Efeitos de diferentes doses de hemodiálise convencional diária na sobrevida de pacientes com injúria renal aguda
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Data
2011-02-11
Autores
Abrão, Juliana Maria Gera [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A Injúria Renal Aguda (IRA) é síndrome associada a elevadas taxas de mortalidade, especialmente entre pacientes que necessitam de suporte renal agudo (SRA). Estudos recentes mostram que a dose de diálise deve ser medida, apesar da definição do valor ideal de dose permanecer inconclusiva. Avaliar a sobrevida de pacientes com IRA de acordo com as doses de hemodiálise convencional diária (HCD) recebidas. Coorte retrospectiva de pacientes com IRA renal e apresentação clínica sugestiva de Necrose Tubular Aguda (NTA), submetidos à HCD, de janeiro de 2004 a janeiro de 2009, em dois hospitais de referência em nefrologia. A dose de diálise obtida por sessão foi calculada segundo a equação do single pool (sp) Kt/V e, de acordo com o Kt/V semanal mediano recebido, os pacientes foram divididos em Grupo Diálise Intensa (GDI: Kt/V maior que a mediana) e Grupo Diálise Menos Intensa (GDMI: Kt/V menor ou igual a mediana). As comparações entre grupos foram realizadas usando-se os testes t Student e Mann- Whitney e as comparações entre proporções, testes do Qui-Quadrado e teste exato de Fisher. Para grupos em que foi encontrada diferença na mortalidade, foi ajustado um modelo de regressão de Cox múltiplo. Também foram construídas curvas de sobrevida pelo método de Kaplan-Meier e realizada a comparação entre grupos pelo teste Logrank. Considerado nível de significância de 5%. Foram estudados 121 pacientes, com idade mediana de 65 anos, sendo 60,3% homens. Sepse e oligúria estiveram presentes em, respectivamente, 65,3% e 62,8% dos pacientes. O ATN-ISS mediano foi 0,68 e a mortalidade ao final do seguimento e em 30 dias foram de 60,3% e 57,8%, respectivamente. O Kt/V semanal mediano obtido foi 5,16 (4,50–6,14). Pacientes do GDI (n=60) apresentaram características clínicas e laboratoriais semelhantes aos do GDMI (n=61). Houve tendência estatística para maior mortalidade...
Acute kidney injury (AKI) is a syndrome associated with high mortality rates, especially among patients requiring acute renal support (ARS). Recent studies have demonstrated that dialysis dosage should be quantified. However, the optimum dose remains undetermined. To assess AKI patient survival according to the daily conventional hemodialysis (DCH) dose received. Retrospective cohort of patients with AKI and clinical presentation suggestive of Acute Tubular Necrosis (ATN), receiving DCH between January/2004 and January/2009 in two reference nephrology hospitals. The per-session dialysis dose was estimated on the basis of the single pool (sp) equation Kt/V, and the median weekly Kt/V received. The patients were allocated into two groups: Intensive Dialysis group (ID: Kt/V > median), and Less Intensive Dialysis group (LID: Kt/V median). Comparisons between groups were performed using Student’s t test and the test of Mann-Whitney, while proportions were compared using the Chi-square test and Fisher’s exact test. When differences in mortality were detected, Cox’s multiple regression model was used. Additionally, Kaplan-Meier curves were built, and groups were compared by the test of Logrank. Statistical significance level was set at 5%. This study included 121 patients (60.3% males) with median age 65 years. Sepsis and oliguria were present in 65.3% and 62.8% of the cases, respectively. Median ATN-ISS was 0.68 and mortality at the end of follow up and 30-day mortality were 60.3% and 57.8%, respectively. Median weekly Kt/V was 5.16 (4.50–6.14). Clinical and laboratory characteristics were similar in both ID (n=60) and LID (n=61). Mortality rate at 30 days tended to be higher in LID (67.2%) than in ID (48.3%, p=0.055). At the end of follow up mortality rates were 68.8% in LID and 51.7% in ID (p=0.080). A subset analysis of 42 patients without Sepsis and 42 without oliguria... (Complete abstract click electronic access below)
Acute kidney injury (AKI) is a syndrome associated with high mortality rates, especially among patients requiring acute renal support (ARS). Recent studies have demonstrated that dialysis dosage should be quantified. However, the optimum dose remains undetermined. To assess AKI patient survival according to the daily conventional hemodialysis (DCH) dose received. Retrospective cohort of patients with AKI and clinical presentation suggestive of Acute Tubular Necrosis (ATN), receiving DCH between January/2004 and January/2009 in two reference nephrology hospitals. The per-session dialysis dose was estimated on the basis of the single pool (sp) equation Kt/V, and the median weekly Kt/V received. The patients were allocated into two groups: Intensive Dialysis group (ID: Kt/V > median), and Less Intensive Dialysis group (LID: Kt/V median). Comparisons between groups were performed using Student’s t test and the test of Mann-Whitney, while proportions were compared using the Chi-square test and Fisher’s exact test. When differences in mortality were detected, Cox’s multiple regression model was used. Additionally, Kaplan-Meier curves were built, and groups were compared by the test of Logrank. Statistical significance level was set at 5%. This study included 121 patients (60.3% males) with median age 65 years. Sepsis and oliguria were present in 65.3% and 62.8% of the cases, respectively. Median ATN-ISS was 0.68 and mortality at the end of follow up and 30-day mortality were 60.3% and 57.8%, respectively. Median weekly Kt/V was 5.16 (4.50–6.14). Clinical and laboratory characteristics were similar in both ID (n=60) and LID (n=61). Mortality rate at 30 days tended to be higher in LID (67.2%) than in ID (48.3%, p=0.055). At the end of follow up mortality rates were 68.8% in LID and 51.7% in ID (p=0.080). A subset analysis of 42 patients without Sepsis and 42 without oliguria... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Hemodialise - Estudo de caso, Injúria renal aguda, Oliguria
Como citar
ABRÃO, Juliana Maria Gera. Efeitos de diferentes doses de hemodiálise convencional diária na sobrevida de pacientes com injúria renal aguda. 2011. 62 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2011.