Enfermedad vascular periférica: prevalencia, mortalidad y asociación con inflamación enhemodiálisis / Peripheral vascular disease: prevalence, mortality and association with inflammation in haemodialysis

RESUMEN

La enfermedad vascular periférica es una complicación frecuente en la población en hemodiálisis que contribuye a aumentar su morbi-mortalidad, al favorecer el estado inflamatorio, la malnutrición y las complicaciones severas como la isquemia y la sepsis secundaria. El objetivo del estudio fue analizar la prevalencia de enfermedad vascular periférica en nuestra población en hemodiálisis, su repercusión en la mortalidad y su asociación con parámetros de inflamación y malnutrición. Fueron incluidos 220 pacientes prevalentes en hemodiálisis, del área perteneciente a nuestro centro hospitalario. Se realizó un estudio basal en el año 2001 y se siguieron durante 48 (..) (AU)

ABSTRACT

Peripheral vascular disease (PVD) is a common disease among patients undergoing hemodialysis leading to increase morbidity and mortality with a high risk of inflammation and sepsis. The aim of the present study was to determinate PVD prevalence in our hemodialysis population and association with inflammation. The study sample consisted of 220 patients prevalents in hemodialysis. A basal study was made in 2001 and a follow up for 47months. Data were collected retrospectively. PVD diagnosis was made attending to limb pulses and doppler in revisions. Diagnosis was classified as rest pain, ischemic ulceration and gangrene. Among a total of 220 patients, 89 had prevalent PVD. Thirty percent had rest pain, 6,5% had ischemic ulceration and 3% had gangrene. Ninety five per cent underwent medical treatment,0,5% were treated by per cutaneous transluminal angioplasty(PTA), 2% were treated with surgical revascularization and 2,5%were treated with amputation. Patients with PVD were older, with higher Charlson index, diabetes, they hay higher CRP and fibrinogen serum levels; and lower albumin and prealbumineserum levels. Survival PVD was decreased in Kaplan-Meier (logrank 012,4; p < 0,000). Adjusted Cox regression analysis revealed that PVD (p = 0,034; OR = 2,10; IC [1,06; 4,23]) ; age (p =0,001; OR = 1,06; IC [1,03; 1,09]) and low serum albumin levels(p = 0,012; OR = 0,93; IC [0,89; 0,98]) predicted significantly the risk of mortality. PVD is an independent mortality risk factor inhemodialysis patients. An early diagnosis and treatment are able with examination and doppler. In our sample, a few patients are treated with PTA or surgical revascularization. There is an association between PVD and inflammation (AU)