Análise dos fatores preditores de mortalidade em pacientes incidentes em hemodiálise / Predictors of mortality in incident patients undergoing hemodialysis

Introdução: A doença renal crônica afeta de 10 a 15 % da população adulta mundial e a piora da função renal, se associa com várias complicações, tais como: desnutrição, inflamação, doenças cardiovasculares e distúrbios do metabolismo mineral. A mortalidade desses pacientes é elevada sendo de 6 a 8 vezes maior que a de indivíduos saudáveis. Cerca de 22% dos pacientes incidentes, ou seja, no primeiro ano de diálise, vão a óbito. O objetivo do presente estudo foi avaliar as características clínicas, laboratoriais de pacientes incidentes em diálise além de identificar fatores de risco que contribuíssem para a mortalidade desses pacientes. Métodos: Estudamos 424 pacientes com sinais e sintomas de uremia e indicação de tratamento dialítico admitidos no serviço de emergência do Hospital das Clínicas entre Janeiro de 2006 e Dezembro de 2012. O tempo de acompanhamento foi de um ano. Analisamos os parâmetros clínicos, tipo de via de acesso para hemodiálise, fatores de risco ligados a doenças cardiovasculares e as alterações do metabolismo mineral bem como eventos clínicos ocorridos durante o seguimento. Avaliamos a sobrevida e os fatores que influenciaram a sobrevida dos pacientes, pela curva de Kaplan-Meier e análise de regressão de Cox, respectivamente. Resultados: A média de idade foi de 50±18 anos, 58,7% eram homens e 69,1% brancos. Hipertensão arterial foi a principal etiologia da doença renal primária (31,8%) seguida de DM (29,5%). Os principais fatores de risco encontrados foram tabagismo (19,6%), dislipidemia (48,8%), doenças cardiovasculares (41%) e na admissão a maioria dos pacientes não tinha acesso vascular para hemodiálise (89,4%). Os resultados dos exames laboratoriais revelaram que a maioria dos pacientes estava anêmico (83,7%), com níveis de PCR elevados (79,9%). Os distúrbios do metabolismo mineral como hipocalcemia, hiperfosfatemia, elevação dos níveis de paratormônio e diminuição dos níveis de 25(OH) vitamina D estavam presentes em...

Introduction: Chronic kidney disease affects 10-15% of the world adult population, and the worsening of renal function is associated with several complications, such as malnutrition, inflammation, cardiovascular diseases and disorders of mineral metabolism. Mortality of those patients is high and 6 to 8 times higher than that of healthy individuals. About 22% of incident patients, that is, during the first year of dialysis, will die. The aim of this study was to evaluate the clinical and laboratory characteristics of incident dialysis patients and identify risk factors that contribute to the mortality of these patients. Methods: We studied 424 patients with signs and symptoms of uremia and dialysis indication admitted to the emergency service at Hospital das Clínicas between January 2006 and December 2012. Follow-up time was one year. We analyzed the clinical parameters, type of hemodialysis access road, risk factors linked to cardiovascular diseases and changes in mineral metabolism as well as clinical events occurred during follow-up. We evaluated survival and the factors that influenced patient survival by Kaplan-Meier curves and Cox regression analysis respectively. Results: Mean age was 50 ± 18 years old; 58.7% were males and 69.1% were white. Hypertension was the main cause of primary kidney disease (31.8%) followed by DM (29.5%). Major risk factors found were smoking (19.6%), dyslipidemia (48.8%), cardiovascular disease (41%), and upon admission most patients had no vascular access for hemodialysis (89.4%). Results of laboratory tests showed that most patients were anemic (83.7%), with high CRP levels (79.9%). Disturbances of mineral metabolism such as hypocalcemia, hyperphosphatemia, elevated parathyroid hormone levels and decreased levels of 25(OH) vitamin D were present in almost all patients. At the end of a year, 60 patients died (14.1%). These patients were significantly older, had signs of congestive heart failure, malnutrition,...

Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study.

BACKGROUND AND OBJECTIVES: Secondary hyperparathyroidism (SHPT) in CKD is associated with an increased risk for mortality, but definitive data showing that parathormone control decreases mortality is still lacking. This study aimed to compare the mortality of patients with severe SHPT submitted to parathyroidectomy(PTX) with those who did not have access to surgery. METHODS: This is a retrospective study in a cohort of 251 CKD patients with severe SHPT who were referred to a CKD-MBD Center for PTX from 2005 until 2012. RESULTS: Most of our patients had indication of PTX, but only 49% of them had access to this surgical procedure. After a mean follow-up of 23 months, 72 patients had died. Non-survivors were older; more often had diabetes, lower serum 25 vitamin D and mostly had not been submitted to surgery. The relative risk of death was lower in the PTX patients (0.428; 95% CI, 0.28 to 0.67; p<0.0001). After adjustments, mortality risk was dependent on age (1.04; 95% CI, 1.01 to 1.07; p = 0.002), 25 vitamin D (0.43; 95% CI, 0.24 to 0.81; p = 0.006) and no access to PTX (4.13; 95% CI, 2.16 to 7.88; p<0.0001). Results remained the same in a second model using the PTX date as the study start date for the PTX group. CONCLUSIONS: Our data confirms the benefit of PTX on mortality in patients with severe SHPT. The high mortality encountered in our population is significant and urges the need to better treat these patients.