1406/2012 - Ensaio sobre a cegueira: mortalidade de pacientes com doença renal crônica em hemodiálise de emergência Mortality of patients with chronic kidney disease during non-elective hemodialysis
• Beatriz Leimann - Leimann, B - ENSP/FIOCRUZ - Subsecret. Vigilância em Saúde/SES-RJ - <leimann@centroin.com.br>
• Dulce Lessi - Lessi, D - Instituto Est. Cardiologia Aloysio de Castro/SES-RJ - <dulcelessi@hotmail.com>
Área Temática:
Não Categorizado
Resumo:
A doença renal crônica (DRC) leva à falência renal e à necessidade de terapia renal substitutiva (TRS). A prevenção secundária pode retardar em muitos anos a evolução da doença. O presente estudo, retrospectivo, objetivou analisar os fatores prognósticos e estimar a mortalidade de portadores de doença renal crônica (DRC) secundária à hipertensão ou diabetes que iniciam a TRS por hemodiálise de emergência, desde a admissão hospitalar até a transferência para clínica-satélite ou óbito, no Rio de Janeiro. A taxa de mortalidade foi de 35,1%. Houve diferença significativa entre as curvas de sobrevida até o óbito, por doença de base (log-rank e Peto, p=0,02) e por presença de fístula funcional (log-rank, p=0,0099; Peto, p=0,0090). A análise multivariada (modelo de Cox) mostrou aumento no risco de óbito de 7% (p=0,002) por ano de idade; a presença de fístula funcional foi associada a uma redução de 81% no risco (p=0,03). Conclui-se que um terço dos pacientes portadores de DRC por hipertensão e diabetes, que iniciam a TRS de forma não planejada, morrem no período entre a admissão hospitalar e a transferência para clínicas-satélites, o que indica baixo acesso à prevenção secundária na DRC, inclusive à cirurgia para a confecção da fístula arteriovenosa
Chronic kidney disease progresses with renal failure and the need for renal replacement therapy (RRT). Secondary prevention may postpone end-stage renal disease for many years. The present, retrospective, study intended to analyze prognostic factors and to estimate the mortality of patients with kidney failure secondary to diabetes mellitus and to hypertension that initiate RRT through non-elective hemodialysis at an emergency hospital unit in Rio de Janeiro, from hospital admission until transfer to referral units. The mortality rate was 35.1%. The study found a significant difference between the survival curves according to disease etiology (log-rank and Peto, p=0.02) and the presence of functional arteriovenous fistule (log-rank, p=0.0099; Peto, p=0.0090). Multivariate analysis (Cox model) showed a 7% increase in the risk of death (p=0.002) by one-year increment in age; the presence of a functional fistule was associated to an 81% reduction in the risk of death (p=0.03). About one third of patients with kidney failure secondary to hypertension or diabetes that initiate renal replacement therapy through non-elective hemodialysis die before being transferred to a referral unit, indicating low access to secondary prevention activities.
Mortality of patients with chronic kidney disease during non-elective hemodialysis
Resumo (abstract):
Chronic kidney disease progresses with renal failure and the need for renal replacement therapy (RRT). Secondary prevention may postpone end-stage renal disease for many years. The present, retrospective, study intended to analyze prognostic factors and to estimate the mortality of patients with kidney failure secondary to diabetes mellitus and to hypertension that initiate RRT through non-elective hemodialysis at an emergency hospital unit in Rio de Janeiro, from hospital admission until transfer to referral units. The mortality rate was 35.1%. The study found a significant difference between the survival curves according to disease etiology (log-rank and Peto, p=0.02) and the presence of functional arteriovenous fistule (log-rank, p=0.0099; Peto, p=0.0090). Multivariate analysis (Cox model) showed a 7% increase in the risk of death (p=0.002) by one-year increment in age; the presence of a functional fistule was associated to an 81% reduction in the risk of death (p=0.03). About one third of patients with kidney failure secondary to hypertension or diabetes that initiate renal replacement therapy through non-elective hemodialysis die before being transferred to a referral unit, indicating low access to secondary prevention activities.
Krauss Silva, L, Branco Alves, M, Bregman, R, Leimann, B, Lessi, D. Ensaio sobre a cegueira: mortalidade de pacientes com doença renal crônica em hemodiálise de emergência. Cien Saude Colet [periódico na internet] (2012/Set). [Citado em 28/09/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/ensaio-sobre-a-cegueira-mortalidade-de-pacientes-com-doenca-renal-cronica-em-hemodialise-de-emergencia/11247
