Implantação do programa de diálise peritoneal não planejada como opção de terapia renal substitutiva em pacientes com doença renal crônica
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Data
2022-04-04
Autores
Alves, Camila Albuquerque
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Universidade Estadual Paulista (Unesp)
Resumo
A diálise peritoneal (DP) não planejada é uma importante opção de tratamento para pacientes com doença renal crônica (DRC) em estágio final e que requerem terapia renal substitutiva (TRS) de início urgente, uma vez que oferece aos pacientes a conveniência do tratamento domiciliar. Objetivos: Analisar e avaliar o programa de DP de início urgente em hospital universitário paulista e implantar o programa em dois outros municípios brasileiros carentes de vagas de hemodiálise (HD). Metodologia: Estudo de coorte retrospectivo e prospectivo, multicêntrico que avaliou pacientes incidentes em DP de três hospitais, cujo início do tratamento dialítico ocorreu de forma urgente no período de julho de 2014 a julho de 2020. Foram incluídos pacientes com DRC estádio 5 que necessitaram de tratamento dialítico imediato, sem acesso vascular definitivo. DP urgent start foi definida como início do método em até 48 horas após o implante do cateter. Os pacientes foram acompanhados desde o momento do implante do cateter e início do método até o período mínimo de 180 dias de terapia e avaliado quanto aos desfechos: óbito, mudança de método devido à falência de técnica e complicações infecciosas ou mecânicas sem sucesso com o tratamento instituído. Resultados: Durante 6 anos foram incluídos o total de 370 pacientes nos três serviços, com idade de 57,8±16,32 anos, sendo a nefropatia diabética a principal doença de base (35,1%) e a uremia a principal causa de indicação de diálise (81,1%). Em 64,9% dos pacientes foi realizado visita domiciliar, 24,3% apresentaram complicações mecânicas, 27,3% tiveram peritonites, falência de técnica ocorreu em 28,01% e a mortalidade foi de 17,8%. A mediana e quartis de complicações mecânicas, infecciosas (peritonite e IOS) e de sobrevida foram de 212 (34,50 - 511,00), 247 (68,75 - 496,50), 212 (42,00-445,00) e 350 (112,75 - 625,50) dias, respectivamente. A regressão logística identificou como fatores associados às peritonites a necessidade de internação (OR=2,29, IC=1,32-3,98 e p=0,003) e presença de IOS (OR=1,12, IC=1,07-1,34 e p=0,002); associados à falência de técnica a presença peritonite (OR= 2,50, IC=1,46-4,26 e p<0,001) e de complicação mecânica (OR=2,17,IC=1,28-3,70 e p=0,004); e associados ao óbito a idade (OR=1,04,IC=1,02-1,07 e p<0,001), necessidade de internação (OR= 2,28, IC=1,20-4,34 e p=0,012) e bacteremia (OR=3,99, IC=1,23-12,90 e p=0,021). Foi observado crescimento de no mínimo 140% no número de pacientes realizando DP em cada centro. Conclusão: A DP tem se mostrado um tratamento viável para pacientes com necessidade de diálise de início urgente, podendo assim ser uma importante ferramenta para escassez de vagas para HD.
Unplanned peritoneal dialysis (PD) is an important treatment option for patients with end-stage chronic kidney disease (CKD) who require urgent-onset renal replacement therapy (RRT) as it offers patients the convenience of home treatment. Objectives: To analyze and evaluate the urgent-onset PD program in a university hospital in São Paulo and to implement the program in two other Brazilian municipalities lacking hemodialysis (HD) vacancies. Methodology: A retrospective and prospective, multicenter cohort study that evaluated incident PD patients from three hospitals, whose dialysis treatment started urgently from July 2014 to July 2020. Patients with CKD stage 5 who required immediate dialysis treatment, without definitive vascular access. PD urgent start was defined as starting the method within 48 hours after catheter implantation. Patients were followed up from the moment of catheter implantation and initiation of the method until a minimum period of 180 days of therapy and evaluated regarding the outcomes: death, change of method due to technique failure, and infectious or mechanical complications without success with the established treatment. Results: For 6 years, a total of 370 patients were included in the three services, aged 57.8±16.32 years, with diabetic nephropathy being the main underlying disease (35.1%) and uremia the main cause of dialysis indication (81.1%). A home visit was carried out in 64.9% of the patients, 24.3% had mechanical complications, 27.3% had peritonitis, technique failure occurred in 28.01% and mortality was 17.8%. The median and quartiles of mechanical, infectious (peritonitis and IOS) and survival complications were 212 (34.50 - 511.00), 247 (68.75 - 496.50), 212 (42.00 - 445.00) and 350 (112.75 - 625.50) days, respectively. Logistic regression identified as factors associated with peritonitis the need for hospitalization (OR=2.29, CI=1.32-3.98 and p=0.003) and the presence of IOS (OR=1.12, CI=1.07- 1.34 and p=0.002); associated with technique failure, the presence of peritonitis (OR= 2.50, CI=1.46-4.26 and p<0.001) and mechanical complications (OR=2.17, CI=1.28-3.70 and p= 0.004); and associated with death with age (OR=1.04, CI=1.02-1.07 and p<0.001), need for hospitalization (OR= 2.28, CI=1.20-4.34 and p=0.012) and bacteremia (OR=3.99, CI=1.23-12.90 and p=0.021). A growth of at least 140% was observed in the number of patients undergoing PD in each center. Conclusion: PD has been shown to be a viable treatment for patients in need of urgent onset dialysis and may thus be an important tool for the shortage of HD spaces.
Unplanned peritoneal dialysis (PD) is an important treatment option for patients with end-stage chronic kidney disease (CKD) who require urgent-onset renal replacement therapy (RRT) as it offers patients the convenience of home treatment. Objectives: To analyze and evaluate the urgent-onset PD program in a university hospital in São Paulo and to implement the program in two other Brazilian municipalities lacking hemodialysis (HD) vacancies. Methodology: A retrospective and prospective, multicenter cohort study that evaluated incident PD patients from three hospitals, whose dialysis treatment started urgently from July 2014 to July 2020. Patients with CKD stage 5 who required immediate dialysis treatment, without definitive vascular access. PD urgent start was defined as starting the method within 48 hours after catheter implantation. Patients were followed up from the moment of catheter implantation and initiation of the method until a minimum period of 180 days of therapy and evaluated regarding the outcomes: death, change of method due to technique failure, and infectious or mechanical complications without success with the established treatment. Results: For 6 years, a total of 370 patients were included in the three services, aged 57.8±16.32 years, with diabetic nephropathy being the main underlying disease (35.1%) and uremia the main cause of dialysis indication (81.1%). A home visit was carried out in 64.9% of the patients, 24.3% had mechanical complications, 27.3% had peritonitis, technique failure occurred in 28.01% and mortality was 17.8%. The median and quartiles of mechanical, infectious (peritonitis and IOS) and survival complications were 212 (34.50 - 511.00), 247 (68.75 - 496.50), 212 (42.00 - 445.00) and 350 (112.75 - 625.50) days, respectively. Logistic regression identified as factors associated with peritonitis the need for hospitalization (OR=2.29, CI=1.32-3.98 and p=0.003) and the presence of IOS (OR=1.12, CI=1.07- 1.34 and p=0.002); associated with technique failure, the presence of peritonitis (OR= 2.50, CI=1.46-4.26 and p<0.001) and mechanical complications (OR=2.17, CI=1.28-3.70 and p= 0.004); and associated with death with age (OR=1.04, CI=1.02-1.07 and p<0.001), need for hospitalization (OR= 2.28, CI=1.20-4.34 and p=0.012) and bacteremia (OR=3.99, CI=1.23-12.90 and p=0.021). A growth of at least 140% was observed in the number of patients undergoing PD in each center. Conclusion: PD has been shown to be a viable treatment for patients in need of urgent onset dialysis and may thus be an important tool for the shortage of HD spaces.
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Palavras-chave
Terapia renal substitutiva, Doença renal crônica, Unplanned peritoneal dialysis, Renal replacement therapy, Chronic kidney disease, Diálise peritoneal não planejada