Impacto do acompanhamento com bioimpedância na predição de eventos cardiovasculares em pacientes em diálise crônica
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Data
2012-02-28
Autores
Antunes, Aline de Araujo [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Desnutrição e sobrecarga líquida têm sido apontadas como fatores que contribuem para o pior prognóstico cardíaco da população em diálise. A bioimpedância é opção para avaliação da composição corporal e monitoramento do estado de hidratação, entretanto faltam estudos que investiguem a relevância dos parâmetros da bioimpedância em relação ao prognóstico cardiovascular. O objetivo deste trabalho foi identificar a importância do monitoramento seriado por bioimpedância na ocorrência de eventos cardiovasculares. Avaliou-se por bioimpedância 145 indivíduos prevalentes em diálise, em intervalos de quatro meses, investigando as relações entre parâmetros da bioimpedância e prognóstico cardiovascular fatal e não fatal. O período de seguimento foi de 23(12; 34) meses, com 27,6% dos pacientes acometidos por eventos cardiovasculares. Análise comparativa entre os pacientes que apresentaram e os que não apresentaram evento cardiovascular revelou que menores valores de ângulo de fase, massa celular corporal e água intracelular e maiores valores das relações massa extracelular/ massa celular corporal e água extracelular/ água corporal total foram indicativos de pior prognóstico cardiovascular. A análise de sobrevida por modelo de Cox convencional considerando unicamente parâmetros obtidos na inserção do paciente no estudo reforçou esses achados, exceto para relação água extracelular/ água corporal total. Na monitoração seriada por bioimpedância, analisada por modelo de Cox com covariável dependente do tempo, os parâmetros não foram preditores de eventos cardiovasculares. Esse conjunto de achados sugere a associação da desnutrição e da sobrecarga líquida com a ocorrência de eventos cardiovasculares, o que reforça a aplicação da bioimpedância em diálise
Malnutrition and fluid overload have been pointed as contribution factors to the poor cardiovascular prognosis of dialysis population. Bioimpedance is an option for both body composition and hydration status evaluations, however there are few studies that have investigated the relevance of the bioimpedance parameters in relation to cardiovascular prognosis. The purpose of this study was identify the importance of continued monitoring by bioimpedance in the prediction of cardiovascular events. One hundred forty five prevalent dialysis patients were evaluated every four months by bioimpedance, and the relations between its parameters and fatal and nonfatal cardiovascular events were investigated. During the follow-up of 23(12; 34) months, 27.6% of patients had cardiovascular events. The comparative analysis between patients that had no events and those that had cardiovascular events showed that lower values of phase angle, body cell mass and intracellular water and higher values of the relation between extracellular water/ total body water and between extracellular mass/ body cell mass pointed to a worse cardiovascular prognosis. The survival analysis by traditional Cox regression considering parameters obtained in first evaluation reinforced these findings, except for extracellular water/ total body water relation. In serial monitoring by bioimpedance, analyzed by time-dependent Cox regression, the parameters were not identify as cardiovascular predictors. This set of findings suggests the association of malnutrition and fluid overload with cardiovascular events occurrence and reinforces the usefulness of bioimpedance in dialysis
Malnutrition and fluid overload have been pointed as contribution factors to the poor cardiovascular prognosis of dialysis population. Bioimpedance is an option for both body composition and hydration status evaluations, however there are few studies that have investigated the relevance of the bioimpedance parameters in relation to cardiovascular prognosis. The purpose of this study was identify the importance of continued monitoring by bioimpedance in the prediction of cardiovascular events. One hundred forty five prevalent dialysis patients were evaluated every four months by bioimpedance, and the relations between its parameters and fatal and nonfatal cardiovascular events were investigated. During the follow-up of 23(12; 34) months, 27.6% of patients had cardiovascular events. The comparative analysis between patients that had no events and those that had cardiovascular events showed that lower values of phase angle, body cell mass and intracellular water and higher values of the relation between extracellular water/ total body water and between extracellular mass/ body cell mass pointed to a worse cardiovascular prognosis. The survival analysis by traditional Cox regression considering parameters obtained in first evaluation reinforced these findings, except for extracellular water/ total body water relation. In serial monitoring by bioimpedance, analyzed by time-dependent Cox regression, the parameters were not identify as cardiovascular predictors. This set of findings suggests the association of malnutrition and fluid overload with cardiovascular events occurrence and reinforces the usefulness of bioimpedance in dialysis
Descrição
Palavras-chave
Corpo - Composição, Impedancia (Eletricidade), Sistema cardiovascular, Dialise, Impedance (Electricity), Cardiovascular system, Dialysis
Como citar
ANTUNES, Aline de Araujo. Impacto do acompanhamento com bioimpedância na predição de eventos cardiovasculares em pacientes em diálise crônica. 2012. 53 f. Tese (doutorado) - Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, 2012.