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Introduction: Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion. Methods: Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. Results: 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (p < 0.0001). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; p < 0.0001). Conclusion: We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.
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JUSTIFICATIVA E OBJETIVOS: A nefropatia diabética (ND) tem assumido posição de destaque como causa de doença renal terminal, tendo uma relação intrínseca com as doenças cardiovasculares. O estabelecimento e a progressão para o estágio de rim terminal pode ser acelerada por diversos fatores, como: hipertensão e hiperglicemia. Além disso, dislipidemia pode estar associadaa esse quadro. O objetivo deste estudo foi avaliar a prevalência desses fatores de risco em pacientes atendidos em ambulatório especializado de hospital universitário. MÉTODO: Estudo retrospectivo de coorte observacional com a análise de 166 prontuários. A nefropatia diabética foi definida como a presença de albuminúria entre 30 e 300 mg/24h ou proteinúria de 24h > 500 mg/24h. Os demais dados foram classificados segundo a VI Diretriz Brasileira de Hipertensão, Diretriz Brasileira de Diagnóstico e Tratamento de Síndrome Metabólica,e Diretrizes Brasileiras de Doença Renal Crônica. RESULTADOS: Apenas 23% apresentavam avaliação adequada para nefropatia diabética. 50% tinham albuminúria, 53% nefropatia incipiente e 47% nefropatia clínica. 63% dos pacientes apresentam níveis pressóricos elevados. LDL > 100 mg/dL em 79%, HDL < 45 mg/dL em 63%, triglicerídeos > 150 mg/dL em 63% e colesterol total > 200 mg/dL em 63%. O índice de massa corpórea evidenciou presença de sobrepeso em 32% e obesidade em 26%. CONCLUSÃO: A maioria dos pacientes está exposta a fatores que aceleram a progressão da ND e predispõem a ocorrência de eventos cardiovasculares. Além disso, a avaliação deficiente para a ND em um centro de referência pode sugerir quadro semelhante nos demais serviços de saúde.
BACKGROUND AND OBJECTIVES: Diabetic nephropathy (DN) is a prominent cause of end stage kidney disease having a close relationship with cardiovascular disease. The establishment and progression to late kidney stage may be accelerated by several factors, such as hypertension and hyperglycemia. Moreover, dyslipidemia may be associated with this picture. This study aims at evaluating the prevalence of these risk factors within a population attending an outpatient clinic of a university hospital. METHOD: A retrospective observational cohort analysis of 166 medical records. Diabetic nephropathy was defined as the presence of albuminuria between 30-300 mg/24 h or 24 h proteinúria > 500 mg/24 hours. The other data were classified according to the VI Brazilian Guidelines on Hypertension, Brazilian Guideline for Diagnosis and Treatment of Metabolic Syndrome, and Brazilian Guidelines for Chronic Kidney Disease. RESULTS : Only 23% had adequate assessment for diabetic nephropathy. These 50% had albuminuria, 53% incipient nephropathy, and 47% clinical nephropathy. 63% of patients hadhigh blood pressure. LDL > 100 mg/dL in 79%, HDL < 45 mg/dL in 63%, triglycerides > 150 mg/dL in 63% and total cholesterol > 200 mg/dL in 63%. Body mass index showed the presence of overweight and obesity in 32% at 26%, respectively. CONCLUSION: Most patients are still exposed to factors that accelerate the progression of DN and predispose to cardiovascular events. Moreover, the poor assessment for ND in a reference center may suggest a similar picture in other health services.