Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar

Detalhes bibliográficos
Autor(a) principal: Vasconcelos, Jardel Martins de
Data de Publicação: 2018
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UFS
Texto Completo: http://ri.ufs.br/jspui/handle/riufs/10465
Resumo: Introduction: Hemodialysis treatment is a therapeutic alternative in reversing the clinical metabolic decompensation of patients with renal insufficiency. The time elapsed between hospital admission and initiation of hemodialysis is determinant in the prognosis of the patient. Thus, late onset hemodialysis may influence the length of hospital stay, number of required hemodialysis sessions, hemodynamic stability, and outcome. Objective: To analyze the prognostic factors associated with the specific survival of patients submitted to hemodialysis (HD) in a hospital unit. Methodology: The research was approved by the human ethics committee with the number of opinion 2,434,202. This is an observational retrospective cohort study of patients undergoing hemodialysis in the period 2016-2017 at Hospital University of Lagarto (HUL) in Sergipe (SE). The sample consisted of the medical record of all the patients who were attended by the hospital HD service that met the inclusion and exclusion criteria during the proposed period. Data were described by means of mean and standard deviation and absolute and relative percentage frequency. Categorical associations were tested using the Chi-Square test. The differences of position measurement were used the Mann-Whitney test. Survival curves were estimated using the Kaplan-Meier method and the differences tested by the Log-Rank test and the Log-Rank test with Dunn-Sidak correction for multiple comparisons. Gross and adjusted risk ratios were estimated using Cox regression. The level of significance was set at 5%. Results: Of the 129 charts analyzed, the majority (n= 88, 68.2%) were older than 60 years and males (n= 76, 58.9%). She presented a longer stay of hospitalization between 8 and 30 days (n= 71; 55%). Early onset of HD (n= 68; 52.7%) with time ≤ 3 days after admission (ADM). Most performed up to 3 HD sessions (n= 48, 37.2%). Patients with acute CKD had a higher prevalence with (n= 53; 41.1%) of the sample. When considering the outcome, it was possible to observe that the onset of HD within 3 days after ADM presented an average survival time (TM) of 69.7 (53.1-86.3) days. TM was higher in patients with acute chronic renal failure (CKD) with 61.9 (46.5-77.4) days. Both the time elapsed between ADM and the onset of HD between 4 to 9 days of ADM and the diagnosis of AKI were more likely to occur at any time of treatment with an RRa of 5.96 (2.35 -15.16) and 4.27 (1.69-7.16), respectively. Those who did up to three HD sessions had an RR of 34.19 (12.63-92.56). Conclusion: The early diagnosis of renal failure and referral to the HD service are determining factors in the average survival time and in the probability of death. Therefore, it is necessary to adopt more effective monitoring measures, with the intention of immediately initiating the HD, guaranteeing an improvement in the patient's prognosis.
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spelling Vasconcelos, Jardel Martins deBarreto, André Sales2019-02-12T11:45:30Z2019-02-12T11:45:30Z2018-08-29VASCONCELOS, Jardel Martins de. Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar. 2018. Dissertação (Mestrado em Ciências Aplicadas à Saúde) - Universidade Federal de Sergipe, Lagarto, 2018.http://ri.ufs.br/jspui/handle/riufs/10465Introduction: Hemodialysis treatment is a therapeutic alternative in reversing the clinical metabolic decompensation of patients with renal insufficiency. The time elapsed between hospital admission and initiation of hemodialysis is determinant in the prognosis of the patient. Thus, late onset hemodialysis may influence the length of hospital stay, number of required hemodialysis sessions, hemodynamic stability, and outcome. Objective: To analyze the prognostic factors associated with the specific survival of patients submitted to hemodialysis (HD) in a hospital unit. Methodology: The research was approved by the human ethics committee with the number of opinion 2,434,202. This is an observational retrospective cohort study of patients undergoing hemodialysis in the period 2016-2017 at Hospital University of Lagarto (HUL) in Sergipe (SE). The sample consisted of the medical record of all the patients who were attended by the hospital HD service that met the inclusion and exclusion criteria during the proposed period. Data were described by means of mean and standard deviation and absolute and relative percentage frequency. Categorical associations were tested using the Chi-Square test. The differences of position measurement were used the Mann-Whitney test. Survival curves were estimated using the Kaplan-Meier method and the differences tested by the Log-Rank test and the Log-Rank test with Dunn-Sidak correction for multiple comparisons. Gross and adjusted risk ratios were estimated using Cox regression. The level of significance was set at 5%. Results: Of the 129 charts analyzed, the majority (n= 88, 68.2%) were older than 60 years and males (n= 76, 58.9%). She presented a longer stay of hospitalization between 8 and 30 days (n= 71; 55%). Early onset of HD (n= 68; 52.7%) with time ≤ 3 days after admission (ADM). Most performed up to 3 HD sessions (n= 48, 37.2%). Patients with acute CKD had a higher prevalence with (n= 53; 41.1%) of the sample. When considering the outcome, it was possible to observe that the onset of HD within 3 days after ADM presented an average survival time (TM) of 69.7 (53.1-86.3) days. TM was higher in patients with acute chronic renal failure (CKD) with 61.9 (46.5-77.4) days. Both the time elapsed between ADM and the onset of HD between 4 to 9 days of ADM and the diagnosis of AKI were more likely to occur at any time of treatment with an RRa of 5.96 (2.35 -15.16) and 4.27 (1.69-7.16), respectively. Those who did up to three HD sessions had an RR of 34.19 (12.63-92.56). Conclusion: The early diagnosis of renal failure and referral to the HD service are determining factors in the average survival time and in the probability of death. Therefore, it is necessary to adopt more effective monitoring measures, with the intention of immediately initiating the HD, guaranteeing an improvement in the patient's prognosis.Introdução: O tratamento hemodialítico é uma alternativa terapêutica na reversão do quadro de descompensação clínico metabólico de pacientes portadores de insuficiência renal. O tempo transcorrido entre a admissão hospitalar e início da hemodiálise é determinante no prognóstico do paciente. Assim, o início tardio da hemodiálise pode influenciar no tempo de permanência em ambiente hospitalar, número de sessões de hemodiálise necessárias, estabilidade hemodinâmica e desfecho. Objetivo: Analisar os fatores prognósticos associados à sobrevida de pacientes submetidos a hemodiálise (HD) em unidade hospitalar. Metodologia: A pesquisa foi aprovada pelo comitê de ética com seres humanos com o número do parecer 2.434.202. Trata-se de um estudo observacional de coorte retrospectivo, dos pacientes submetidos à hemodiálise no período de 2016-2017 em um Hospital Público do município de Lagarto em Sergipe (SE). A amostra foi constituída através da análise de prontuário de todos os pacientes que foram atendidos pelo serviço de HD do hospital que atendiam aos critérios de inclusão e exclusão, durante o período proposto. Os dados foram descritos por meio de média e desvio padrão e frequência absoluta e relativa percentual. As associações categóricas foram testadas utilizando o teste Qui-Quadrado. As diferenças de medida de posição foram utilizadas o teste de Mann-Whitney. Foram estimadas curvas de sobrevivência através do método de Kaplan-Meier e as diferenças testadas pelo teste Log-Rank e pelo teste de Log-Rank com correção de Dunn-Sidak para múltiplas comparações. Foram estimadas razões de risco brutas e ajustadas por meio da regressão de Cox. O nível de significância adotado foi de 5%. Resultados: De 129 prontuários analisados, a maioria (n= 88; 68,2%) tinham idade superior a 60 anos e o sexo masculino (n= 76; 58,9%). A permanência de internamento apresentou maior prevalência entre 8 e 30 dias (n= 71; 55%). O início da HD com tempo ≤ 3 dias após admissão (ADM) foi o mais recorrente (n= 68; 52,7%). A maioria realizou até 3 sessões de HD (n= 48; 37,2%). O diagnóstico clínico mais prevalente foi IRC agudizada (n= 53; 41,1%). Ao considerar o desfecho foi possível observar que o início da HD em até 3 dias após ADM apresentou um tempo médio de sobrevida (TM) maior de 69,7 (53,1-86,3) dias. O TM foi maior em pacientes com insuficiência renal crônica (IRC) agudizada com 61,9 (46,5-77,4) dias. Ambos, tempo transcorrido entre a ADM e o início da HD entre 4 a 9 dias da ADM e diagnóstico de IRA apresentaram maior probabilidade de óbito a qualquer momento do tratamento com uma razão de risco ajustado (RRa) de 5,96 (2,35-15,16) e 4,27 (1,69-7,16), respectivamente. Os que fizeram até três sessões de HD apresentaram uma RRa de 34,19 (12,63-92,56). Conclusão: O diagnóstico precoce de insuficiência renal e encaminhamento ao serviço de HD são fatores determinantes no tempo de médio de sobrevida quanto na probabilidade de evoluir à óbito. Dessa forma, é necessário adotar medidas de monitoramento mais eficazes, com o intuito de iniciar imediatamente a HD, garantido uma melhoria do prognóstico do paciente.Lagarto, SEporHemodiáliseRinsDoençasInsuficiência renalTempo de sobrevidaHemodialysisRenal failureSurvival timeFatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalarPrognostic factors associated with the survival of patients undergoing hemodialysis in a hospital unitinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisPós-Graduação em Ciências Aplicadas à SaúdeUFSreponame:Repositório Institucional da UFSinstname:Universidade Federal de Sergipe (UFS)instacron:UFSinfo:eu-repo/semantics/openAccessTEXTJARDEL_MARTINS_DE_VASCONCELOS.pdf.txtJARDEL_MARTINS_DE_VASCONCELOS.pdf.txtExtracted texttext/plain110884https://ri.ufs.br/jspui/bitstream/riufs/10465/3/JARDEL_MARTINS_DE_VASCONCELOS.pdf.txte7687538bbb49f396d563504b1dffb7dMD53THUMBNAILJARDEL_MARTINS_DE_VASCONCELOS.pdf.jpgJARDEL_MARTINS_DE_VASCONCELOS.pdf.jpgGenerated Thumbnailimage/jpeg1390https://ri.ufs.br/jspui/bitstream/riufs/10465/4/JARDEL_MARTINS_DE_VASCONCELOS.pdf.jpgbac75677e4391cc30644ad861bd28228MD54LICENSElicense.txtlicense.txttext/plain; charset=utf-81475https://ri.ufs.br/jspui/bitstream/riufs/10465/1/license.txt098cbbf65c2c15e1fb2e49c5d306a44cMD51ORIGINALJARDEL_MARTINS_DE_VASCONCELOS.pdfJARDEL_MARTINS_DE_VASCONCELOS.pdfapplication/pdf1672898https://ri.ufs.br/jspui/bitstream/riufs/10465/2/JARDEL_MARTINS_DE_VASCONCELOS.pdf5be0035122d2e175955d8e1533f6d480MD52riufs/104652019-02-12 08:45:30.848oai:ufs.br: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Repositório InstitucionalPUBhttps://ri.ufs.br/oai/requestrepositorio@academico.ufs.bropendoar:2019-02-12T11:45:30Repositório Institucional da UFS - Universidade Federal de Sergipe (UFS)false
dc.title.pt_BR.fl_str_mv Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
dc.title.alternative.eng.fl_str_mv Prognostic factors associated with the survival of patients undergoing hemodialysis in a hospital unit
title Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
spellingShingle Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
Vasconcelos, Jardel Martins de
Hemodiálise
Rins
Doenças
Insuficiência renal
Tempo de sobrevida
Hemodialysis
Renal failure
Survival time
title_short Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
title_full Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
title_fullStr Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
title_full_unstemmed Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
title_sort Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar
author Vasconcelos, Jardel Martins de
author_facet Vasconcelos, Jardel Martins de
author_role author
dc.contributor.author.fl_str_mv Vasconcelos, Jardel Martins de
dc.contributor.advisor1.fl_str_mv Barreto, André Sales
contributor_str_mv Barreto, André Sales
dc.subject.por.fl_str_mv Hemodiálise
Rins
Doenças
Insuficiência renal
Tempo de sobrevida
topic Hemodiálise
Rins
Doenças
Insuficiência renal
Tempo de sobrevida
Hemodialysis
Renal failure
Survival time
dc.subject.eng.fl_str_mv Hemodialysis
Renal failure
Survival time
description Introduction: Hemodialysis treatment is a therapeutic alternative in reversing the clinical metabolic decompensation of patients with renal insufficiency. The time elapsed between hospital admission and initiation of hemodialysis is determinant in the prognosis of the patient. Thus, late onset hemodialysis may influence the length of hospital stay, number of required hemodialysis sessions, hemodynamic stability, and outcome. Objective: To analyze the prognostic factors associated with the specific survival of patients submitted to hemodialysis (HD) in a hospital unit. Methodology: The research was approved by the human ethics committee with the number of opinion 2,434,202. This is an observational retrospective cohort study of patients undergoing hemodialysis in the period 2016-2017 at Hospital University of Lagarto (HUL) in Sergipe (SE). The sample consisted of the medical record of all the patients who were attended by the hospital HD service that met the inclusion and exclusion criteria during the proposed period. Data were described by means of mean and standard deviation and absolute and relative percentage frequency. Categorical associations were tested using the Chi-Square test. The differences of position measurement were used the Mann-Whitney test. Survival curves were estimated using the Kaplan-Meier method and the differences tested by the Log-Rank test and the Log-Rank test with Dunn-Sidak correction for multiple comparisons. Gross and adjusted risk ratios were estimated using Cox regression. The level of significance was set at 5%. Results: Of the 129 charts analyzed, the majority (n= 88, 68.2%) were older than 60 years and males (n= 76, 58.9%). She presented a longer stay of hospitalization between 8 and 30 days (n= 71; 55%). Early onset of HD (n= 68; 52.7%) with time ≤ 3 days after admission (ADM). Most performed up to 3 HD sessions (n= 48, 37.2%). Patients with acute CKD had a higher prevalence with (n= 53; 41.1%) of the sample. When considering the outcome, it was possible to observe that the onset of HD within 3 days after ADM presented an average survival time (TM) of 69.7 (53.1-86.3) days. TM was higher in patients with acute chronic renal failure (CKD) with 61.9 (46.5-77.4) days. Both the time elapsed between ADM and the onset of HD between 4 to 9 days of ADM and the diagnosis of AKI were more likely to occur at any time of treatment with an RRa of 5.96 (2.35 -15.16) and 4.27 (1.69-7.16), respectively. Those who did up to three HD sessions had an RR of 34.19 (12.63-92.56). Conclusion: The early diagnosis of renal failure and referral to the HD service are determining factors in the average survival time and in the probability of death. Therefore, it is necessary to adopt more effective monitoring measures, with the intention of immediately initiating the HD, guaranteeing an improvement in the patient's prognosis.
publishDate 2018
dc.date.issued.fl_str_mv 2018-08-29
dc.date.accessioned.fl_str_mv 2019-02-12T11:45:30Z
dc.date.available.fl_str_mv 2019-02-12T11:45:30Z
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dc.identifier.citation.fl_str_mv VASCONCELOS, Jardel Martins de. Fatores prognósticos associados a sobrevida de pacientes submetidos a hemodiálise em uma unidade hospitalar. 2018. Dissertação (Mestrado em Ciências Aplicadas à Saúde) - Universidade Federal de Sergipe, Lagarto, 2018.
dc.identifier.uri.fl_str_mv http://ri.ufs.br/jspui/handle/riufs/10465
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