RESEARCH ON FREQUENCY AND CHARACTERISTICS OF PATIENTS WITH FEVER AND CHILLS OCCURRED DURING DIALYSIS AT THONG NHAT HOSPITAL: FIVE-YEAR FOLLOW-UP STUDY

Introduction: Chills and fever are relatively common complications during hemodialysis, posing challenges in diagnosis and management, particularly in high-volume dialysis units. This study aimed to evaluate the incidence and clinical characteristics of patients experiencing these complications at Thong Nhat Hospital over a five-year period. Methods: We conducted a descriptive cross-sectional study with longitudinal follow-up, including all emergency and maintenance hemodialysis sessions performed between January 1, 2020, and December 31, 2024. Inclusion criteria were patients with stable vital signs before dialysis who developed fever and/or chills during treatment. Exclusion criteria included dialysis for poisoning, critically ill patients requiring vasopressors, plasma exchange, or concurrent blood transfusion during dialysis. Results: A total of 114,282 dialysis sessions met the inclusion criteria. The number of sessions increased annually, with the most significant rise in 2024 (55.7% increase from 2020). The incidence of chills and/or fever ranged from 0.039% to 0.113%, with a rising trend in recent years. Initial endotoxin concentrations in the dialysate ranged from 0.143 to 0.262 EU/mL. Most complications occurred within the first 1–2 hours of dialysis (75%), with chills alone or combined with fever present in 91.2% of cases. Blood culture positivity was 49.3%, while dialysate cultures had a lower positivity rate (14.5%). Of affected patients, 72.5% were managed successfully and continued dialysis, while 27.5% required discontinuation and hospitalization. Conclusion: Chills and fever remain significant complications during hemodialysis, with an increasing trend parallel to rising dialysis volume. Regular surveillance and improvements in the capacity and microbiological standards of the RO water system are essential to ensure patient safety.