PURPOSE: Patients with End Stage Renal Disease (ESRD) are often admitted to the Medical Intensive Care Unit (MICU). To date, little data is available on this cohort with regards to their outcomes.
METHODS: This is a retrospective study of ESRD patients on chronic hemodialysis admitted to a 12-bed MICU in a community hospital between January 1, 2004 and September 30, 2007. Data on admission to the MICU, hospital course and outcomes was collected; 30-day mortality was used as the primary outcome of this study.
RESULTS: 37 patients with ESRD (Table 1) were admitted to the MICU during this period. The most common admitting diagnosis was sepsis –17 (46%) followed by respiratory failure –13 (35%) and gastrointestinal bleeding –4 (11%). Vasopressors were required in 14 (38%) patients and 21 (57%) patients required mechanical ventilation. Continuous veno-venous hemodialysis was instituted on 8 patients, 22 patients were on hemodialysis and 7 patients were on both modalities. Significant acidosis (pH <7.20) was recorded in 7 cases and lactic acidosis (>4.0mmol/L) in 8 patients. Overall 30-day mortality was 59% (22 patients) with a mean ICU length of stay for survivors at 5.3 days. In groups of patients requiring vasopressors, mortality was 86% and 62% in those requiring MV; patients on vasopressor and mechanical ventilation had a mortality of 91%. The highest mortality risk was in patients diagnosed with sepsis on mechanical ventilation and vasopressors –100% (Table 2).
CONCLUSION: This cohort of patients has a high mortality rate in the ICU. The presence of sepsis in the setting of hemodynamic instability and respiratory support carries a very poor prognosis. Other factors of poor outcome identified include significant acidosis, lactic acidosis, hypoalbuminemia (<3.0g/dL) and hyperphosphatemia (>5.5mmol/L).
CLINICAL IMPLICATIONS: ESRD patients may require a lower threshold for ICU admission, especially with a clinical diagnosis of sepsis. More studies on a larger scale would be required on this cohort to validate these findings.
DISCLOSURE: Avinesh Bhar, No Financial Disclosure Information; No Product/Research Disclosure Information