Desfecho clínico de pacientes em urgência dialítica: uma revisão integrativa da literatura / Resultado clínico de pacientes en urgencia dialítica: una revisión integradora de la literatura / Clinical outcome of patients in dialysis urgency: an integrative literature review

RESUMO Objetivo : Investigar o desfecho clínico de pacientes em urgência dialítica submetidos à terapia renal substitutiva, por meio de uma revisão integrativa da literatura. Método : Revisão integrativa da literatura de estudos publicados de janeiro de 2010 a julho de 2020, na íntegra, em inglês e português, nas bases de dados: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem e PUBMED. Foram utilizadas palavras-chave e descritores: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" e "urgência dialítica". Os textos foram pré-selecionados a partir da leitura dos títulos e resumos, verificando sua aderência ao tema, encontrando-se 344 artigos. A seguir, foi realizada a leitura dos resultados e considerações dos estudos. Dos 334 artigos pré-selecionados, apenas 13foram incluídos. Resultados : Há recorrência da urgência dialítica, sendo o óbito o principal desfecho clínico. Conclusão : Os estudos acerca dos desfechos clínicos de pacientes em urgência dialítica ainda são poucos se comparado à dimensão que a doença renal possui na população mundial. Conhecer esses desfechos dará subsídios para novos estudos sobre a sobrevida desses pacientes e para políticas de saúde mais eficazes.

RESUMEN Objetivo : investigar el resultado clínico de pacientes en urgencia dialítica sometidos a la terapia renal sustitutiva, por medio de una revisión integradora de la literatura. Método : revisión integradora de la literatura de estudios publicados de enero de 2010 a julio de 2020, en su totalidad, en inglés y portugués, en las bases de datos: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem y PUBMED. Fueron utilizados los descriptores y las palabras clave en portugués: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" y "urgência dialítica". Los textos fueron pre-seleccionados a partir de la lectura de los títulos y resúmenes, verificando su adherencia al tema, fueron encontrados 344 artículos. A continuación, fue realizada la lectura de los resultados y las consideraciones de los estudios. De los 334 artículos pre-seleccionados, apenas 13 fueron incluidos. Resultados : hay recurrencia de la urgencia dialítica, siendo el óbito el principal resultado clínico. Conclusión: los estudios acerca de los resultados clínicos de pacientes en urgencia dialítica todavía son pocos comparados a la dimensión que la enfermedad renal posee en la población mundial. Conocer estos resultados dará herramientas para nuevos estudios respecto a la pervivencia de estos pacientes y para políticas de salud más eficaces.

ABSTRACT Objective: To investigate the clinical outcome of patients in dialysis urgency who have undergone renal replacement therapy, through an integrative literature review. Method: Integrative literature review of studies published from January 2010 to July 2020, in full, in English and Portuguese, in the databases: Latin American and Caribbean Literature in Health Science, Medical Literature Analysis and Retrieval System Online, Nursing and PUBMED database. The keywords and descriptors were used: "hemodialysis", "emergency", "renal dialysis", "mortality", "clinical outcome" and "dialysis urgency". The texts were pre-selected from reading the titles and abstracts, verifying their adherence to the theme, and 344 articles were found. Next, the results and study considerations were read. Of the 334 pre-selected articles, only 13 were included. Results: There is recurrence of dialysis urgency, with death being the main clinical outcome. Conclusion: Studies on the clinical outcomes of patients in dialysis urgency are still few compared to the dimension that kidney disease has in the world population. Knowing these outcomes will provide support for further studies on the survival of these patients and for more effective health policies.

Effects of sertraline in the prevention of low blood pressure in patients undergoing hemodialysis / Efeitos da sertralina na prevenção de hipotensão arterial em pacientes submetidos à hemodiálise

Abstract Introduction: Intradialytic hypotension (IDH) is a major complication of hemodialysis, with a prevalence of about 25% during hemodialysis sessions, causing increased morbidity and mortality. Objective: To study the effects of sertraline to prevent IDH in hemodialysis patients. Methods: This was a double-blind, crossover clinical trial comparing the use of sertraline versus placebo to reduce intradialytic hypotension. Results: Sixteen patients completed the two phases of the study during a 12-week period. The IDH prevalence was 32%. A comparison between intradialytic interventions, intradialytic symptoms, and IDH episodes revealed no statistical difference in the reduction of IDH episodes (p = 0.207) between the two intervention groups. However, the risk of IDH interventions was 60% higher in the placebo group compared to the sertraline group, and the risk of IDH symptoms was 40% higher in the placebo group compared to the sertraline group. Survival analysis using Kaplan-Meier estimator supported the results of this study. Sertraline presented a number needed to treat (NNT) of 16.3 patients to prevent an episode from IDH intervention and 14.2 patients to prevent an episode from intradialytic symptoms. Conclusion: This study suggests that the use of sertraline may be beneficial to reduce the number of symptoms and ID interventions, although there was no statistically significant difference in the blood pressure levels.

Resumo Introdução: A hipotensão intradialítica (HID) é uma das principais complicações da hemodiálise, com uma prevalência de cerca de 25% durante as sessões de hemodiálise, causando aumento da morbimortalidade. Objetivo: Estudar os efeitos da sertralina na prevenção da HID em pacientes em hemodiálise. Métodos: Este foi um ensaio clínico duplo-cego, cruzado, comparando o uso de sertralina versus placebo para reduzir a hipotensão intradialítica. Resultados: Dezesseis pacientes completaram as duas fases do estudo durante um período de 12 semanas. A prevalência de HID foi de 32%. Uma comparação entre intervenções intradialíticas, sintomas intradialíticos (ID) e episódios de HID não revelou diferença estatística na redução dos episódios de HID (p = 0,207) entre os dois grupos de intervenção. No entanto, o risco de intervenções para HID foi 60% maior no grupo placebo em comparação com o grupo Sertralina, e o risco de sintomas ID foi 40% maior no grupo placebo em comparação com o grupo Sertralina. A análise de sobrevida utilizando o estimador de Kaplan-Meier corroborou os resultados deste estudo. A sertralina apresentou um número necessário para tratar (NNT) de 16,3 pacientes para prevenir um episódio de intervenção de HID e 14,2 pacientes para prevenir um episódio de sintomas intradialíticos. Conclusão: Este estudo sugere que o uso de sertralina pode ser benéfico para reduzir o número de sintomas e intervenções de HID, embora não tenha havido diferença estatisticamente significante nos níveis pressóricos.

The impact of dialysis on critically ill elderly patients with acute kidney injury: an analysis by propensity score matching / Impacto da diálise em pacientes críticos idosos com injúria renal aguda: uma análise por propensity-score matching

ABSTRACT Introduction: Aging is a global phenomenon. Recent forecasts indicate that Brazil will be the sixth country in population of elderly individuals in 2020. The incidence of acute kidney injury (AKI) among the elderly varies, but studies have indicated that older individuals are more prone to developing AKI and have higher mortality rates than the general population with renal disease. The impact of dialysis in elderly patients with AKI - and critically ill individuals with multiple dysfunctions - has been discussed for years. Evidence indicates that for this group of patients dialysis does not positively impact survival and, in some situations, it might even accelerate death. This study investigated a population of elderly individuals with AKI seen in intensive care units to assess, through Propensity Score Matching, the impact dialysis has had for them. Methods: Data from the charts of patients aged 60 years or older seen at the intensive care unit of a general hospital between January 2012 and December 2014 and diagnosed with AKI were collected. Results: The study included 329 patients with a mean age of 75.4 ± 9.3 years. Ischemic AKI was the most prevalent disease (54.7%) and 28.9% of the patients needed dialysis. No difference was seen in the death rates of dialysis and non-dialysis patients aged 70+ years. Conclusions: The data suggested that dialysis did not seem to impact the death rates of critically ill patients with AKI aged 70+ years.

RESUMO Introdução: O crescimento da população idosa é um fenômeno mundial. Projeções recentes demonstram que o Brasil será o sexto país do mundo em número de idosos no ano de 2020. A incidência de injúria renal aguda (IRA) nos idosos varia de acordo com a população estudada, mas vários estudos têm sugerido que os idosos são mais suscetíveis ao desenvolvimento de IRA e apresentam maior mortalidade que a população geral. Há anos se discute o real impacto da instituição da diálise em pacientes idosos com IRA, principalmente em pacientes críticos com múltiplas disfunções. Há evidências de que o início da diálise nesses indivíduos não tenha impacto positivo na sobrevida e, em algumas situações, até acelere o óbito. O objetivo deste estudo foi analisar uma população de idosos que desenvolveu IRA em unidades de terapia intensiva e avaliar, através do Propensity Score Matching, o impacto da diálise nesses indivíduos. Métodos: Foram coletados dados de prontuários de idosos acima dos 60 anos, internados na UTI de um hospital geral, de janeiro de 2012 a dezembro de 2014, e que evoluíram com IRA. Resultados: Foram incluídos 329 pacientes, com idade média de 75,4 ± 9,3 anos. A IRA isquêmica foi a mais prevalente (54,7%), e 28,9% necessitaram de diálise. Nos indivíduos acima de 70 anos, não foi observada diferença na mortalidade entre os pacientes que realizaram ou não diálise. Conclusões: Esses dados sugerem que a diálise parece não apresentar impacto sobre a mortalidade de pacientes críticos com IRA, acima de 70 anos.

Mortalidad y factores asociados en pacientes con enfermedad renal crónica en hemodiálisis en un hospital peruano / Mortality and associated factors in chronic kidney disease patients under hemodialysis in a Peruvian hospital

Introducción: La enfermedad renal crónica es un problema de salud en Perú. Objetivo: Determinar la mortalidad y los factores asociados en pacientes con enfermedad renal crónica en hemodiálisis de una población incidente en un hospital peruano. Material y Métodos: Estudio de cohorte retrospectiva, de los pacientes que ingresaron al programa de hemodiálisis crónica del hospital Antonio Lorena (Cusco-Perú), entre 2010-2016. Para el análisis de supervivencia se utilizó el método de Kaplan-Meier, para determinar los factores asociados a mortalidad se realizó la Regresión de Cox, se obtuvo el Hazard Ratio (HR) y sus intervalos de confianza al 95 por ciento (IC 95). Resultados: Se estudiaron 187 pacientes, con una mediana de edad de 57 años (rango intercuartílico: 43-66. El 47 por ciento (89) de los pacientes fallecieron durante el seguimiento. La tasa de mortalidad fue de 24 muertes/100 personas-por año (IC 95 por ciento: 19,6-29,6). La mediana de supervivencia fue de 2,8 años (IC 95 por ciento: 1,9-4,0). La dilatación de la aurícula izquierda en la ecocardiografía (HR: 2,63; IC 95 por ciento: 1,03-6,69; p=0,041), el recuento de leucocitos ≥ 12x103u/mm3 (HR: 6,86; IC 95 por ciento: 2,08-22,66; p=0,002), y la hemoglobina < 7 g/dL (HR: 3,62; IC 95 por ciento: 1,05-12,48; p=0,041) se asociaron a mortalidad. Conclusiones: Se encontró una baja frecuencia de supervivencia la misma que estuvo asociada a factores potencialmente modificable(AU)

Introduction: Chronic kidney disease is a health problem in Perú. Objective: To determine the mortality and the associated factors in chronic kidney disease patients under hemodialysis in an incident population in a Peruvian hospital. Material and Methods: A retrospective cohort study was conducted in patients admitted to the chronic hemodialysis program at Hospital Antonio Lorena (Cusco-Peru), from 2010 to 2016. Kaplan-Meier method was used for the survival analysis to determine the factors associated with mortality, Cox´s Regression was carried out, obtaining Hazard Ratio (HR) and 95 percent confidence intervals (95 percent CI). Results: A total of 187 patients were studied, with a mean age of 57 years (interquartile range: 43-66). The 47 percent (89) of patients died during follow-up. Mortality rate was 24 deaths / 100 people-per year (95 percent CI: 19.6-29.6). The mean survival rate was 2.8 years (95 percent CI: 1.9-4.0). Dilatation of the left atrium in the echocardiography (HR: 2.63; 95 percent CI: 1.03-6.69; p=0.041), a white blood cell count ≥ 12x103u/mm3 (HR: 6.86; 95 percent CI: 2.08-22.66; p=0.002), and hemoglobin <7 g/dL (HR: 3.62; 95 percent CI: 1.05-12.48; p=0.041) were associated with mortality. Conclusions: A low frequency of survival was found, which was associated with potentially modifiable factors(AU)

Survival and risk factors among dialytic acute kidney injury patients after cardiovascular surgery

Abstract Objective: Acute kidney injury (AKI) is a frequent postoperative complication after cardiovascular surgery. It has been described as a predictor of decreased survival rates, but how dialysis decreases survival when initiated on the postoperative period has yet to be determined. To analyze the survival of patients who presented postoperative AKI requiring dialysis up to 30 days after cardiovascular surgery and its risk factors is the aim of this study. Methods: Of the 5,189 cardiovascular surgeries performed in a 4-year period, 157 patients developed AKI requiring dialysis in the postoperative period. The Kaplan-Meier survival curve and log-rank test were used in the statistical analysis to compare the curves of categorical variables. P-value< 0.05 was considered significant. Results: Patient average survival was 546 days and mortality was 70.7%. The need for dialysis on the postoperative period decreased late survival. Risk factors for decreased survival included age (P<0.001) and postoperative complications (P<0.0003). Conclusion: The average survival was approximately one year among dialytic patients. Age and postoperative complications were risk factors that determined decreased survival.

Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study / Índice Tornozelo-Braquial Como Preditor de Mortalidade em Hemodiálise: Um Estudo de Coorte de 5 Anos

Abstract Background: Abnormal ankle-brachial index (ABI) has been found to be a strong predictor of mortality in some hemodialysis populations in studies with relatively short periods of follow-up, lower than 2 years. Objective: This study aimed to assess the predictive value of abnormal ABI as a risk factor for death among patients on maintenance hemodialysis after a 5-year follow-up. Methods: A total of 478 patients on hemodialysis for at least 12 months were included in the study. ABI measurement was performed using a mercury column sphygmomanometer and portable Doppler. Patients were divided into 3 groups according to ABI (low: <0.9; normal: 0.9 to 1.3; and high: >1.3) and followed for a 60-month period. Results: The prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%, respectively. The 5-year survival rate was lower in the groups with low ABI (44.1%, P<0.0001) and high ABI (60.8%, P= 0.025) than in the group with normal ABI (71.7%). Cox regression was used to evaluate the association between ABI and mortality, adjusting for potential confounders. Using normal ABI as reference, a low, but not a high ABI was found to be an independent risk factor for all-cause mortality (HR2.57; 95% CI, 1.84-3.57 and HR 1.62; 95% CI, 0.93-2.83, respectively). Conclusions: long-term survival rates of patients with either low or high ABI were lower than the one from those with normal ABI. However, after adjustment for potential confounders, only low ABI persisted as an independent risk factor for all-cause mortality among hemodialysis patients.

Resumo Fundamento: O índice tornozelo-braquial (ITB) foi apontado como um forte preditor de mortalidade em algumas populações de pacientes em hemodiálise em estudos com períodos relativamente curtos de acompanhamento (inferior a 2 anos). Objetivo: Avaliar o valor preditivo do ITB anormal como um fator de risco de morte em pacientes em hemodiálise após 5 anos de acompanhamento. Métodos: Um total de 478 pacientes em hemodiálise por pelo menos 12 meses foram incluídos no estudo. A medida de ITB foi realizada usando-se esfigmomanômetro com coluna de mercúrio e Doppler portátil. Os pacientes foram divididos em 3 grupos de acordo com o ITB (baixo: < 0,9; normal: 0,9 - 1,3; e alto: >1,3), e acompanhados por um período de 60 meses. Resultados: As prevalências de ITB baixo, normal e alto foram 26,8%, 64,6% e 8,6%, respectivamente. A taxa de sobrevida de 5 anos foi menor nos grupos com ITB baixo (44,1%, p <0,0001) e ITB alto (60,8%, p = 0,025) que no grupo com ITB normal (71,7%). A regressão de Cox foi usada para avaliar a associação entre ITB e mortalidade, ajustando para potenciais fatores de confusão. Usando o ITB normal como referência, um baixo ITB, mas não um alto ITB foi identificado como um fator de risco independente para mortalidade por todas as causas (HR2,57; IC95%, 1,84-3,57 e HR 1,62; 95% CI, 0,93-2,83, respectivamente). Conclusões: as taxas de sobrevida em longo prazo de pacientes com um ITB baixo ou alto foram menores que de pacientes com um ITB normal. No entanto, após ajuste por fatores de confusão, somente o ITB baixo manteve-se como um fator de risco independente para mortalidade por todas as causas entre pacientes em hemodiálise.

Analysis of the Use of Extracorporeal Circulation on the In-Hospital Outcomes of Dialytic Patients Who Underwent Myocardial Revascularization Surgery / Análise do Uso da Circulação Extracorpórea na Evolução Intra-Hospitalar de Pacientes Dialíticos Submetidos à Revascularização Cirúrgica do Miocárdio

Abstract Background: Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients. Objectives: To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization. Methods: Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014. Results: Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and increased need for blood components (77.7% vs. 25.6%; p <0.0001) and inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative course, the group "without ECC" required less vasoactive drugs, (61.5% vs. 82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p = 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as compared with the group with ECC surgery. No difference in mortality was found between the groups. Conclusion: Myocardial revascularization with ECC in patients on dialysis resulted in higher morbidity in the perioperative period in comparison with the procedure without ECC, with no difference in mortality though.

Resumo Fundamento: A revascularização cirúrgica do miocárdio é o melhor tratamento para o paciente dialítico com doença coronariana multiarterial. Contudo, o procedimento ainda apresenta elevada morbimortalidade. O uso da circulação extracorpórea (CEC) pode impactar de maneira negativa na evolução intra-hospitalar desses pacientes. Objetivos: Avaliar a diferença entre as técnicas com ou sem CEC na evolução intra-hospitalar de pacientes dialíticos submetidos a cirurgia de revascularização do miocárdio. Métodos: Estudo unicêntrico de 102 pacientes dialíticos consecutivos e não selecionados, submetidos à revascularização cirúrgica do miocárdio em um hospital terciário universitário no período de 2007 a 2014. Resultados: 63 pacientes foram operados com CEC e 39 sem o uso de CEC. Foi observada alta prevalência de fatores de risco cardiovascular em ambos grupos, porém sem diferença estatisticamente significante entre eles. O grupo "com CEC" apresentou maior número de coronárias revascularizadas (2,4 vs 1,7; p <0,0001), maior necessidade de hemocomponentes (77,7% vs 25,6%; p <0,0001) e apoio inotrópico (82,5% vs 35,8%; p <0,0001). Na evolução pós-operatória, o grupo "sem CEC" apresentou menor necessidade de drogas vasoativas (61,5% vs 82,5%; p = 0,0340), maior taxa de extubação em sala cirúrgica (58,9% vs 23,8%, p = 0,0006), menor tempo de ventilação mecânica (13,0 horas vs 36,3 horas, p = 0,0217), menor taxa de infecções (7,6% vs 28,5%; p = 0,0120) e menor tempo de internação em UTI (5,2 dias vs 8,1 dias; p = 0,0054) em comparação ao grupo "com CEC". Não houve diferença de mortalidade entre os grupos. Conclusão: O uso da CEC na revascularização do miocárdio em pacientes dialíticos resultou em maior morbidade no período perioperatório em comparação ao procedimento realizado sem CEC, contudo, sem diferença de mortalidade.

Análisis de sobrevida en pacientes de edad avanzada que inician hemodiálisis crónica en Servicio de Salud Chileno / Survival of older patients starting hemodialysis in Chile

The proportion of older people with end stage renal disease is increasing. Their prognosis is characterized by a high mortality and poor quality of life. Aim: To analyze the survival of patients starting chronic hemodialysis (CHD) according to their age. Material and Methods: Patients admitted to CHD in the East Metropolitan Health Service of Santiago in a 2-year period were analyzed. Four age groups were created, separating patients older than 70 years in a special group. Results: During the study period, 459 patients were admitted to CHD and were followed for an average of 27 months. The frequency of cardiovascular comorbidity, cancer, and chronic renal disease of unknown cause (attributed to nephrosclerosis) increased along with age. Mortality was higher at older ages. There was a significant association between starting CHD with a catheter, Charlson comorbidity index and increasing age with mortality. For those aged over 80 years, mortality at three months and one year was 25 and 43% respectively. Conclusions: Age, Charlson index and vascular access are predictors of mortality in older adults entering hemodialysis. This study suggests the importance of considering comorbidities, assessment by specialists and creating an arteriovenous fistula in this age group.

Factores asociados a mortalidad intrahospitalaria de una población en hemodiálisis en el Perú / Factors associated with in hospital deaths in a hemodialysis population in Peru

Determinar los factores asociados a la mortalidad durante la primera hospitalización de una población incidente en hemodiálisis. Materiales y métodos. Estudio observacional y retrospectivo de pacientes que ingresaron al Hospital Nacional Dos de Mayo entre enero de 2012 y diciembre de 2013. Para el análisis de la supervivencia utilizamos el método de Kaplan-Meier. Se realizó un análisis de regresión logístico multivariado para evaluar los factores asociados a mortalidad intrahospitalaria. Resultados. Se estudiaron 216 pacientes con edad promedio de 56,9 ± 15,5 años. El 24% de los paciente (n=51) fallecieron durante la estancia hospitalaria. La tasa de mortalidad fue de 9,3 muertes/100 personas-semanas (IC 95%: 7,0 a 12,3). Se evidenció una tendencia a menor riesgo de fallecer en pacientes que tenían entre uno y seis meses con diagnóstico de enfermedad renal crónica (OR 0,84; IC 95%: 0,32 a 2,26), y en aquellos con más de seis meses comparado con aquellos que lo tenían hace menos de un mes (OR 0,55; IC 95%: 0,19 a 1,57). La atención previa por un nefrólogo no estuvo asociada a diferencias en la mortalidad menor (OR 1,14; IC 95%: 0,39 a 3,31). Conclusiones. Existe una deficiente atención previa entre los pacientes en hemodiálisis que forman parte de una inadecuada estructura de atención de salud y que está asociado a una alta mortalidad intrahospitalaria...

To determine the factors associated with mortality during the first hospitalization of patients admitted to a hemodialysis unit. Materials and methods. Observational and retrospective study of patients admitted to ôDos de Mayoõ National Hospital between January 2012 and December 2013. For the survival analysis we used the Kaplan-Meier method. A multivariate logistic regression was performed to evaluate the factors associated with hospital mortality. Results. 216 patients with a mean age of 56.9 ± 15.5 years were studied. 24% of patients (n = 51) died during their hospital stay. The mortality rate was 9.3 deaths/100 person-weeks (95% CI: 7.0 to 12.3). We found a tendency of less risk of death in patients with between 1 and 6 months from chronic kidney disease diagnosis (OR 0.84, 95% CI: 0.32 to 2.26) and in those with more than six months from chronic kidney disease diagnosis compared with those who had less than a month from chronic kidney disease diagnosis (OR 0.55, 95% CI: 0.19 to 1.57). Previous care by a nephrologist was not associated with differences in lower mortality (OR 1.14, 95% CI: 0.39 to 3.31). Conclusions. There is poor prior care among hemodialysis patients that form part of an inadequate health care structure and this is associated with high inhospital mortality...

Encaminhamento tardio ao nefrologista e a associação com mortalidade em pacientes em hemodiálise / Late nephrologist referral and mortality assotiation in dialytic patients

Introdução: A doença renal crônica (DRC) caracteriza-se pela perda progressiva da função renal. Intervenções em estágios iniciais melhoram significativamente o prognóstico dos pacientes com DRC e vários estudos mostram que o encaminhamento precoce (EP) ao nefrologista reduz a taxa de mortalidade. Objetivo: Analisar o perfil dos pacientes em diálise e o tempo transcorrido entre a primeira consulta na unidade de diálise e o início do programa dialítico. Métodos: Foi realizado um estudo de coorte retrospectivo com dois eixos de análise: perfil socioepidemiológico e clínico dos pacientes em hemodiálise e o tempo transcorrido entre a primeira consulta na unidade de diálise e o início do programa dialítico. Utilizaram-se métodos analíticos para comparar estes dados com o EP e com a mortalidade em 12 meses após o início da diálise. Resultados: Foram analisados 111 pacientes. A taxa de mortalidade dos pacientes encaminhados tardiamente e precocemente foi, respectivamente, de 47,8% e 20,5% (razão de risco [HR] = 2,38; intervalo de confiança [IC] = 1,06-5,36; p = 0,035). Os pacientes que iniciaram a diálise por cateter e fístula arteriovenosa (FAV) tiveram mortalidade, respectivamente, de 51,4% e 10,3% (HR = 4,61; IC = 1,54-13,75; p = 0,006). Conclusão: O tempo de encaminhamento foi predominantemente tardio. Foi demonstrado que o encaminhamento tardio (ET) esteve relacionado a maior mortalidade. Outros fatores associados a maior mortalidade foram a idade maior ou igual a 70 anos, presença de DM e uso de cateter ao início da diálise. .

Introduction: Chronic kidney disease is defined by the progressive loss of renal function. Interventions in early stages significantly improve the prognosis of patients with chronic kidney disease, reducing the mortality, and many studies show that early nephrologist referral reduces the mortality rate. Objective: To analyze the characteristics of the patients in dialysis and the time between the first consultation in the dialysis clinic and the beginning of the dialytic program. Methods: It was made a cohort retrospective study with two analysis axis: the social and epidemiological characteristics of the patients in hemodialysis and the time between the first consultation in the clinic and the beginning of the dialytic program. Analytical and descriptive methods where used to compare these data with the early referral and the mortality 12 months after the dialysis onset. Results: One hundred and one patients were analized. The mortality rate of the early and lately referred patients was 47.8% and 20.5%, respectively (HR = 2.38; IC = 1.06-5.36; p = 0.035). Concerning the patients which initiated the dialysis with catheter and arteriovenous fistula, the mortality was respectively 51.4% and 10.3% (HR = 4.61; IC = 1,54-13,75; p = 0.006). Conclusion: The referral timing was predominantly late. The late referral was associated with a greater mortality. Other variables associated with a greater mortality were age of 70 or more, presence of diabetes and the use of catheter by the dialysis onset. .

Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes / Sobrevida e Fatores Preditores de Letalidade em Hemodiálise: Polimorfismos D/I do Gene da Enzima Conversora da Angiotensina I e o M235T do Angiotensinogênio

Background: End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. Objective: To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. Methods: Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. Results: The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. Conclusions: The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene. .

Fundamento: Os pacientes em hemodiálise continuam tendo um significativo aumento na morbiletalidade, especialmente a causada por doenças cardiovasculares. A análise dos fatores genéticos ligados ao sistema renina-angiotensina que influenciam na sobrevivência destes pacientes poderá ajudar na busca por melhores resultados. Objetivo: Avaliar a sobrevida em hemodialisados e sua associação com polimorfismo dos genes do sistema reninaangiotensina: deleção/inserção do gene que codifica a enzima conversora da angiotensina I e o M235T do angiotensinogênio. Métodos: Estudo observacional desenhado para ver o papel dos genes do sistema renina-angiotensina. Foram analisados 473 pacientes tratados com hemodiálise crônica em quatro unidades de diálise do Estado do Rio de Janeiro. As taxas de sobrevida foram calculadas pelo método de Kaplan-Meier e as diferenças entre as curvas avaliadas pelos testes de: Tarone-Ware, Peto-Prentice e Log-rank. Foram utilizados também modelos de regressão logística e multinomial. Um valor de p ≤ 0,05 foi considerado estatisticamente significativo. O comitê de ética aprovou este estudo. Resultados: A idade média dos pacientes foi de 45,8%. A taxa de sobrevida global foi de 48% em 11 anos. As principais causas de óbito foram: doenças do aparelho circulatório (34 %) e infecções (15%). A análise de regressão logística encontrou significância estatística para as seguintes variáveis: idade, o TT do angiotensinogênio e a renda familiar acima de cinco salários mínimos, esta última como fator de proteção (p valor: 0,000038, 0,08261 e 0,03089, respectivamente). Conclusões: Nossos dados sugerem que o risco de letalidade em pacientes em hemodiálise pode ser influenciado também pelo polimorfismo ...

Morbimortality study of infection in patients undergoing different types of dialysis in a renal replacement therapy center

INTRODUCTION: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality. OBJECTIVES: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. METHODS: This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). RESULTS: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13-5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. CONCLUSIONS: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group. .

Trasplante renal y disminución de la mortalidad en los programas de diálisis crónica / The role of kidney transplantation in reducing mortality in a chronic dialysis program

El trasplante renal (TR) presenta mejor supervivencia, calidad de vida y costos que la diálisis en la insuficiencia renal crónica (IRC). Estudiamos pacientes en diálisis que recibieron TR durante 2010, las causas de finalización del tratamiento y la supervivencia en diálisis. Evaluamos si criterios más amplios para la aceptación de trasplantes hubieran afectado los resultados del procedimiento en ese período. Incluimos 118 pacientes en diálisis, edad media 56.9 ± 18.4 años, tiempo en diálisis 45.5 ± 59.6 meses, 35 (30%) presentaban diabetes como causa de IRC, y 58 (49%) estaban en espera del TR. Treinta y cuatro finalizaron diálisis, 18 por TR y 12 por fallecimiento. Las principales causas de muerte fueron cardiovasculares, 6 (50%) e infecciones, 2 (17%). La supervivencia al año fue 85% para el grupo total, 98% para los pacientes inscriptos en lista de espera y 72% para no inscriptos. Durante 2010 se realizaron 88 TR (62 con donantes cadavéricos [DC], 18 donantes vivos y 8 dobles trasplantes páncreas-riñón). Los receptores de DC tenían en promedio 50.7 años, 67 meses en diálisis, 8 (13%) eran diabéticos, 12 (20%) con TR previos y 3 cross match contra panel de anticuerpos > 20%. Los donantes tenían edad media 45 años, 28 (45%) con criterios expandidos y 27.7 h de isquemia fría. A los 11.4 meses de seguimiento, 13 (21%) presentó rechazo agudo, la supervivencia para injerto fue de 88% y 93% para pacientes. La principal causa de finalización de diálisis fue TR, sin detectarse que el empleo de DC afectara la supervivencia del TR.

For patients with chronic renal failure (CRF), kidney transplant (KT) is a better alternative to dialysis in terms of survival, life quality and costs. We studied the general characteristics, causes and survival rate of the dialysis population in 2010. We evaluated broader criteria for acceptance of transplants has affected the results of the procedure in that period. A total of 118 dialysis patients were included; mean age 56.9 ± 18.4 years, dialysis duration 45.5 ± 59.6 months, main cause of CRF was diabetes in 35 (30%), and 58 (49%) were included in waiting list for KT. Of the 34 patients who finished dialysis in 2010, 18 (53%) were KT, while 12 (35%) died (cardiovascular 50%, infectious 17%). Survival at 12 months was 85% for the total group, 98% on waiting list and 72% those who were not enrolled. During 2010 there were 88 KT, 62 with cadaveric donors (CD), 18 with living donors and 8 with double pancreas-kidney transplants. Recipients of CD were 50.7 years old, with 67 months on dialysis, 8 (13%) diabetics, and 12 (20%) with previous KT. Donors had a mean age of 45 years, 28 (45%) expanded criteria, and 27.7 hours of cold ischemia time. During an approximate follow-up of 11.4 months, 13 (21%) suffered acute graft rejection, survival was 88% for graft and 93% for patients. We emphasize KT as the main cause of success as regards dialysis. No differences in risk factors were found to significantly affect graft or patient survival.

Letalidade e internacoes de pacientes em hemodialise em plano de saude / Mortalidad e internaciones de pacientes en hemodialisis con seguro de salud / Fatality and hospitalization in hemodialysis patients in a health plan

OBJETIVO: Analisar desfechos clínicos de pacientes incidentes em hemodiálise vinculados a operadora de plano de saúde. MÉTODOS: Estudo de coorte de incidentes em hemodiálise em Belo Horizonte, MG, de 2004 a 2008, a partir de registros no banco de dados de operadora de planos de saúde. Variáveis independentes: sexo, idade, tempo entre primeira consulta com nefrologista e início da hemodiálise, tipo do primeiro acesso vascular, diabetes mellitus, tempo de permanência hospitalar/ano de tratamento e óbito. Variáveis dependentes: tempo entre início da hemodiálise e óbito e tempo de permanência hospitalar/ano de tratamento > 7,5 dias. Análise estatística: teste Qui-quadrado de Pearson na análise univariada para os desfechos óbito e tempo de permanência hospitalar/ano de tratamento; método de Kaplan-Meier para análise de sobrevida; modelo de Cox e regressão Poisson para risco de óbito e chance de tempo de permanência hospitalar/ano de tratamento > 7,5 dias. Foi utilizada ferramenta de Business Intelligence para extração dos dados e software Stata(r) 10.0. RESULTADOS: Estudados 311 indivíduos em hemodiálise, 55,5% homens, média de 62 anos (dp: 16,6 anos). A prevalência aumentou 160% no período estudado. Na análise de sobrevivência a mortalidade foi maior entre os mais idosos, nos que não realizaram consulta com nefrologista, fizeram uso de cateter vascular temporário como primeiro acesso, com diabetes mellitus, nos que foram internados no mesmo mês do início da hemodiálise. No modelo de Cox associaram-se a maior risco para óbito a idade avançada, diabetes mellitus, não realizar consulta prévia com nefrologista e internar-se no primeiro mês de hemodiálise. Maior tempo de permanência hospitalar/ano ...

OBJETIVO: Analizar los resultados clínicos de pacientes incidentes en hemodiálisis vinculados a operadora de seguro de salud MÉTODOS: Estudio de cohorte de incidentes en hemodiálisis en Belo Horizonte, MG, Brasil, de 2004 a 2008, a partir de registros en el banco de datos de operadora seguros de salud. Variables independientes: sexo, edad, tiempo entre primera consulta con nefrólogo e inicio de hemodiálisis, tipo del primer acceso vascular, diabetes mellitus, tiempo de permanencia en el hospital /año de tratamiento y óbito. Variables dependientes: tiempo entre inicio de hemodiálisis y óbito y tiempo de permanencia en hospital/año de tratamiento > 7,5 días. Análisis estadístico: prueba Chi-cuadrado de Pearson en el análisis univariado para los resultados óbito y tiempo de permanencia en el hospital/año de tratamiento; método de Kaplan-Meier para análisis de sobrevida; modelo de Cox y regresión Poisson para riesgo de óbito y chance de tiempo de permanencia en hospital/año de tratamiento > 7,5 días. Se utilizó herramienta de Business Intelligence para extracción de los datos y software Stata(r) 10.0. RESULTADOS: Se evaluaron 311 individuos en hemodiálisis, 55,5% hombres, promedio de edad de 62 años (ds: 16,6 años). La prevalencia aumentó 160% en el período estudiado. En el análisis de sobrevivencia la mortalidad fue mayor entre los adultos de mayor edad, en los que no realizaron consulta con el nefrólogo, uso de catéter vascular temporario como primer acceso, con diabetes mellitus, en los que fueron internados en el mismo mes de inicio de la hemodiálisis. En el modelo de Cox se asociaron a mayor riesgo de óbito la edad avanzada, diabetes mellitus, no realizar consulta previa con nefrólogo e internarse en el primer mes de hemodiálisis. El mayor ...

OBJECTIVE: To analyze clinical outcomes of patients on hemodialysis linked to health care plan provider. METHODS: Cohort study of hemodialysis events in Belo Horizonte, MG, Southeastern Brazil, between 2004 and 2008, based on records from health care plan provider databases. The independent variables were: sex, age, time between first appointment with nephrologist and starting hemodialysis, type of first vascular access, diabetes mellitus, length of time spent in hospital/year of treatment and death. Dependent variables: time between starting hemodialysis and death and length of time spent in hospital/year of treatment > 7.5 days. Statistical analysis was carried out using Pearson's Chi-squared test in the univariate analysis for the outcomes 'death' and 'length of time spent in hospital/year of treatment'; the Kaplan-Meier method was used to analyze survival; the Cox model and Poisson regression were used for risk of death and chance of length of time spent in hospital/year of treatment > 7.5 days. The Business Intelligence tool and Stata(r) 10.0 software were used to extract data. RESULTS: There were 311 patients on hemodialysis included in the study, with a mean age of 62 (sd 16.6 years), of whom 55.5% were male. Prevalence increased 160% during the period in question. Survival analysis showed a higher mortality among older patients, patients that did not consult a nephrologists, those whose first vascular access was using a temporary catheter, those with diabetes mellitus, those admitted to hospital within a month of beginning hemodialysis. The Cox model showed that a higher risk of death was associated with age, diabetes mellitus, not consulting a nephrologists and those that were hospitalized within a month of beginning hemodialysis. Greater length of time spent in hospital/year of treatment was not associated with sex or diabetes. According to Poisson regression, the variables were not significant. CONCLUSIONS: ...

Influencia de la infección por el virus de la hepatitis C en la mortalidad de los pacientes en hemodiálisis / Influence of infection by the hepatitis C virus on mortality in hemodialysis patients

Introducción: la hepatitis C se mantiene como un problema de salud en los centros de hemodiálisis. Métodos: se realizó un estudio de cohorte histórico donde se incluyeron 215 pacientes que ingresaron al centro de hemodiálisis del Hospital Militar Dr. Luis Díaz Soto, entre 1995 y 2008. Se tomaron como períodos de exposición los criterios de aislamiento de pacientes con hepatitis C. Resultados: se halló mortalidad general de 30,2 por ciento, la letalidad y la mortalidad por hepatitis C fueron mayores en el período de exposición con 53,8 por ciento y 16,6 por ciento, respectivamente. En el análisis multivariado por regresión de Cox se observó que constituyeron factores de riesgo de morir, en un menor tiempo de observación, la presencia de hepatitis C y recibir tratamiento con hemodiálisis en los períodos de mayor incidencia (p=0,014), independientemente de la carga de comorbilidades. Conclusiones: la infección por el VHC contribuye a aumentar la mortalidad de los pacientes en tratamiento con hemodiálisis, cuando se tiene en cuenta la carga de comorbilidades

Introduction: hepatitis C remains a health problem in hemodialysis centers. Methods: a historical cohort study was conducted. 215 patients who entered Dr. Luis Díaz Soto Military Hospital hemodialysis center from 1995 to 2008 were included. Isolation criteria of patients with hepatitis C were considered as exposure periods. Results: overall mortality was 30.2 percent, lethality and mortality from hepatitis C were higher in the exposure period (53.8 percent and 16.6 percent respectively). In multivariate analysis by Cox regression, the presence of hepatitis C and treatment with hemodialysis were observed to be death risk factors in a shorter time of observation, during periods of increased incidence (p = 0.014), regardless of the burden of comorbidities. Conclusions: HCV infection in patients on hemodialysis contributes to increased mortality even when taking into account the burden of comorbidities

Haemodialysis vascular access practice patterns in north Pakistan

Mortality and morbidity rates in patients on haemodialysis vary among different countries widely due to variation in vascular access practices. Documented evidence of patterns and practices of various vascular access modalities in our population is scarce to allow for development of local guidelines or formulating steps to encourage adoption of international guidelines in Pakistani healthcare setup. To assess Vascular Access practices for haemodialysis patients in five dialysis facilities of Northern Pakistan. Cross sectional study. This study was carried out at five dialysis facilities in three cities of Northern Pakistan over a period of one year from March 2011 to March 2012. This cross sectional survey was completed by interviewing 536 end stage renal disease patients between 18 to 70 years of age over a period of one year. Duration of dialysis, types of access, current state and past history of vascular access were recorded and compared with International guidelines. Commonest 'current vascular access' was found to be AV fistula in 317 out of 536 patients [almost 60%] and the most common mode of 'first Vascular Access' [i.e. vascular access first used for haemodialysis] was catheter [83%]. Amongst patients who had dialysis during last eight months, 76.27% were still being dialysed via percutaneous catheters while this figure is less than 34% in Europe. Although the initial mode of dialysis in most cases is a line yet, majority of patients are dialyzed through native fistula. Need for a pre-emptive fistula is required to have superior longevity and fewer complications in haemodialysis patients

Sobrevida de pacientes em diálise no SUS no Brasil / Survival analysis of dialysis patients in the Brazilian Unified National Health System

O objetivo deste estudo foi analisar a sobrevida dos que iniciaram tratamento renal substitutivo em hemodiálise e diálise peritoneal no SUS, entre 2002 a 2004. Estudo observacional, prospectivo não concorrente. Utilizou-se a Base Nacional em Terapias Renais Substitutivas resultante de pareamento probabilístico dos sistemas Autorização de Procedimentos de Alta Complexidade/Sistema de Informações Ambulatoriais e Sistema de Informações sobre Mortalidade do SUS. Incluíram-se os admitidos em 2002 e 2003, com 3 meses de tratamento e maiores de 18 anos. Dos 31.298 pacientes, a maioria iniciou em hemodiálise, era do sexo masculino, com média de 54 anos e residentes na Região Sudeste, e em municípios com IDH médio foi de 0,78. Associou-se a maior risco óbito: sexo feminino, idade superior a 55 anos, diagnóstico de diabete mellitus, em diálise peritoneal, não residir na Região Sudeste. Residir em cidades com melhor IDH proporcionou menor risco. Risco ajustado de HR = 1,17 em favor da hemodiálise. Os resultados sugerem menor sobrevida para os de diálise peritoneal e mais velhos. Portanto, torna-se necessário subsidiar políticas que avaliem melhor a escolha da modalidade, com estudos que aprofundem os achados encontrados.

The aim of this study was to analyze the survival of patients who initiated renal replacement therapy (RRT) with hemodialysis or peritoneal dialysis in the Brazilian Unified National Health System from 2002 to 2004. This was an observational, prospective, non-concurrent study. The study used the National Database for Renal Replacement Therapies resulting from probabilistic matching of Authorization of High-Complexity Procedures/Outpatient Information System and the Mortality Information System. The study included patients admitted in 2002 and 2003, with 3 months of treatment, and 18 years or older. Of the 31,298 patients, the majority: began RRT with hemodialysis, were male, with mean age 54 years, and living in the Southeast region and in municipalities with a mean HDI of 0.78. Increased risk of death was associated with: female gender, age greater than 55 years, diagnosis of diabetes mellitus, peritoneal dialysis, and not residing in the Southeast region. Residing in cities with higher HDI was associated with lower risk. Adjusted risk was HR = 1.17 in favor of hemodialysis. The results suggest shorter survival for peritoneal dialysis and older patients. It is thus necessary to support policies to better evaluate the RRT modality with studies that further elucidate the findings.

[ impact of malnutrition on the mortality in hemodialysis patients]

The mortality rate is still elevated in hemodialysis population despite the advances in the dialysis techniques. In fact dialysis patients are exposed to many risk factors including cardiovascular diseases [CVD] accounting for 50%, diabetes mellitus and infections. Recent studies have focused on the role of malnutrition [MN] as an additional risk factor in increasing the mortality rate, since malnutrition is a frequent complication in chronic renal failure and hemodialysis patients. To study the relationship between malnutrition and increased mortality rate in hemodialysis patients at Al - Assad University Hospital. A cross sectional study was carried out in hemodialysis unit at Al- Assad University Hospital, Damascus - Syria, in February 2008 then the patients were followed for 24 months. There were 68 patients [43 men, 25 women]. Nutritional status was assessed by Malnutrition Score [MS]. Biochemical nutritional parameters including serum albumin, total protein, total cholesterol, serum creatinine, serum phosphorous, hemoglobin, CRP and blood urea before and after the dialysis session were measured. Some anthropometric measurements such as dry weight, body mass index, biceps, triceps and scapular skinfold thickness to evaluate the fat store, mid arm circumference and mid arm muscle circumference were also performed to assess the muscular mass. According to MS, 51.4% were well nourished, [48.6%] were malnourished. The mortality rate was elevated [27.9%]. Kaplan Meier analysis showed high survival rate in well nourished patients [Log Rank 4.89], [P = 0.027]. Multiple logistic regression analysis showed that the predictor factors of mortality were: Malnutrition Score [P = 0.010], low serum albumin [P = 0.001], mid - arm muscle circumference [MAMC] [P = 0.025] and vintage [years on dialysis] [P = 0.03]. The mortality rate as well as malnutrition was highly elevated in our study as many international studies, the study showed also that malnutrition was correlated with the high mortality rate; therefore it can be added to the other risk factors increasing the mortality rate such as cardiovascular diseases.

Avaliação da sobrevida de cinco anos em hemodiálise no Brasil: uma coorte de 3.082 pacientes incidentes / Assessment of a five-year survival on hemodialysis in Brazil: a cohort of 3,082 incident patients

O Brasil tem o terceiro maior contingente de pacientes em hemodiálise (HD) no mundo. Todavia, pouco conhece-se sobre a taxa de sobrevida e os preditores do risco de mortalidade nessa população, que são os objetivos deste estudo. Um total de 3.082 pacientes incidentes em HD, de 2000 a 2004, em 25 unidades de diálise distribuídas por 7 dos 26 estados do Brasil, foi acompanhado até 2009. Os pacientes tinham entre 52 ± 16 anos de idade, 57,8 por cento eram homens e 20,4 por cento, diabéticos. O desfecho primário foi de mortalidade por todas as causas. Os dados foram censurados aos cinco anos de seguimento. A taxa global de sobrevida em cinco anos foi de 58,2 por cento. No modelo proporcional de Cox, as variáveis associadas ao risco de óbito foram: a idade (risco relativo - RR = 1,44 por década; p < 0,0001), diabetes (RR = 1,51; p < 0,0001), albumina sérica (RR = 0,76 por g/dL; p = 0,001), creatinina (RR = 0,92 por mg/dL; p < 0,0001) e fósforo (RR = 1,06 por mg/dL; p = 0,04). Os resultados mostram que a taxa de mortalidade em HD nesta coorte brasileira foi relativamente baixa, mas a população é mais jovem e com prevalência de diabetes mais baixa do que aquela descrita nos países desenvolvidos.

Brazil has the third largest contingent of patients on maintenance hemodialysis (HD) worldwide. However, little is known regarding survival rate and predictors of mortality risk in that population, which are the purposes of this study. A total of 3,082 patients incident on HD, from 2000 to 2004, at 25 dialysis facilities distributed among 7 out of 26 states of Brazil were followed-up until 2009. Patients were 52 ± 16 years-old, 57.8 percent men, and 20.4 percent, diabetics. The primary outcome was all causes of mortality. Data were censored at five years of follow-up. The global five-year survival rate was 58.2 percent. In the Cox proportional model, variables associated with risk of death were: age (hazard ratio - HR = 1.44 per decade, p < 0.0001), diabetes (HR = 1.51, p < 0.0001), serum albumin (HR = 0.76 per g/dL, p = 0.001), creatinine (HR = 0.92 per mg/dL, p < 0.0001), and phosphorus (HR = 1.06 per mg/dL, p = 0.04). The present results show that the mortality rate on HD in this Brazilian cohort was relatively low, but the population is younger and with a lower prevalence of diabetes than the ones reported for developed countries.