Emergency Dialysis in End-Stage Renal Disease: Incidence and Characteristics in La Paz, Baja California Sur

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According to international guidelines of Kidney Disease: Improving Global Outcomes (KDIGO, 2012); chronic renal failure (CRF) is defined as those abnormalities of kidney structure or function, present for more than 3 months with implications for health. CRF is classified according to cause, category of glomerular filtration rate (GFR) and category of albuminuria. The estimated prevalence of CRF is 16.8% worldwide. CRF can progress to end-stage renal disease (ESRD), which requires dialysis or transplantation. However, many patients cannot undergo such therapies because of its high cost [2- 3].Complications of CRF include dialytic emergency, anemia, renal osteodystrophy and malnutrition, among others.

CRF is a highly prevalent pathology that affects people of all races, nationalities, age, gender and economic level. Low socioeconomic status and poor access to health services contribute to inequality in health care and exacerbate negative effects of genetic or biological predisposition [5-6]. It is precisely the people with little or no access to health services who are at greater risk for complications of CRF.

According to annual report of the United States Renal Data System, main causes of end-stage renal failure in patients with CRF are diabetes (153 cases per million inhabitants in 2009), arterial hypertension (99 cases per million inhabitants) and glomerulonephritis (23 cases per million inhabitants). Cardiovascular disease is also an important cause; however, about 28% of patients with clinically significant CRF (stage 3 or higher) are not diabetic or hypertensive, especially those older than 65 years. In developing countries, diabetes and hypertension are currently the leading causes of CRF with a prevalence of 30% and 21% respectively, but glomerulonephritis and CRF of unknown origin are responsible for a greater proportion of ESRD, especially in young patients.

In Mexico, CRF is one of main causes of morbidity and mortality and one of main causes of hospitalization in emergency departments. CRF is considered a catastrophic disease due to increasing number of cases, high investment costs, limited infrastructure and human resources, late detection and high morbidity and mortality rates in substitution programs. In Mexico, prevalence and incidence of patients with CRF is unknown and the precise number of patients in any of its stages, age groups and gender most affected is unknown. An incidence of 377 cases per million inhabitants and a prevalence of 1,142 per million is estimated. In Mexico there are about 52,000 patients on dialysis, of which 80% are treated at the Mexican Social Security Institute (IMSS).