Mode of Presentation of Patients for the First Dialysis in the Haemodialysis Unit of East Medical Ward Mayo Hospital, Lahore.

Abstract

It is a prospective study of 50 patients carried out in the haemodialysis Unit of East Medical Ward, Mayo Hospital, Lahore from April 2000 to June 2000. Acute and Chronic renal failure no longer remains a dilemma to the treating physicians on account of emergence of novel techniques of management like dialysis and renal transplantation. Haemodialysis has revolutionized the science of Nephrology and the morbidity and the incidence of early mortality has significantly decreased during the last three decades in the patients of chronic and even acute renal failure. As no report on the mode of presentation of patients presenting for the first time for haemodialysis was available in Pakistan, we sought to determine the clinical and biochemical parameters responsible for bringing the patients for the first time to the dialysis unit of East Medical ward Mayo hospital, Lahore. All fifty patients between the age of 18-70 years who were suffering from acute or chronic renal failure and presented to the dialysis unit of East Medical ward Mayo hospital, Lahore for the first dialysis were included in the study and were evaluated for their modes of presentation. The syndrome of uraemia was diagnosed on the basis of clinical and biochemical criteria. Blood urea, serum creatinine, Arterial blood gases, serum electrolytes and Blood sugar was estimated in all cases under scrutiny. Abdominal ultrasound was done for the radiological evidence of bilateral renal parenchymal disease and all the cases were judged on the clinical criteria for evidence of uraemia before the commencement of haemodialysis while simultaneously taking in to account the reversible factors in selected cases Among fifty patients under study uraemia
was found in all the cases while hyperkalaemia and metabolic acidosis emerged as the most important biochemical factors with a percentage of 98%. Only 8% patients were suffering from acute renal failure while all other cases had Chronic renal failure. Pulmonary oedema with severe dyspnoea, chest pain due to uraemic pericarditis, oliguria and anuria were present as the mode of presentation in 74%, 50%, 46% and 28% respectively. Severe infections, coma, drowsiness and oedema and swelling of the body were found as presenting factors in 36%, 28%, 22% and 46% respectively. Only 24% patients presented with fits and convulsions. The results of this study revealed metabolic acidosis, hyperkalaemia, pulmonary oedema, pericarditis and oliguria as the most prevalent modes of presentation in the patients attending the dialysis unit of East Medical ward Mayo hospital, Lahore for their first dialysis session.