Clinical Profile of Adult Patients Presenting With Renal Dysfunction to a Tertiary Hospital Emergency Department

• Published in: Curēus (Palo Alto, CA) Vol. 14; no. 2; p. e21873
• Main Authors: Masina, John, Moolla, Muhammed, Motara, Feroza, Kalla, Ismail S, Laher, Abdullah E
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 03.02.2022; Cureus
• Subjects: Age; Creatinine; Data collection; Developing countries; Diabetes; Emergency Medicine; Epidemiology; Hemodialysis; HIV; Hospitals; Human immunodeficiency virus; Hypertension; Intensive care; Kidney diseases; Laboratories; LDCs; Medical records; Mortality; Nephrology; Patients; Renal replacement therapy; Risk factors; Sepsis; Urine; Working groups; chronic kidney disease; hiv; acute kidney injury; diabetes mellitus; renal dysfunction; emergency department; hypertension; sepsis
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.21873

Background Renal dysfunction is a potentially life-threatening condition that is commonly encountered in the emergency department (ED). This study aimed to describe the clinical profile of patients presenting with renal dysfunction to a tertiary-level hospital ED. Methods Medical records of patients presenting to the ED with renal dysfunction over a six-month period (July-December 2017) were reviewed. A descriptive analysis of the data was performed. Results Serum creatinine levels were measured in 7,442 (69.9%) of the 10,642 patients that were triaged into the ED. Of these, 208 (2.8%) were identified with renal dysfunction, of which 192 consented to study participation. The median age of study subjects was 49.5 (IQR 38.8-63.0) years; 108 (56.3%) were male; proteinuria on urine dipsticks was demonstrated in 108 (56.3%); 72 (37.5%) were HIV-positive; 66 (39.6%) required dialysis; 11 (5.7%) were admitted to the ICU; and 59 (30.7%) died prior to hospital discharge. More patients presented with acute kidney injury (AKI) (46.9%) compared to chronic kidney disease (CKD) (27.6%) and acute on chronic kidney disease (AoCKD) (25.5%). Sepsis was the most common precipitant of AKI (42.2%) and AoCKD (30.6%), while chronic hypertension (35.8%) and diabetes mellitus (34.0%) were the most common comorbidities in subjects with CKD. Conclusion Patients presenting to the ED with various risk factors and comorbidities, including HIV, sepsis, hypertension, and diabetes mellitus, may have underlying renal dysfunction. ED clinicians should therefore adopt a low threshold to screen for renal dysfunction in these patients.