Terapia de reemplazo renal en paciente crítico: cambios evolutivos del tratamiento en los últimos años / Renal replacement therapy in the critical patient: treatment variation over time

RESUMEN

Objetivos: Analizar la evolución de los pacientes con insuficiencia renal aguda tratados con terapia de reemplazo renal (TRR) y determinar los factores de riesgo asociados a mortalidad y recuperación de la función renal. Diseño: Estudio prospectivo y observacional en pacientes críticos. Ámbito Unidad de Cuidados Intensivos (UCI) polivalente del Hospital de Sabadell. Pacientes Inclusión de los pacientes con insuficiencia renal que precisaron TRR en nuestra unidad. Principales variables de interés Registro de variables epidemiológicas, de gravedad (APACHE II) así como el tipo y duración de la TRR, mortalidad y recuperación de la función renal al alta de UCI. El periodo de estudio comprende 10 años, repartiendo la muestra en 2 periodos inicial (2000-2004) y reciente (2005-2009). Análisis estadístico comparativo de ambos periodos y análisis de regresión logística múltiple para determinar factores de riesgo de mortalidad y de (..) (AU)

ABSTRACT

Objectives: To analyze the evolution of patients subjected to renal replacement therapy (RRT), andto determine risk factorsassociated with mortality and the recovery of renal function. Design: A prospective, observational study of critically ill patients. Setting: Clinical-surgical Intensive Care Unit (ICU) of Sabadell Hospital (Spain). Patients Inclusion of all patients treated in our Unit due to acute renal failure (ARF) requiring RRT. Primary variables of interest We recorded epidemiological data, severity using the APACHE II score, days of the technique, ICU mortality, and renal function recovery. The study period was divided into 2 parts part 1 (2000-2004) and part 2 (2005-2009). The 2 periods were compared using the Student t-test for continuous variables and the chi-squared test for categorical variables. Multiple regression analysis was performed to determine the risk factors for mortality and recovery of renal function. Results: A total of 304 patients were treated. Sepsis was the main etiology of ARF (61%), involving principally respiratory and abdominal foci. In the second period the convective technique and community-acquired ARF were far more prevalent than in the first period. There were fewer days of therapy in the second period (19.7 versus 12.3 days; P=.015). Total ICU mortality was 52.3%, with a decrease in the last period (61.9% to 45.5% P=.003). The risk factors associated to mortality were creatinine upon admission (odds ratio [OR] 0.77; 95% confidence interval [95%CI] 0.61-0.97) and treatment with IHD alone (OR 0.37, 95%CI 0.16-0.87). Survivors had normal renal function at ICU discharge in 56.7% of the cases in the second period, vs in 72.9% in the first period, with (..) (AU)