Is emergency renal replacement therapy in the emergency department as effective and safe as in the intensive care unit? A retrospective observational study

Abstract

Patients needing renal replacement therapy (RRT) are usually admitted to the intensive care unit (ICU); however, due to limited beds in ICU, emergency RRT is often performed in the emergency department (ED). This study aimed to investigate whether emergency RRT performed in the ED is as effective and safe as in the ICU. This single-center retrospective observational study was conducted at a tertiary medical institution. Among patients who visited the ED from 01 March 2016, to 28 February 2021, the data of those who received RRT within 12 hours of visiting the ED were assessed. The patients were classified into an ICU and an ED group according to the location the first emergency dialysis was performed. In addition, a log-rank test was used to compare the survival rates of the ICU and ED groups. A total of 181 patients were included in this study, and there were no statistically significant differences between the demographic and clinical characteristics of the two groups. The proportion of patients with chronic kidney disease was higher in the ED group (p = 0.011), but there was no statistically significant difference in comorbidity rates of diabetes mellitus, hypertension, heart failure, coronary artery disease, and liver disease between the two groups. Additionally, no statistically significant difference was observed in the cumulative survival rate between the two groups (ICU group: 85.3% vs. ED group: 82.2%; p = 0.529). In conclusion, there was no difference in survival rate between patients who underwent emergency RRT in the ICU and ED and those who received emergency RRT in the ED, indicating that emergency RRT performed in the ED seems to be as effective and safe as in the ICU.