Care of the critically ill patient with advanced chronic kidney disease or end-stage renal disease.
Curr Opin Crit Care
; 18(6): 599-606, 2012 Dec.
Article
en En
| MEDLINE
| ID: mdl-23079618
ABSTRACT
PURPOSE OF REVIEW The number of individuals with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is rising, and these individuals often require intensive care. RECENT FINDINGS:
Patients with CKD and ESRD require critical care more frequently than those without these conditions and have similar reasons for requiring critical care as the general population. However, the burden of comorbidities, overall severity of illness as assessed by standard scoring systems, and mortality are higher in patients with ESRD than in the non-ESRD critically ill. After adjustment for demographics, comorbidities, and physiologic variables, the increased mortality risk in patients with ESRD is attenuated. In comparison to patients with dialysis-requiring acute kidney injury (AKI), critically ill patients with ESRD have a more favorable prognosis. Severity of illness scoring systems such as Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Score tend to overestimate the risk of death in critically ill ESRD patients. ICU admission does not appear to dramatically affect long-term mortality in those with ESRD who survive their initial acute illness as compared ESRD patients without critical illness.SUMMARY:
Despite the manifest physiologic derangements attending CKD/ESRD, a higher burden of comorbid conditions and a greater severity of illness on presentation account for much of the increased mortality. There is no justification for therapeutic nihilism in this population.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Cuidados Críticos
/
Fallo Renal Crónico
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
Curr Opin Crit Care
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2012
Tipo del documento:
Article
País de afiliación:
Estados Unidos