RESUMEN
AIM: Renal supportive care (RSC) programs are used to manage non-dialysis end-stage kidney disease (ESKD) patients. The aim of this study was to analyse the impact of RSC programs on hospitalization and survival outcomes in these patients. METHODS: A retrospective, single-centre observational cohort study of non-dialysis ESKD patients was undertaken. Hospitalizations and survival from eGFR≤15 ml/min was compared between patients managed in an RSC program (RSC group) and patients receiving standard conservative therapy (non-RSC group). Local databases, physician letters and electronic medical records were used for data collection. Prevalent patients from 2013 to 2017 with eGFR ≤15 ml/min were included. Cox proportion hazard testing and generalized linear modelling was undertaken to adjust for confounders. RESULTS: A total of 172 patients were included (95 RSC; 75 non-RSC). The median age was 82 years [IQR 78-85], 46% were male, the median Charlson-comorbidity Index was 5 [IQR 4-7]. The RSC group had significantly lowered haemoglobin level (102 g/L vs. 111 g/L) and fewer English-speakers (34% vs. 44%). RSC was associated with the decreased number of days in hospital per year (estimated means 46.6 days [95% CI 21-67] vs. 83.2 days [95%CI 60.5-105.8]; p = .01) and decreased number of hospital admissions per year (estimated means 5.4 [95%CI 2.1-8.8] vs. 12.3 [95%CI 8.2-16.4]; p = .01) compared with non-RSC. Median overall survival from eGFR≤15 in the entire cohort was 735 days, with no significant difference between RSC and non-RSC groups (p = .9), both unadjusted and adjusted for confounders. CONCLUSION: RSC programs can significantly decrease the number and length of hospitalizations in conservatively managed ESKD patients.
Asunto(s)
Hospitalización/estadística & datos numéricos , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Acetazolamida/administración & dosificación , Glucocorticoides/administración & dosificación , Cefalea , Hipertensión Intracraneal , Nefritis Lúpica , Punción Espinal/métodos , Trastornos de la Visión , Anticonvulsivantes/administración & dosificación , Encéfalo/diagnóstico por imagen , Técnicas de Diagnóstico Oftalmológico , Femenino , Glomerulonefritis Membranosa/patología , Cefalea/diagnóstico , Cefalea/etiología , Cefalea/terapia , Humanos , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/tratamiento farmacológico , Hipertensión Intracraneal/etiología , Nefritis Lúpica/diagnóstico , Nefritis Lúpica/tratamiento farmacológico , Nefritis Lúpica/fisiopatología , Imagen por Resonancia Magnética/métodos , Resultado del Tratamiento , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Trastornos de la Visión/terapia , Adulto JovenAsunto(s)
Antivirales/uso terapéutico , Glomerulonefritis/tratamiento farmacológico , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Imidazoles/uso terapéutico , Sofosbuvir/uso terapéutico , Carbamatos , Glomerulonefritis/diagnóstico , Glomerulonefritis/inmunología , Glomerulonefritis/virología , Hepacivirus/inmunología , Hepacivirus/patogenicidad , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/inmunología , Hepatitis C Crónica/virología , Interacciones Huésped-Patógeno , Humanos , Masculino , Persona de Mediana Edad , Pirrolidinas , Resultado del Tratamiento , Valina/análogos & derivados , Carga ViralRESUMEN
We need to have a high index of suspicion for subdural hemorrhage (SDH) post-lumbar puncture in hematological patients given their increased risk and the significant morbidity and mortality associated with SDHs.