Factors Associated with Unplanned Emergency Hemodialysis Initiation among Adult Sudanese Patients with Chronic Kidney Disease: A Cross-Sectional, Single-Center Study

Abstract

Background: The number of patients starting hemodialysis is increasing worldwide. In Sudan, most patients with chronic kidney disease undergo emergency, unplanned initiation of hemodialysis, which is associated with higher costs and increased risks of morbidity and mortality. Studies have shown that patients with arteriovenous fistulas have better survival compared with those with central venous catheters (CVCs). Objective: This study aimed to identify factors associated with the unplanned initiation of emergency hemodialysis among patients known to have chronic kidney disease. Study design: A descriptive cross-sectional, hospital-based study. Setting and participants: Data were collected from 129 adult Sudanese who received emergency hemodialysis at Bahri Hemodialysis Center, Khartoum State, Sudan. Since this is a cross-sectional study, a simplified formula to calculate the sample size was used. Data were entered into an Excel sheet, then exported to SPSS version 25.0 for data analysis. Results: 24.8% (n = 32) of the study participants were in the age group 41 - 50 years. 67.4% (n = 87) were males, while 32.6% (n = 42) were females, with a male to female ratio of 2:1. 55.8% (n = 72) of the study participants were diagnosed with chronic kidney disease at least one year before starting dialysis. 69% (n = 89) were on regular follow-up, 58.1% (n = 75) with a nephrologist. Only 12.4% (n = 16) had an arteriovenous (AV) fistula before initiation of hemodialysis. 41.9% (n = 54) were vaccinated against the hepatitis B virus, while 58.1% (n = 75) were not vaccinated. 53.7% (n = 29) of the vaccinated group received vaccination after initiation of hemodialysis. 89.4% (n = 67) of those not vaccinated reported that none had told them to take the vaccine. 52.7% (n = 68) were compliant with their medications for chronic kidney disease, while non-compliant ones were 47.3% (n = 61); the main reasons for non-compliance were negligence and financial issues in 62.4% (n = 38) and 19.6% (n = 12) of the non-compliant, respectively. 51.9% (n = 67) of the study participants received blood transfusions during emergency hemodialysis. The results reported that patients with arteriovenous (AV) fistula access before initiation of hemodialysis, in association with a duration of diagnosis of one year or more, plus regular follow-up, were statistically significant (p values Conclusion: Lack of patient preparedness and an emergency start to hemodialysis are associated with lower survival and higher morbidity. Only 12.4% (n = 16) had an arteriovenous (AV) fistula before the initiation of hemodialysis. The circumstances of dialysis initiation and the choices regarding initial modality and access can significantly affect patient experiences and outcomes. Awareness-raising campaigns should be implemented at the community level to increase knowledge among patients with chronic kidney disease about the importance of regular follow-up and adherence to medication. Hepatitis B vaccination sessions should be mandatory for all patients with chronic kidney disease. Research is urgently needed to inform policy and guide clinical decision-making and preventive strategies for preparing patients with chronic kidney disease for hemodialysis.