Diálise no paciente idoso: um desafio do século XXI - revisão narrativa / Dialysis in the elderly patient: a challenge of the XXI century - narrative review

Com o aumento da expectativa de vida, com a melhora do arsenal terapêutico, conhecimento e controle das doenças crônicas degenerativas, a população mundial tem atingido faixas etárias elevadas. Por ser a idade avançada fator de risco para a doença renal crônica (DRC), juntamente com o bônus da maior sobrevida, vive-se hoje o ônus da maior e progressiva incidência de pacientes idosos em terapia renal substitutiva (TRS). A diálise nos pacientes idosos, que há três décadas era considerada fora de questão, hoje em dia é rotina para o nefrologista, que enfrenta o desafio de prestar atendimento a pacientes idosos com DRC em estágio 5 com indicação dialítica. Atualmente, o grupo de pacientes idosos incidentes em diálise é o que mais cresce. Apesar de não se haver chegado a um consenso, parece ser indiscutível que o importante é viver com qualidade de vida. Neste artigo, buscamos discutir a diálise no paciente idoso.

With the increase in life expectancy, the improvement of therapeutic arsenal, knowledge and control of chronic degenerative diseases, the world population has reached older age groups. As advanced age is a risk factor for chronic kidney disease (CKD), along with the bonus of increased survival, today we are experiencing the greatest burden of progressive incidence of elderly patients on renal replacement therapy (RRT). Dialysis in elderly patients, which for three decades was considered out of question, today is a routine for nephrologists, who face the challenge of providing care to elderly patients with CKD stage 5 with dialysis indication. In fact, what we see nowadays are dialysis incidents elderly patients as the fastest growing group on RRT. Although without reaching a consensus, it seems indisputable that for elderly patients with CKD, the most important is the quality of life. In this paper we discuss the dialysis in the elderly patient.

Body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study

OBJECTIVES: To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients. PATIENTS AND METHODS: Patients (n = 1911) older than 18 years of age recruited from 114 dialysis centers (Dec/ 2004-Oct/2007) and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died). RESULTS: Survival analyses were performed using Kaplan-Meier survival curves and Cox proportional hazards. Total follow-up was 34 months. The mean age was 59 years (54% female). The weight category percentages were as follows: underweight: 8%; normal: 51%; overweight: 29%; and obese 12%. The multivariate model showed a higher risk of death for a body mass index <18.5 kg/m², a neutral risk between 25 and 29.9 kg/m² and a protective effect for an index >30 kg/m². Patients were divided into five categories according to quintiles of body weight changes during the first year of dialysis: <-3.1%, -3.1 to+0.12%, +0.12 to <+3.1% (reference category), +3.1 to +7.1% and >+7.1%. Patients in the lowest quintile had significantly higher mortality, whereas no negative impact was observed in the other quintiles. CONCLUSION: These findings suggest that overweight/obesity and a positive body weight variation during the first year of peritoneal dialysis therapy do not increase mortality in incident dialysis patients in Brazil.

Diagnóstico precoce e tratamento da insuficiência renal crônica em idosos / Early diagnosis and treatment of chronic renal failure in elderly

A insuficiência renal crônica é um problema de saúde pública mundial, afetando todas as idades. Atualmente apresenta prevalência acentuada entre os pacientes idosos. Seu diagnóstico envolve a necessidade de classificação quanto ao estágio em que o paciente se encontra. A avaliação da função renal mais prática inclui as fórmulas de cálculo do ritmo de filtração glomerular (RFG), que são apresentadas no texto. As manifestações da uremia nos idosos são semelhantes àquelas observadas nos segmentos mais jovens. O tratamento conservador visa à correção das mesmas e à manutenção da função renal, com o objetivo de dispensar o tratamento dialítico ou retardar o seu início.

The chronic renal failure constitutes a world wide health problem, affecting all ages, but nowadays with an accentuation of its prevalence among old people. Its diagnosis deserves the needing of a classification of the level of the renal function of the patient. The most practical renal function evaluation includes the equations for the estimation of the glomerular filtration rate which are presented in the text. The uremic manifestations of the aged are the same observed in younger groups and their conservative treatment is in order to promote the corrections of those manifestations and the renal function preservation for preventing the dialysis treatment or its beginning.