Emergency department presentation of chronic peritoneal dialysis patients

Background. The patterns of emergency department (ED) presentation of chronic peritoneal dialysis (PD) patients have not been well documented. This study was designed to analyze the ED presentation, evaluation, and disposition of these patients. Materials and Methods. We retrospectively reviewed the charts of all chronic PD patients who had been treated for more than 1 month at our dialysis center between January 1995 and December 2003. We included patients who visited the ED during this period. Data were collected on demographics, etiology of renal failure, chief complaint, diagnosis, length of stay, and disposition. Results. A total of 68 chronic PD patients (26 male, 42 female) were treated at our center during this period. Eight patients were not studied because of incomplete medical records. In addition, 18 patients never visited the ED. The remaining 42 patients made 96 ED visits. The most common presenting complaints were abdominal pain, dyspnea, and nausea/vomiting. The major diagnoses were peritonitis, respiratory tract infection, hypovolemia associated with excessive ultrafiltration, and acute gastroenteritis. Symptomatic hypokalemia was also seen in 5% of patients visiting the ED. Among the patients, 58.3% were admitted. The average duration of admission was 172 +/- 41.2 days. Conclusion. The patients on PD had a different clinical picture of ED presentation than did the patients on hemodialysis. PD-associated complications-especially peritonitis-constitute major reasons for ED visits. Aggressive patient education and monitoring are recommended to reduce the number of ED visits by these patients.