Função renal alterada: prevalência e fatores associados em pacientes de risco / Altered renal function: prevalence and associated factors in risk patients / Función renal alterada: prevalencia y factores asociados en pacientes de riesgo

Introdução: a doença renal crônica (DRC) nos estágios iniciais não apresenta manifestações clínicas e, por isso, as pessoas somente procuram as unidades de saúde já na fase terminal da doença. Isso ainda é uma rotina no Brasil. Objetivo: identificar a prevalência de taxa de filtração glomerular estimada (TFGe) alterada e fatores associados em usuários do sistema único de saúde com Diabetes Mellitus e/ou com Hipertensão Arterial Sistêmica de alto e muito alto risco para doença cardiovascular. Materiais e Métodos: estudo transversal com prontuários de 331 usuários do Centro Estadual de Atenção Especializada no Centro-Oeste mineiro/ Minas Gerais/ Brasil, entre setembro de 2017 a junho de 2019. Realizou-se análise descritiva, univariada e regressão logística multivariada. Resultados: do total de participantes, 118 (35,6%) tiveram TFGe alterada. Identificou-se associação significativa da TFGe alterada com a idade: idosos ≥ 60 anos apresentaram 5,53 vezes mais chance de ter a TFGe alterada. Os participantes em uso da polifarmácia tiveram 2,64 vezes mais chance de terem a TFGe alterada. Discussão: em analogia com estudos semelhantes, registrou-se a ausência de acompanhamento da instalação e desenvolvimento da DRC nas fases iniciais, implicando em abordagem tardia e ações limitadas para preservação das funções renais. Conclusões: identificou-se alta prevalência de TFGe alterada (35,6%), sem registros nos prontuários que pudessem direcionar uma abordagem preventiva da degeneração das funções renais. A idade avançada e polifarmácia foram identificadas como variáveis independentes para alteração da função renal.

Introduction: Chronic kidney disease (CKD) does not have any clinical symptoms in the early stages and, therefore, most people only attend healthcare units when they are already in the terminal phase of the disease, which is still common in Brazil. Objective: To identify the prevalence of altered estimated glomerular filtration rate (eGFR) and associated factors in users of the unified health system suffering from diabetes mellitus and/or systemic hypertension at high risk of cardiovascular disease. Materials and Methods: A cross-sectional study was conducted based on the medical records of 331 users attending the State Specialty Care Center located in the west-central region of Minas Gerais, Brazil between September 2017 and June 2019. A descriptive univariate analysis and multivariate logistic regression were performed. Results: A total of 118 (35.6%) of the participants had altered eGFR. A significant association between altered eGFR and age was identified: older people ≥ 60 years old were 5.53 times more likely to have altered eGFR. Participants using polypharmacy were 2.64 times more likely to have altered eGFR. Discussion: In line with similar studies, a lack of follow-up on the initiation and development of CKD in the early stages was identified, implying a late approach and limited actions to preserve kidney function. Conclusions: A high prevalence of altered eGFR was identified (35.6%) with no records in the tables that could lead to a preventive approach to impaired kidney function. Advanced age and polypharmacy were identified as independent variables in the alteration of kidney function.

Introducción: La enfermedad renal crónica (ERC) en sus primeras etapas no presenta manifestaciones clínicas y, por lo tanto, la mayoría de las personas solo se acercan a las unidades de salud cuando ya están en la fase terminal de la enfermedad, lo cual sigue siendo habitual en Brasil. Objetivo: Identificar la prevalencia de la tasa estimada de filtración glomerular (TFG) alterada y los factores asociados en usuarios del sistema de salud único que sufran de diabetes mellitus y/o hipertensión sistémica de alto riesgo de enfermedad cardiovascular. Materiales y métodos: Se realizó un estudio transversal con las historias clínicas de 331 usuarios del Centro Estatal de Atención Especializada ubicado en el centro oeste de Minas Gerais, Brasil entre septiembre de 2017 y junio de 2019. Se realizaron un análisis univariado descriptivo y una regresión logística multivariante. Resultados: Del total de participantes, 118 (35,6%) tenían la TFG alterada. Se identificó una asociación significativa entre la alteración de la TFG y la edad: los ancianos ≥ 60 años tenían 5,53 veces más posibilidades de tener la TFG alterada. Los participantes que utilizaron la polifarmacia tenían 2,64 veces más probabilidades de que se alterara la TFG. Discusión: En consonancia con estudios similares, se registró la falta de seguimiento del inicio y el desarrollo de la ERC en las primeras etapas, lo que implica un enfoque tardío y acciones limitadas para preservar las funciones renales. Conclusiones: Se identificó una alta prevalencia de TFG alterada (35,6%) sin registros en las tablas que pudieran conducir a un enfoque preventivo de la degeneración de la función renal. La edad avanzada y la polifarmacia se identificaron como variables independientes en la alteración de la función renal.

Omeprazole use and risk of chronic kidney disease evolution.

RATIONALE, AIMS AND OBJECTIVES: In recent years, the use of proton pump inhibitors (PPI), especially omeprazole, has been associated with development of chronic kidney disease (CKD). These drugs are widely used worldwide. Although some studies have found an association between the use of PPI and the onset of acute renal failure and CKD. This study aims to analyze the association between the continuous use of omeprazole and the progression of CKD in adult and elderly individuals. METHOD: A retrospective cohort study was conducted with patients followed up at a nephrology clinic in Brazil, in 2016 and 2017. Information about clinical and sociodemographic data, health behaviors, and medication use were collected from all patients diagnosed with CKD through consultation of medical charts and the Brazilian health information system (SIS). The participants were allocated into two groups: users and non-users of omeprazole, and the progression of CKD was then evaluated for each group. In the bivariate analysis, the Mann-Whitney U test to compare the quantitative variables between groups, and the Pearson/Fisher two-tailed chi-square test to compare the categorical variables were applied. Multivariate analysis was performed using Cox regression. RESULTS: A total of 199 CKD patients were attended in the polyclinic, and of these, 42.7% were omeprazole users. There was a higher percentage of CKD progression in users (70.6%) compared to non-users (10.5%). The hazard ratio was 7.34 (CI: 3.94-13.71), indicating a higher risk of progression to worse stages of CKD in omeprazole users than in non-users. As for the other variables, no statistically significant difference was found between groups (p > 0.05). CONCLUSION: An association between omeprazole use and progression of CKD stage was identified, showing a higher risk of disease evolution among omeprazole users.