Emergency medicine evaluation and management of the end stage renal disease patient

Brit Long, Alex Koyfman, Courtney M. Lee

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. Objective: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. Discussion: ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. Conclusions: Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - 2017

Fingerprint

Emergency Medicine
Chronic Kidney Failure
Infection
Nervous System
Renal Dialysis
Pathology
Neuromuscular Blocking Agents
Kidney
Air Embolism
Cardiac Tamponade
Pericarditis
Renal Replacement Therapy
Pericardial Effusion
False Aneurysm
Sudden Cardiac Death
Brain Diseases
Peritoneal Dialysis
Pulmonary Edema
Acute Coronary Syndrome
Nervous System Diseases

Keywords

  • Bleeding
  • Chronic kidney disease
  • Continuous ambulatory peritoneal dialysis
  • Encephalopathy
  • End stage renal disease
  • Hemodialysis
  • Hemodialysis
  • Uremia

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency medicine evaluation and management of the end stage renal disease patient. / Long, Brit; Koyfman, Alex; Lee, Courtney M.

In: American Journal of Emergency Medicine, 2017.

Research output: Contribution to journalArticle

@article{21dfeb63ffc94cd2b66c93da39b66bcc,
title = "Emergency medicine evaluation and management of the end stage renal disease patient",
abstract = "Background: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. Objective: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. Discussion: ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. Conclusions: Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.",
keywords = "Bleeding, Chronic kidney disease, Continuous ambulatory peritoneal dialysis, Encephalopathy, End stage renal disease, Hemodialysis, Hemodialysis, Uremia",
author = "Brit Long and Alex Koyfman and Lee, {Courtney M.}",
year = "2017",
doi = "10.1016/j.ajem.2017.09.002",
language = "English (US)",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Emergency medicine evaluation and management of the end stage renal disease patient

AU - Long, Brit

AU - Koyfman, Alex

AU - Lee, Courtney M.

PY - 2017

Y1 - 2017

N2 - Background: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. Objective: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. Discussion: ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. Conclusions: Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.

AB - Background: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. Objective: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. Discussion: ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. Conclusions: Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.

KW - Bleeding

KW - Chronic kidney disease

KW - Continuous ambulatory peritoneal dialysis

KW - Encephalopathy

KW - End stage renal disease

KW - Hemodialysis

KW - Hemodialysis

KW - Uremia

UR - http://www.scopus.com/inward/record.url?scp=85028948748&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028948748&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2017.09.002

DO - 10.1016/j.ajem.2017.09.002

M3 - Article

C2 - 28893450

AN - SCOPUS:85028948748

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

ER -