Chronic kidney disease in the emergency centre: A prospective observational study

INTRODUCTION: Late presentation, usually to the emergency centre (EC), is frequently reported among patients with chronic kidney disease (CKD) in resource-limited settings, and is known to be associated with poor outcomes. This study aims to describe the pattern of EC presentation of adults with CKD in Southwest Nigeria. METHODS: This was a prospective observational study of 158 consecutively presenting CKD patients at the EC of two tertiary hospitals in Southwest Nigeria. Patients 18 years of age or older who were admitted into the EC at either study site with an admitting diagnosis of CKD and who consented to participate in the study were recruited. Socio-demographic characteristics, primary reason(s) for admission into the EC, requirement for dialysis, as well as the indication for dialysis were documented. The patients were followed-up for the duration of their stay in the EC and the outcome of EC admission documented. RESULTS: Overall, 54 (34.2%) were females, median age was 49 years and 74.1% were not known to have CKD prior to EC admission. The commonest indications for admission into the EC were uraemia, sepsis and hypertensive crisis, with 73.4% of the patients having at least one indication for dialysis at EC admission. The commonest indications for dialysis were uraemia, marked azotaemia and acute pulmonary oedema. The median time to first session of dialysis was 48 h and 24.1% of patients who required dialysis were not dialysed. Death during the period of EC admission occurred in 14 (8.9%) patients all of whom were not previously known to have CKD. DISCUSSION: There is a large pool of undiagnosed CKD among the general population. In many of these, the diagnosis will likely be made only when they present to the EC with complications. Late diagnosis is associated with worse outcomes.