Abstract: TH-PO823

Adverse Drug Effects in Patients with ESRD Who Present to the Emergency Department

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Poojary, Priti, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Saha, Aparna, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Chauhan, Kinsuk, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Garimella, Pranav S., University of California San Diego, San Diego, California, United States
  • Nadkarni, Girish N., Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

Patients on dialysis are at high risk for adverse drug effects (ADEs) due to impaired renal clearance of medications and polypharmacy. We aimed to explore trends and outcomes of ADEs in dialysis patients.

Methods

We utilized a nationally representative database, the Nationwide Emergency Department Sample, to identify dialysis patients who present to the emergency department (ED) for an ADE. We excluded illicit drug toxicities, intentional poisoning, renal transplantation, pregnancy and age <18. Incidence was calculated using the United States Renal Data System and the United States Census Bureau data.

Results

From 2008 to 2013, there were 9,734,821 ED visits for ADEs. ED visits for ADEs were consistently higher in dialysis patients compared to non-dialysis patients, 70-94/1000 patients vs. 4-5/1000 patients (Figure 1a). In dialysis patients, ADEs were more common in females, age ≥ 65 years, and hemodialysis vs. peritoneal dialysis patients. Incidence of ED visits for ADEs increased with increasing number of co-morbidities (Figure 1b). In-patient admission was more common in dialysis patients, 88% vs. 58%, P <0.001. Mortality of ESRD patients who were admitted was 3 times that of non-dialysis patients.

Conclusion

ED visits for ADEs are common in dialysis patients, and substantially higher than in non-dialysis patients. Nearly 90% of all ER visits for ADEs in dialysis patients results in an inpatient hospital admission which contributes to great financial burden on the health care system.