Abstract: PO0870
Cardiac Arrests During Hemodialysis Among Maintenance Hemodialysis Patients in a Large Dialysis Network in India
Session Information
- Fluid, Electrolytes, and Clinical Events with Dialysis: Getting to the "Heart" of the Matter
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sankarasubbaiyan, Suresh, Nephroplus, Hyderabad, Telengana, India
- Ganapathi Subraman, Venkatraman, Nephroplus, Hyderabad, Telengana, India
- Gowda, Mallikarjuna Gowda Bg, Nephroplus, Hyderabad, Telengana, India
- Puvvada, Sataynarayana Rajesh, Nephroplus, Hyderabad, Telengana, India
- Sonawane, Vikram Ashok, Nephroplus, Hyderabad, Telengana, India
- Kumar, Kaparaboina Kartheek, Nephroplus, Hyderabad, Telengana, India
- Husain, Mohammad Sarwar, Nephroplus, Hyderabad, Telengana, India
- Shah, Kamal D., Nephroplus, Hyderabad, Telengana, India
Background
Cardiac arrest (CA) during a HD session carries a high mortality and is reported associations inclue age, comorbiity, dialysis characteristics. Since much is unknown in India, we aimed to study Incidence of CA, prediposing factors and outcome of CPR following intra HD cardiac arrests
Methods
Consecutive CA in a large dialysis network from July 2019 to March 2021 were reviewed for age, gender, HD frequency, adequacy, vascular access, HD facility location, size, nephrologist coverage, h/o DM and IHD, HD session timing, delivered HD frequency & hospitlalization in recent past & ultrafitltration rate. Survivors vs non-survivors of CPR were compared with t-test, Chi-square test or Fisher's exact statistic and risk ratio (RR) for significance of associated factors were analyzed using STATA, v 14. 2. Two-sided tests with a P-value < 0.05 was considered significant
Results
122 CA occured among 2,981,759 sessions; rate of 1/24441. 71 survived CPR and 51 died. μ age: 55.5 ± 1.2 yrs, M;F =77%:23%. Tier 1/2/3 cities: 11.4%,37.7% 50,8%, daily Nephrologist visits: 67.2%, Facilites monthly sessions: < 250 : 10.6%, 250-749: 42.6%, >750 :46.7%. μ Hb: 8.7 ± .2 g% Temp access: 43.4%, HD freq 1/2/3 per wk: 36.9/28.7/34.4%, DM: 48.4% IHD: 26.2%. Morn afternoon, eve session(%): 39.3/15.6/39.3%, hospitlalized < 2mon: 40%, < 2HD/week in recent past: 27%, μ UFR: 10.4 ± .5 ml/kg/hr. RR for signifcant factors are shown in Table 1.
Conclusion
Incidence of CA in India mirrors developed countries experience; larger facilities & smaller cities form a high proportion of events. Age > 80 ↑ risk of death. Female, ↓ Hb & adequacy, UFR >10ml/kg/hour, low HD freq in 2 months prior to CA show tendency to higher risk for non survival. Limitation includes lack of analysis of CPR and post CPR hospitalization course
Relative risk of major factors associated with non-survival following CPR for CA
| Factors | Relative risk (95% CI) |
| Age <39 ref ≥ 80 | 1.4 (1.1-2) |
| Gender (male: ref) Female | 1.8 (.8 - 3.7) |
| Hb (10-12 g ref) <8 | 1.1 (0.7-1.5) |
| Recent HD freq (2X ref) 1x 3x | 1.3 (0.7-1.5) 1.7 (0.7 - 4.1) |
| Adequacy (≥ 1.2 ref) Abnormal | 1.1 (0.5-2.2) |
| UF rate (< 7ml/kg/hr ref) 10-14 >14 | 1.2 (0.7 - 2.3) 1.5 (0.7-2.9) |