Incidência, perfil e desfecho dos pacientes com lesão renal aguda e com necessidade de tratamento dialítico internados na unidade de terapia intensiva adulto

• Autor(a) principal: Oliveira, Marisa Aparecida de Souza [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4806414; http://repositorio.unifesp.br/handle/11600/46136
• topic: Acute kidney injury; Intensive care unit; Lesão renal aguda; Diálise contínua; Comorbidades; Hemodiálise; Terapia intensiva

Objective: To evaluate the incidence and outcomes of patients with acute kidney injury-requiring dialysis (AKI-D) admitted to intensive care unit (UTI) as well as the main comorbidities, the AKI causes and the most used dialysis therapies. Methodology: A retrospective study was conductedat Hospital Israelita Albert Einstein, São Paulo, Brazil and covered a 14-year period. We evaluated 3 periods for the temporal analysis: 1999-2003, 2004-2008 and 2009-2012. Results: We identified 1,493 individuals with AKI-D. Most of them were clinical patients (73.3%), men (65%), and aged 63±18. The most common comorbidities were diabetes (36.2%), arterial hypertension (36%), heart disease (35.4%) and solid organ transplantation (35.2%). The main AKI causes were sepsis (56.2%) and low cardiac output (18.1%). The most prevalent sources of infections were the lung (43.7%) and abdomen (37.3%). Throughout the time, we noticed an increase in the incidence of AKI-D from 2.56% to 5.17%, in the initial use of the continuous dialysis therapy from 64.2% to 72.2%, in the number of solid organ transplantations (mainly liver transplantations) from 19.2% to 43.2%, and in the APACHE II score from 20 to 26 between the first and the third periods, respectively(p<0.001). Mortality rates (58.3% to 52.8%) and dependence on dialysis at hospital discharge (9.6% to 12.1%) did not significantly differ throughout the periods (p=0.352). The multivariate analysis identified that APACHE II score [OR 1.52 (1.46-1.58), p<0.001] and medical patients with AKI due to sepsis [OR 2.93 (1.81-4.75), p<0.001] were independent factors associated with death. By evaluating renal recovery, the estimated glomerular filtration rate (GFR) at hospital discharge for those patients initially submitted to venovenous hemodiafiltration (CVVHDF) was higher than for those individuals submitted to conventional hemodialysis (54 x 46 ml/min/1,73m2, p=0.014). Conclusions: The incidence of AKI-D increased throughout the period of study. The main AKI-D cause was sepsis. Whereas medical conditions of patients were more severe, death rates kept steady. CVVHDF was the most used dialysis method at first. CVVHDF seemed to maintain better GFR for those survivors who had recovered renal function.