improve patient quality of life. Trial registration: Not applicable—observational study design.

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