Influência do ganho de peso interdialítico na sobrevida e risco de óbito em pacientes tratados por hemodiálise crônica
Carregando...
Data
2013-02-19
Autores
Batistão, Samantha Marqueti [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
A mortalidade por causa cardiovascular e por todas as causas em pacientes tratados por hemodiálise (HD) é fortemente influenciada pela presença de inflamação e de depleção nutricional. O ganho de peso interdialítico (GID) é outro fator associado ao risco cardiovascular nesses pacientes, sendo que elevado GID é considerado indicador de não adesão à restrição de sódio e líquidos. Entretanto a associação entre GID e mortalidade em pacientes dialisados não é uniformemente relatada, sendo que pacientes com maior GID têm maiores concentrações de albumina e de creatinina e que estas variáveis são negativamente associadas ao risco de óbito. Considerando a conhecida influência da inflamação sobre o estado nutricional e aterosclerose, este estudo objetivou avaliar a influência do GID sobre a sobrevida e risco de óbito de pacientes cronicamente tratados por HD, de acordo com a presença ou ausência de inflamação. Foram estudados 104 pacientes > 18 anos em HD regular a pelo menos 90 dias, incidentes em HD entre janeiro de 2005 e dezembro de 2010, divididos em quatro grupos: grupo G>I>: 25 pacientes com %GID ≥ 3,1% do peso seco e PCR ≥0,55 mg/dl; grupo G<I>:23 pacientes com %GID < 3,1% do peso seco e PCR ≥ 0,55 mg/dl; grupo G>I<: 29 pacientes com %GID ≥ 3,1% do peso seco e PCR < 0,55 mg/dl e grupo G<I<: 27 pacientes com %GID < 3,1% do peso seco e PCR < 0,55 mg/dl. Os valores de GID e de PCR, utilizados para composição dos grupos corresponderam à mediana do conjunto de pacientes nos primeiros seis meses de observação. Dados demográficos, clínicos, dialíticos, laboratoriais e nutricionais foram obtidos dos registros clínicos da Unidade de Diálise, sendo os pacientes acompanhados por até 24 meses. Os grupos G>I>e G<I> apresentaram menor probabilidade de sobrevida (p=0.004). Idade (HR=1,159, p=0,02) e concentração da PCR (HR=1.224, p=0.03)...
In hemodialysis (HD) patients mortality from cardiovascular disease and from all causes is strongly influenced by the presence of inflammation and wasting. The interdialytic weight gain (IDWG) is another factor associated with cardiovascular risk in these patients; it is considered an indicator of non-adherence of sodium and fluid restriction. However the association between IDWG and mortality in dialysis patients is not uniformly reported; patients with greater IDWG have higher serum concentrations of albumin and creatinine and these variables are negatively associated with death risk. Considering the strong influence of inflammation on nutritional status and atherosclerosis, this study aimed to evaluate the influence of IDWG on survival and risk of death in HD patients, according to the presence or absence of inflammation. We studied 104 adult patients in regular HD to at least 90 days, incidents between January 2005 and December 2010, divided into four groups: group G>I>: 25 patients with %IDWG ≥ 3.1 % of dry weight and CRP ≥0.55 mg/dl; group G<I>:23 patients with %IDWG< 3.1 % of dry weight and CRP) ≥ 0.55 mg/dl; group G>I<:29 patients with %IDWG ≥ 3.1 % of dry weight and CRP < 0.55 mg/dl, and group G<I<: 27 patients with %IDWG < 3.1 % of dry weight and CRP < 0.55 mg/dl. The values of IDWG and CRP concentrations, used for composition of the groups, corresponded to the median of the set of patients in the first six months of observation. Demographic, clinical, dialytic, laboratory, and nutritional data were obtained of the clinical records of Dialysis Unit. Patients were followed for up to 24 months. The groups G>I>and G<I> presented lower probability of survival (p=0.004) compared to the groups G>I< and G<I<. Age (HR=1.159, p=0.02) and CRP (HR=1.224, p=0.03) were independent predictors of death, whereas higher BMI was associated with reduced risk... (Complete abstract click electronic access below)
In hemodialysis (HD) patients mortality from cardiovascular disease and from all causes is strongly influenced by the presence of inflammation and wasting. The interdialytic weight gain (IDWG) is another factor associated with cardiovascular risk in these patients; it is considered an indicator of non-adherence of sodium and fluid restriction. However the association between IDWG and mortality in dialysis patients is not uniformly reported; patients with greater IDWG have higher serum concentrations of albumin and creatinine and these variables are negatively associated with death risk. Considering the strong influence of inflammation on nutritional status and atherosclerosis, this study aimed to evaluate the influence of IDWG on survival and risk of death in HD patients, according to the presence or absence of inflammation. We studied 104 adult patients in regular HD to at least 90 days, incidents between January 2005 and December 2010, divided into four groups: group G>I>: 25 patients with %IDWG ≥ 3.1 % of dry weight and CRP ≥0.55 mg/dl; group G<I>:23 patients with %IDWG< 3.1 % of dry weight and CRP) ≥ 0.55 mg/dl; group G>I<:29 patients with %IDWG ≥ 3.1 % of dry weight and CRP < 0.55 mg/dl, and group G<I<: 27 patients with %IDWG < 3.1 % of dry weight and CRP < 0.55 mg/dl. The values of IDWG and CRP concentrations, used for composition of the groups, corresponded to the median of the set of patients in the first six months of observation. Demographic, clinical, dialytic, laboratory, and nutritional data were obtained of the clinical records of Dialysis Unit. Patients were followed for up to 24 months. The groups G>I>and G<I> presented lower probability of survival (p=0.004) compared to the groups G>I< and G<I<. Age (HR=1.159, p=0.02) and CRP (HR=1.224, p=0.03) were independent predictors of death, whereas higher BMI was associated with reduced risk... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Hemodialise, Desnutrição, Nutrição - Avaliação, Inflamação, Indice de massa corporal, Corpo - Peso, Inflammation
Como citar
BATISTÃO, Samantha Marqueti. Influência do ganho de peso interdialítico na sobrevida e risco de óbito em pacientes tratados por hemodiálise crônica. 2013. 61 f. Tese (doutorado) - Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, 2013.