CLINICAL FEATURES AND OUTCOME OF END-STAGE RENAL DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS ADMITTED TO MEDICAL INTENSIVE CARE UNIT

Abstract

Background: The increasing prevalence of end-stage renal disease (ESRD) has resulted in a growing number of maintenance hemodialysis (MHD) patients, particularly among older individuals with conditions such as diabetic nephropathy and microvascular disease. MHD patients face a higher risk of medical complications, which often leads to their admission to the intensive care unit (ICU). However, there is a notable gap in data regarding the outcomes of MHD patients admitted to ICUs. This study addresses this gap by providing insights into the clinical features and outcomes of MHD patients admitted to the medical ICU.

Objective: This study investigates the epidemiology and outcomes of MHD patients admitted to the ICU, explicitly focusing on assessing the predictive accuracy of the Simplified Acute Physiology Score II (SAPS II) in determining mortality.

Methodology: A prospective observational study was conducted at Bahria International Hospital Lahore, involving 189 consecutive MHD patients admitted to the ICU from January 2021 to December 2022. Data collection included recording patient diagnoses, SAPS II variables, organ system failures (OSFs), and additional laboratory parameters. Multivariate logistic regression analysis was utilized to identify significant predictors of survival at ICU discharge.

Results: Among the 189 patients studied, the average age was 61.2 ± 12.8 years, with a male predominance. Diabetic nephropathy emerged as the most prevalent primary renal disease. ICU mortality showed an upward trend with each additional OSF at admission. Univariate analysis revealed significant associations between non-survivor status and higher SAPS II scores, increased OSFs, longer mechanical ventilation duration, and abnormal serum phosphorus levels. Multivariate analysis confirmed OSFs and mechanical ventilation duration as significant predictors of ICU mortality.

Conclusion: This study sheds light on the changing demographic of MHD patients and underscores the importance of OSFs and mechanical ventilation duration as critical determinants of ICU mortality. The limited predictive utility of SAPS II in this cohort highlights the necessity for tailored prognostic indicators for critically ill MHD patients. These findings offer valuable insights for clinicians managing this vulnerable patient population in the intensive care setting.