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Kidney Week

Abstract: PO0870

Cardiac Arrests During Hemodialysis Among Maintenance Hemodialysis Patients in a Large Dialysis Network in India

Session Information

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
FactorsRelative 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)