Open Journal of Nephrology, 2020, 10, 338-347

https://www.scirp.org/journal/ojneph
ISSN Online: 2164-2869
ISSN Print: 2164-2842

First Emergency Hemodialysis Session at the

Nephrology Department of the Teaching
Hospital of Yopougon: About 146 Cases

Konan Serge Didier1*, Kissou Pegdebamba François2, Guei Monlet Cyr2, Diopoh Sery Patrick1,
Aka Jean Astrid1, Yao Kouamé Hubert1

Nephrology-Internal Medicine Department D, CHU Treichville, Abidjan, Ivory Coast

1

Department of Nephrology, CHU Yopougon, Abidjan, Ivory Coast

2

How to cite this paper: Didier, K.S., Abstract

François, K.P., Cyr, G.M., Patrick, D.S.,
Astrid, A.J. and Hubert, Y.K. (2020) First Context: Due to the late referral of the pads to the nephrologist and the lack
Emergency Hemodialysis Session at the of medical follow-up, many patients are admitted with complications from
Nephrology Department of the Teaching kidney disease requiring the urgent start of hemodialysis sessions. Purpose:
Hospital of Yopougon: About 146 Cases.
Study the profile of emergency hemodialysis patients in order to ease their
Open Journal of Nephrology, 10, 338-347.
https://doi.org/10.4236/ojneph.2020.104033 management. Methods: This was a retrospective, descriptive and analytical
study carried out at the Nephrology Department of the Teaching Hospital of
Received: October 14, 2020 Yopougon from January 1st to December 31st, 2016. This study included all
Accepted: November 20, 2020
patients who had received a first session of hemodialysis in an emergency
Published: November 23, 2020
context. Results: We collected 146 patients with an average age of 39.80 ±
Copyright © 2020 by author(s) and 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were
Scientific Research Publishing Inc. known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected
This work is licensed under the Creative (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%)
Commons Attribution International
License (CC BY 4.0).
and coma (30.1%). Anemia was observed in 97.2% of cases and it was less
http://creativecommons.org/licenses/by/4.0/ than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%.
Open Access Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main
indications for hemodialysis were encephalopathy (33.5%), severe uremia
(28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and
hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral
site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death
was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma
(p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of
death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88)
seemed to be associated with mortality risk for our patients. Conclusion:
Hemodialysis in an emergency situation is a common practice in the
Teaching Hospital of Yopougon and mainly concerns patients with CKD.

DOI: 10.4236/ojneph.2020.104033 Nov. 23, 2020 338 Open Journal of Nephrology

 K. S. Didier et al.

Keywords
Kidney Failure, Hemodialysis, Emergency

1. Introduction
Kidney pathology constitutes a major public health problem in the world due to
its frequency, high mortality rate and the costs of its treatment [1] [2].
Nephrological emergencies are not so frequent but they most often deal with
management problems [3]. Their treatment often calls for hemodialysis, which
can supplement the functions of cleaning uremic toxins and fluid and electrolytes
balance, thereby improving their prognosis [4]. Despite these therapeutic advances
made over the past 50 years, the mortality of patients with kidney impairment
requiring emergency dialysis remains high [5] [6].
In 2010, replacement therapy ensured the survival of nearly 3 million patients
worldwide, 78% of whom were on dialysis [7]. The incidence of acute kidney
injury requiring hemodialysis is increasing and associated with high mortality
[8].
In France, the 2011 REIN report estimated the incidence of dialysis patients at
144/million inhabitants [9]. In the United States of America, the rate of acute
renal damage requiring extrarenal purification increased from 3227/million
peope/year in 1996 to 5224/million people/year in 2003. In Canada, it increased
from 0.8% to 3% from 1996 to 2010 [6].
In Senegal in 2016, a hospital study noted that 84.7% of patients in a
hemodialysis center had received emergency sessions and that 34.2% of these
patients had acute renal failure [10].
Data on emergency dialysis patients are scarce in our practice setting. Our
work aims to study the profile of patients who have benefited from a first
emergency hemodialysis session in order to facilitate decision-making for their
management.

2. Methods
2.1. Type and Scope of the Study
Our study took place in the Nephrology department of the Teaching Hospital of
Yopougon in Abidjan, Ivory Coast. This was a retrospective, descriptive and
analytical study that took place over a period going from January 1st to
December 31st, 2016.
This department includes an inpatient unit with a capacity of 20 beds, an
outpatient unit, a hemodialysis unit with 07 generators, one of which is broken.

2.2. Study Population

We included all patients who received a first dialysis session in an emergency
setting during the study period. Dialysis patients admitted urgently but who

DOI: 10.4236/ojneph.2020.104033 339 Open Journal of Nephrology

K. S. Didier et al.

were not having their first dialysis session at that moment and those whose
medical records were incomplete for the parameters sought were not included.

2.3. Variables
For each patient included, the following data were collected using a standardized
survey sheet:
- Sociodemographic data: age, sex, profession, level of education;
- Co-morbidities: hypertension, diabetes, HIV, CKD, drug abuse (alcohol,
tobacco, NSAIDs, PCI, use of traditional products);
- Clinical data: the department of origin, reasons for hospitalization, state of
consciousness, state of hydration, blood pressure; edema, acute lung edema,
urine output;
- Blood biological data: hemoglobin level, number of white blood cells and
platelets, creatinine, urea, sodium, potassium, calcium, CRP;
- The type of renal failure: acute kidney injury (AKI) or chronic kidney desease
(CKD) with the different mechanisms;
- Therapeutic data: hemodialysis with the indication of the session, the vascular
access and the number of sessions, other treatments;
- Evolutionary data: duration of hospitalization, recovery or not of renal
function, death.

2.4. Definition of Operational Terms

Renal function was assessed using the MDRD formula. Renal failure was defined
by a glomerular filtration rate (GFR) of less than 60 ml/min for 1.73 m2. The
chronic nature was defined by the length of renal failure (more than 3 months)
and/or normochromium are generative normocytic anemia and/or hypocalcemia
and/or associated renal atrophy. The IRC was said to be terminal (or stage 5)
when it was less than 15 ml/min.
In the absence of renal biopsies, the etiological research of renal failure was
based on a set of clinical and paraclinical arguments. Thus, chronic glomerular
nephropathy (CGN) has been evoked by the presence of proteinuria greater
than 2 g/d or proteinuria associated with hematuria. Chronic vascular
nephropathy nephroangiosclerosis type was retained due to the existence of
hypertension, low flow proteinuria (<1 g/d), and renal failure associated with
signs of hypertensive retinopathy in the fundus. Nephropathy associated with
HIV has been evoked in the presence of massive proteinuria without arterial
hypertension or hematuria, in any patient infected with HIV and of recent
discovery (<3 months), diabetic nephropathy in the presence of proteinuria
greater than 500 mg/24 hours associated with diabetic retinopathy on fundus
examination, chronic tubulointerstitial nephropathy (CTIN) before the existence
of proteinuria (<1 g/24 h) associated with leukocyturia without germ and
kidneys with irregular and dented outlines.
Functional acute kidney failure (AKI) was retained in the presence of renal

DOI: 10.4236/ojneph.2020.104033 340 Open Journal of Nephrology

 K. S. Didier et al.

hypoperfusion factor (diarrhea, vomiting, low cardiac output) or in front of

signs of extracellular dehydration. Obstructive AKI was retained in the presence
of bilateral dilation of the pyelocalicular cavities. Organic AKI was retained after
exclusion of functional and obstructive AKIs.
Arterial hypertension was defined by the observation of blood pressure levels
greater than or equal to 140 mmHg systolic-wise and/or greater than or equal to
90 mmHg diastolic-wise. The arterial pressure was divided into three grades:
grade 1 or mild hypertension between 140 and 159 mmHg systolic-wise and
between 90 and 99 mmHg diastolic-wise; grade 2 or mean hypertension
between 160 and 179 mmHg systolic-wise and between 100 and 109 mmHg
diastolic-wise; grade 3 or severe hypertension for blood pressure greater than or
equal to 180 mmHg systolic-wise and greater than or equal to 110 mmHg
diastolic-wise.
Anemia was defined as a hemoglobin level less than 12 g/dl. It was said to be
severe when the hemoglobin level was less than 8 g/dl and moderate between 8
and 12 g/dl.

2.5. Statistical Analysis

The data were entered using Excel software and analyzed using SPSS software in
version 22. The statistical test used was the exact chi-square test with a
significance level p < 0.05.

3. Results
During the study period, 213 patients received emergency dialysis in the ward.
Of these, 146 met the inclusion criteria. The patients’ medium age was 39.80 ±
14.55 years with the extremes of 13 and 85 years. The age group of [35 – 65]
years was the most represented with 54.7%. We observed 59.5% of male subjects
and 40.4% of female subjects.
Patients’ medical history was dominated by hypertension (63.9%), CKD
(23.9%) and HIV-infection (8.2%). The main clinical signs were hypertensive
surge (64.3%), edema (44.5%) and coma (30.1%) (Table 1). This hypertension
was grade 3 in 42.5% of cases.
Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%.
The other laboratory abnormalities were hyperkalemia (28%), hypocalcemia
(70.1%), hyponatremia (68.7%) and elevated C Reactive Protein (CRP) (93.3%)
(Table 1).
Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies
were glomerular (54.1%), vascular (20.5%).
The main indications for hemodialysis were encephalopathy (33.5%),
severe uremia (28%), acute lung edema (19.8%), persistent anuria (11.6%) and
hyperkalaemia (5.4%).
The vascular access was a catheter in 97.2% (femoral site in 53.4% and jugular
in 43.8%) and an arteriovenous fistula in 2.7%.

DOI: 10.4236/ojneph.2020.104033 341 Open Journal of Nephrology

K. S. Didier et al.

Table 1. General characteristics of the patients.

Total Deceased alive

Variables p OR (IC = 95%)
(n = 146) (n = 26) (n = 120)

Sex
Male 59.6% (87/146) 61.5% (16/26) 59.1% (71/120) 0.8
Female 40.4% (59/146) 38.6% (10/26) 40.8% (49/120) 0.8
Age (years)
<35 39.7% (58/146) 23.0% (6/26) 43.3% (52/120) 0.05
[35-65] 54.7% (80/146) 61.5% (16/26) 53.3% (64/120) 0.4

4.18
≥65 5.4% (8/146) 15.3% (4/26) 3.3% (4/120) 0.04
(1.04 - 16.8)

Comorbidities
Hypertension 63.6% (93/146) 53.8% (14/26) 65.8% (79/120) 0.24
CKD 23.9% (35/146) 15.3% (4/26) 25.8% (31/120) 0.25
HIV 8.2% (12/146) 38% (1/26) 9.1% (11/120) 0.3
Clinical Signs
Hypertension 64.3% (94/120) 46.1% (12/26) 68.3% (82/120) 0.1
Edema 44.5% (65/146) 42.3% (11/26) 45.% (54/120) 0.3

7.14
Coma 30.1% (44/146) 57.6% (15/26) 24.1% (29/120) 0.008
(1.6 - 30.8)

Dehydration 12.3% (18/146) 23.1% (6/26) 10% (12/120) 0.06

Lung edema 6.8% (10/146) 3.8% (1/26) 7.5% (9/120) 0.8

Blood pressure
grade
1 14.9% (14/94) 19.2% (5/26) 13.2% (9/68) 0.06

0.29
2 42.5% (40/94) 11.5% (3/26) 54.4% (37/68) 0.05
(0.08 - 1.03)

3 42.5% (40/94) 15.3% (4/26) 52.9% (36/68) 0.13

Biology
Elevated CRP 93.3% (127/136) 92.3% (24/26) 85.8% (103/120) 0.7
Hypocalcemia 70.1% (54/146) 26.9% (7/26) 39.1% (47/120) 0.6
Hyponatremia 68.7 (99/144) 65.3% (17/26) 39.1% (47/120) 0.51
Hb < 8 57.5% (84/146) 50% (13/26) 59.1% (71/120) 0.61
Hyperkaliemia 28.1% (41/146) 42.3% (11/26) 25% (30/120) 0.06

Acute Kidney 2.7

24.6% (36/146) 42.3% (11/26) 20.8% (25/120) 0.02
Injury (1.1 - 6.8)

The outcome was favorable in 82.2% and death observed in 17.8%. Kidney
function stabilized in 71.9% and normalized in 10.2%. In univariate analysis,
age > 65 years (p = 0.04), coma (p = 0.004) and acute acute kidney injury (p =
0.02) were associated with the risk of death (Table 1).
In multivariate analysis, only coma seemed to be associated with the risk of
mortality in our patients (Table 2).

DOI: 10.4236/ojneph.2020.104033 342 Open Journal of Nephrology

 K. S. Didier et al.

Table 2. Risk factor for death after multivariate logistic regression analysis.

Variables P OR IC (95%)
Age > 65 ans 0.2 0.4 0.07 - 1.8
AKI 0.2 0.5 0.18 - 13
Coma 0.02 5.8 1.2 - 33.3

4. Discussion
This work describes the profile of patients undergoing their first hemodialysis
session in an emergency situation. The majority of these were young adults. Our
results are similar to those found by Yaya Kane et al. in Senegal [10] who noted
an average age of 41.3 years. On the other hand, our patients seemed younger
than those of Dali Youcef et al. in Algeria [11] who had found a medium age of
57.8 ± 16 years. This difference could be explained by the difference in life
expectancy which seems to be higher in Maghreb.
The male predominance observed in our work is found in all the African
series [11] [12]. This could be explained by the predominance of Kidney disease
in men.
The comorbidities were dominated by hypertension found in one out of ten
patients, followed by HIV infection. Fayrouz Zemed et al observed hypertension
in 46% of cases in Morocco in 2017 [13]. In our context, hypertension followed
by HIV infection is the two main risk factors for chronic renal failure [14].
Almost one in four patients (24%) had a known CKD. The fact that the latter
begin their hemodialysis sessions under emergency conditions could be explained
by the high cost of treatment and/or the availability of centers. This would be
added the refusal to accept the disease in some cases.
The clinical signs vary according to the departments in which the studies are
carried out. Thus, the hypertensive surge observed in six out of ten patients in
our study is a common situation in nephrology. In intensive care settings,
neurological disorders are frequent and may affect eight out of ten patients as
observed by Fayrouz Zemed et al. [12].
CKD was predominant and found in over two-thirds of our patients. In
Algeria, Dali Youcef [11] noted a predominance of AKIs with 65%. This
difference could be explained by the difficulty of access to hemodialysis by
patients in our context. This difficulty could be attributable not only to the high
cost of dialysis in private centers but also to the availability of public centers,
which remains limited.
The probable etiologies of CKD were dominated by CGN with 70.91% of
cases. Our results corroborate with those of the numerous studies that show a
high proportion of CGN in the aetiologies of especially in our context [14].
In our study, the indications for hemodialysis were dominated by uremic
encephalopathy and severe uremia. Other authors [11] [15] have reported
hyperkalemia and anuria as the main indications for emergency dialysis. This
difference could be explained by the predominance of CKD cases in our study

DOI: 10.4236/ojneph.2020.104033 343 Open Journal of Nephrology

K. S. Didier et al.

versus a predominance of AKIs in these studies.

The catheter is the main vascular access for emergency hemodialysis, as
reported by various authors [11] [12] [13] [15]. The installation site varies
according to the habits of the services. Thus, the femoral catheter was the most
used followed by the jugular catheter in our patients. Dali Youcef et al. [11]
reported the femoral catheter in 72.5%, the site in 15% and the AVF in 12.5%.
The mortality of 17.80% in our series was lower than that observed in the
Moroccan series, respectively 32.2% [13] and 70% [15].
The high proportion of CKD cases in our work and the comorbidities of the
patients could explain this difference. When analyzing the cases of AKI in our
patients, mortality was in the order of 30.55%. In the sub-Saharan African series,
mortality varies between 34.1% [16] and 42.1% [10] in the event of AKI.
Globally, AKI-related mortality can reach 50% according to some meta-analyzes
and this mortality could be higher in the absence of hemodialysis [6] [17].
On univariate analysis, age > 65 years, coma, and AKI appeared to be risk
factors for mortality. But in multivariate analysis, only coma was significantly
linked to death. Talbi Sofia et al. [13] reported that hyperkalaemia was
significantly associated with death in emergency hemodialysis AKIs. In the study
by Suter Mendonça et al. [18], age ≥ 65 years was a risk factor for death in AKI.

5. Conclusions
Hemodialysis in an emergency is a common practice at the Yopougon University
Hospital. Our patients were predominantly young with a predominance of men.
Almost all of the patients were hospitalized for various reasons dominated by
neurological disorders and edema. The main physical signs were hypertension,
edema and coma. Apart from very high urea levels and serum creatinine, anemia
and inflammatory syndrome were found in almost all of our patients.
CKD cases were predominant and found in three out of four patients with
CGN as the main initial nephropathy. Uremic encephalopathy dominated the
indications for the hemodialysis session. The femoral catheter was the most
widely used vascular access.
Mortality was 17.80% and higher in AKI cases. Coma seems to be a factor of
poor prognosis.
It turns out that emergency hemodialysis is a critical situation especially for
AKI cases. It is therefore imperative to be prompt in performing hemodialysis.

Limitations of the Study

Our study had limitations due to its retrospective nature. The information
sought in the clinical records of patients was sometimes not complete.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this pa-
per.

DOI: 10.4236/ojneph.2020.104033 344 Open Journal of Nephrology

 K. S. Didier et al.

References
[1] Bello, A.K., Levin, A., Tonelli, M., Okpechi, I.G., Feehally, J., Harris, D., et al. (2017)
Assessment of Global Kidney Health Care Status. JAMA, 317, 1864-1881.
https://doi.org/10.1001/jama.2017.4046
[2] Fouda, H., Ashuntantang, G., Kaze, F. and Halle, M.-P. (2017) Survival among
Chronic Hemodialysed Patient in Cameroon. Pan African Medical Journal, 26, 97.
[3] Suisse, D. (2016) Quand appeler le néphrologue aux urgences. Revue Médicale
Suisse, 12, 398-403.
[4] James, M.T., Heerspink, H.J.L., Pollock, C.A. and Stevens, P.E. (2018) Improving
the Prognosis of Patients with Severely Decreased Glomerular Filtration Rate (CKD
G4+): Conclusions from a Kidney Disease Improving Global Outcomes (KDIGO)
Controversies Conference. Kidney International, 93, 1281-1292.
[5] Thervet, E. (2017) Traité de Néphrologie. Editions Lavoisier Médecine Sciences.
[6] Town, C., Mehta, R.L., Cerdá, J., Burdmann, E.A., Tonelli, M., García-garcía, G., et
al. (2015) Congress International Society of Nephrology’s 0by25 Initiative for Acute
Kidney Injury (Zero Preventable Deaths by 2025): A Human Rights Case for Ne-
phrology. The Lancet, 385, 2616-2643.
https://doi.org/10.1016/S0140-6736(15)60126-X
[7] Liyanage, T., Ninomiya, T., Jha, V., Neal, B., Patrice, H.M., Okpechi, I., et al. (2013)
Worldwide Access to Treatment for End-Stage Kidney Disease. The Lancet, 385,
1975-1982. https://doi.org/10.1016/S0140-6736(14)61601-9
[8] Kolhe, N.V., Muirhead, A.W., Wilkes, S.R., Fluck, R.J. and Taal, M.W. (2015) Na-
tional Trends in Acute Kidney Injury Requiring Dialysis in England between 1998
and 2013. Kidney International, 88, 1161-1169.
https://doi.org/10.1038/ki.2015.234
[9] Couchoud, C., Lassalle, M. and Jacquelinet, C. (2013) Rapport Rein 2011—Synthèse.
Néphrologie Thérapeutique, 9, S3-S6.
https://doi.org/10.1016/S1769-7255(13)70036-1
[10] Yaya, K., De, S., Aristide, H., Dantec, L. and Sénégal, D. (2016) Décentralisation De
La Dialyse Au Sénégal: Expérience d’un an du centre de Tambacounda à l’Est du
Pays. European Scientific Journal, 12, 164-173.
https://doi.org/10.19044/esj.2016.v12n36p164
[11] Dali Youcef, H.S. (2016) La Dialyse en Urgence. Thèse Médecine 2017. Université
Abou Bekr Belkaid Tlmen, Algerie.
[12] Farouz, Z. (2017) Epuration extrarénale en réanimation. Thèse de médecine,
Université Cadi Ayyad Marrakech (Maroc).
[13] Talbi, S. (2011) Hémodialyse en situation d’urgence (à propos de 207 cas). Thèse de
Médecine, Université Sidi Mohammed Ben Abdellah Fès (Maro).
[14] Yao, H.K., Konan, S.D., Sanogo, S., Diopoh, S.P. and Diallo, A.D. (2018) Prevalence
and Risk Factors of Chronic Kidney Disease in Cote D’Ivoire: An Analytic Study
Conducted in the Department of Internal Medicine. Saudi Journal of Kidney
Diseases and Transplantation, 29, 153-159.
https://doi.org/10.4103/1319-2442.225201
[15] Bouda, R. (2016) Epuration extrarénale en réanimation (à propos de 40 cas). Thèse
de médecine, Université Cadi Ayyad Marrakech (Maroc).
[16] Adu, D., Okyere, P., Doima, V., Malekole, M. and Osafo, C. (2016) Commu-
nity-Acquired Acute Kidney Injury in Adults in Africa. Clinical Nephrology, 86,
S48-S52. https://doi.org/10.5414/CNP86S121

DOI: 10.4236/ojneph.2020.104033 345 Open Journal of Nephrology

K. S. Didier et al.

[17] Igiraneza, G., Ndayishimiye, B., Nkeshimana, M., Dusabejambo, V. and Ogbuagu,
O. (2018) Clinical Profile and Outcome of Patients with Acute Kidney Injury Re-
quiring Hemodialysis: Two Years’ Experience at a Tertiary Hospital in Rwanda.
BioMed Research International, 2018, Article ID: 1716420.
https://doi.org/10.1155/2018/1716420
[18] Suter, P.M., Moreno, R., Dearden, N.M., Antonelli, M., Takala, J., St, A., et al.
(2000) Acute Renal Failure in the ICU: Risk Factors and Outcome Evaluated by the
SOFA Score. Intensive Care Medicine, 26, 915-921.
https://doi.org/10.1007/s001340051281

DOI: 10.4236/ojneph.2020.104033 346 Open Journal of Nephrology

 K. S. Didier et al.

Appendix
Standardized Survey Sheet
Hospitalization file number: …………………………………………
1) DEMOGRAPHIC DATA
Age: …. Years Sex: M □ F □
Level of study: primary □ secondary □ University□ lliterate □
Profession: ……………
2) CLINICS
Reason for admission ……………………………………………………………….
Antecedents
Hypertension: Yes □ No □
Diabetes: Yes □ No □; CKD: Yes □ No □; HIV: Yes □ No □
Taking toxic substances: Tobacco: Yes □ No □; alcohol: Yes □ No □;
Traditional medicines: Yes □ No □; NSAIDs: Yes □ No □,
Exams
State of consciousness: …………… .. State of hydration: …………………………
Blood pressure: ………….mmHg
3) BLOOD BIOLOGY
WBC ……. /mm3, Hb: …… g/dL, Platelets: …. ×103/mm3, Urea ……… g/L
Creatinine …..mg/L, CRP: …..mg/L, Na+: ……MEq/L, Ca2+: ….mg/L,
K+: …..mEq/L
4) DIAGNOSTIC
Acute Kidney Injury: Yes □ No □ if yes type: ………………………...
Chronic Kidney Desease: Yes □ No □ if yes type: ……………………
5) TREATMENT
Hemodialysis
HD indication: ………………………………………………………
Vascular access: ………………………………………………………….…
Number of sessions: …………………………………………………………….
Other treatments
Blood Transfusion: Yes □ No □
Antibiotic therapy: Yes □ No □
6) EVOLUTION
Healing: Yes □ No □
Stabilization: Yes □ No □
Death: Yes □ No □ if Yes cause: …………………………………
Duration of hospitalization: ………………………………………

DOI: 10.4236/ojneph.2020.104033 347 Open Journal of Nephrology