L’Hémodialyse en Situation d’Urgence : une Étude de 107 Cas au Centre d’Hémodialyse du CHR de Thiès (Sénégal)

RESUME Introduction. L’objectif de ce travail etait de determiner la prevalence de l’hemodialyse en situation d’urgence, les indications, les profils cliniques, paracliniques, evolutifs et le devenir des patients. Patients et methodes. Il s’agissait d’une etude prospective monocentrique descriptive et analytique sur une periode d’un an (01 Mars 2018 au 30 Avril 2019) realisee au centre hospitalier regional de Thies. Etaient inclus tous les patients insuffisants renaux aigu ou chronique ayant beneficie des seances d’hemodialyse en situation d’urgence. Resultats. Sur 263 patients, 107 patients etaient mis en hemodialyse en urgence soit une prevalence de 40,68%. L’âge moyen de nos patients etait de 46,39 ± 17,13 ans et le sex-ratio etait de 1,05. Les principales indications de l’hemodialyse en urgence etaient l’uremie mal toleree chez 54 patients (50.47%) suivie de l’hyperkaliemie chez 43 patients (40,19%). L’insuffisance renale chronique (IRC) etait le type d’insuffisance renale le plus note chez 74 patients (69,15%) avec comme premiere etiologie la nephroangiosclerose (25,2%). L’insuffisance renale aigue (IRA) ete trouvee chez 33 patients (38,85%) avec la necrose tubulaire aigue (10,8%) comme etiologie principale. La voie d’abord la plus utilisee etait la voie femorale chez 87 patients (81,3%).Dix-neuf patients (17,8%) etaient decedes dont 13 patients en dehors de la dialyse et 6 patients en per dialyse. Conclusion. Au Senegal, les patients sont vus le plus souvent aux stades tardifs et l’inaccessibilite au traitement d’epuration extra-renale font que l’hemodialyse est le plus souvent debutee dans un contexte d’urgence. ABSTRACT Introduction. The goal of this work was to determine the hemodialysis’ prevalence in emergency situations, indications, clinical, paraclinical, evolutionary and patient future. Patients and methods. It was a prospective monocentric descriptive and analytical study over a period of one year (01 March 2018 to 30 April 2019) carried out at the regional hospital of Thies. Was included all patients with acute or chronic renal failure who were under emergency hemodialysis sessions. Results. Out of 263 patients, 107 patients underwent emergency hemodialysis with a prevalence of 40.68%. The average age of our patients was 46.39 ± 17.13 years and the sex ratio was 1.05. The main indications for emergency hemodialysis were poorly tolerated uremia in 54 patients (50.47%) followed by hyperkalemia in 43 patients (40.19%). Chronic renal failure (CRF) was the most noted type of renal disease in 74 patients (69.15%) with nephroangiosclerosis as the primary cause (25.2%). Acute renal failure (ARF) was found in 33 patients (38.85%) with acute tubular necrosis (10.8%) as the main etiology. The most frequently used approach was the femoral route in 87 patients (81.3%). Nineteen patients (17.8%) died including 13 patients outside dialysis and 6 patients on dialysis. Conclusion. In Senegal, patients are seen most often in the late stages and the inaccessibility to treatment of extra-renal treatment make that the hemodialysis is most often started in a context of urgency.