Recuperación de la función renal en pacientes bogotanos con lesión renal aguda tratados con terapia de reemplazo renal continua versus diálisis intermitente

Autor: Buitrago Bejarano, Roberto José, Huérfano Castro, Manuel Alejandro
Přispěvatelé: Moreno-Montoya, Jose
Jazyk: Spanish; Castilian
Rok vydání: 2017
Předmět:
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Repositorio EdocUR-U. Rosario
Universidad del Rosario
instacron:Universidad del Rosario
DOI: 10.48713/10336_13833
Popis: Introducción: la lesión renal aguda (LRA) es una patología que afecta millones de personas en el mundo, asociándose con alta morbi-mortalidad. En los pacientes críticos con LRA que requieren terapia de reemplazo renal (TRR) la mortalidad es alta (55,8%); mientras, la dependencia de diálisis crónica en los sobrevivientes es aproximadamente 10%; generando disminución en la calidad de vida y aumentando los costos en la atención en salud a largo plazo. El desarrollo de nuevas tecnologías, como la hemofiltración, se centra en la recuperación de la función renal; sin embargo, cuando se compara con la diálisis intermitente se encuentran resultados no concluyentes. Objetivos: demostrar que existe mayor incidencia acumulada de recuperación de la función renal en pacientes con LRA tratados con terapia de reemplazo renal continua (TRRC) versus los tratados con diálisis intermitente (DI), analizando los distintos factores que pueden influir en el desenlace. Metodología: se realizó un estudio de cohorte histórica, en donde se compararon pacientes adultos en cuidado crítico con LRA y que requirieron TRR entre los años 2013 y 2016 en el Hospital Universitario Mayor en Bogotá. Se calculó un tamaño de muestra de 71 pacientes para DI y 52 para TRRC. Se decidió trabajar con un mínimo de 71 pacientes en cada grupo. Se definió recuperación de la función renal como la dependencia o no de diálisis crónica. Resultados: se analizó un total de 161 pacientes (DI=80 y TRRC=81). El 64% hombres y una mediana de edad de 71 años. La patología más frecuente en la LRA fue sepsis. La causa de inicio de TRR más frecuente fue sobrecarga hídrica e hiperazoemia. Se encontró RR de 1,9 (IC95% 1,08-3,35) veces recuperación de la función renal en la TRRC en comparación con la DI. Las variables tipo de terapia, edad, sepsis, enfermedad cardiovascular, balance hídrico acumulado, tiempo hospitalario y ultrafiltración están asociadas estadísticamente la recuperación de la función renal en el modelo logístico predictivo. Discusión: La TRRC se asoció con mayor recuperación de la función renal frente a la DI en los pacientes con LRA que están críticamente enfermos. Se propone un modelo de predicción de recuperación de la función renal con base en los resultados del análisis multivariado. Los resultados del presente estudio muestran que el uso de la TRRC podría tener un impacto positivo en mejorar la calidad de vida de los pacientes y en disminuir los costos en la atención en salud. Introduction: Acute kidney injury (AKI) is a pathology affecting millions of people worldwide, associated with high morbidity and mortality. Criticall ill patients with AKI requiring renal replacement therapy (RRT), mortality is high (55. 8%); while chronic dialysis dependence, on survivors, is approximately 10%; generating a decrease in life quality and increasing the costs of long-term health care. The development of new technologies, such as hemofiltration, focuses on the recovery of renal function; However, when compared with intermittent dialysis, the results are inconclusive. Objectives: To demonstrate that there is a greater accumulated incidence of recovery of renal function in patients with AKI treated with continuous renal replacement therapy (CRRT) versus intermittent dialysis (ID), analyzing the various factors that may affect the outcome. Methodology: A historical cohort study was performed, comparing patients in critical care with AKI who required RRT, between the years 2013 and 2016 at the Hospital Universitario Mayor in Bogotá. A sample size of 71 patients was calculated for ID and 52 for CRRT. It was decided to work with a minimum of 71 patients in each group. Recovery of renal function was defined as dependence of chronic dialysis. Results: a total of 161 patients (ID = 80 and TRRC = 81) were analyzed. Men 64% and a median age of 71 years. The most frequent pathology in AKI was sepsis. The most frequent cause of RRT was fluid overload and hyperazoemia. We found RR of 1, 9 (95% CI 1, 08-3, 35) times renal recovery function in CRRT compared with ID. Therapy modality, age, sepsis, cardiovascular disease, accumulated fluid balance, hospitalization time and total ultrafiltration were statistically associated with recovery of renal function in the predictive logistic model. Discussion: CRRT was associated with greater recovery of renal function compared to ID in critically ill patients with AKI. A predictive model of recovery of renal function was proposed based on the results of the multivariate analysis. The results of the present study support that CRRT could have a positive impact on patients` quality of life and could reduce costs in health care.
Databáze: OpenAIRE
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