Preparation for Hemodialysis in Patients with Chronic Kidney Disease (Stage 5).

Milda Samajauskaitė. ‘’Preparation for Hemodialysis in Patients with Chronic Kidney Disease (Stage 5)’’. Aim: To assess the preparation of patients with renal failure who started hemodialysis in LSMUL KK the year of 2015-2016. Objetives: 1. To determine the demoghraphics and renal function in patients with end stage renal disease before initiation of hemodialysis. 2. To assess the importance of early referral to the nephrologist by comparing the clinical findings, laboratory results and outcomes in patients who started dialysis on time and late. 3. To compare the number of hospitalizations and death rate in first 12 months since the initiation of HD between the nephrologist care groups. 4. To compare the duration of first hospital stay between different nephrologist care groups. Methods: A retrospective study involving 140 patients who started hemodialysis in LSMUL KK during the year of 2015-2016. The data was gathered from the patient’s case reports, registry journals. The statistical analysis of the data was performed using the SPSS 22.0 program. We calculated descriptive statistics, ANOVA for multiple samples; and correlation was evaluated using Spearman’s rho. Results: The sample consisted of 79 men (56,4%) and 61 women (43,6%), mean of age was 64,32±15,44 years. There was no statistically significant differences genderwise. The causes of end stage renal disease did not differ between genders. During the entire observation period, 37 people died (26,4%) , were transplanted 7 (5%), switched to peritoneal dialysis 2 (1,4%) and 89 (63,6%) patients continued with hemodialysis. The number of deaths in 2015 (64,9%) was higher that in 2016 (35,1%). There is a statistically significant correlation between older age (75+.) and death. The main cause of end stage renal failure was arterial hypertension/ischemic nephropathy (37,9%). Majority of patients started their dialysis through central venous (CV) catheter (75,7%). There is a significant difference in the blood hemoglobin (Hb) concentration between groups who started dialysis through arteriovenous fistula (AVF) and CV catheter. Also, Hb levels are statistically significantly different between groups of early and late referral to nephrologist. There is no relation between early or late referral to nephrology care and lethal outcomes. Conclusions: 1. The sample consisted of 79 men (56,4%) and 61 women (43,6%), mean of age was 64,32±15,44 years. The causes of end stage renal disease did not differ between genders. 2. Early referral to the nephrologist can improve the severity of chronic kidney disease complications, but there is no proven link with the patient‘s outcomes. There was a significant difference in hemoglobin levels between patients who started kidney replacement therapy late and patients who started dialysis on time. 3. There was no significant difference between nephrology care groups and the number of hospitalizations (p = 0.545). In first 12 months of 2015 after initiation of dialysis, 15 patients died (40.5%) and in 2016 - 22 (59.45%).Majority of the people that died in the year of 2015 were referred to nephrologist < 3 months prior the start of the hemodialysis. However, in 2016 the number of deaths did not significantly differ from nephrological care groups. 4. If patients are not properly prepared, the duration of their hospital stay will increase. There was a significant difference between patients who had scheduled and urgent dialysis (p=0,0001)