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Abstract Introduction: Acute kidney injury (AKI) is a frequent complication of severe COVID-19 and is associated with high case fatality rate (CFR). However, there is scarcity of data referring to the CFR of AKI patients that underwent kidney replacement therapy (KRT) in Brazil. The main objective of this study was to describe the CFR of critically ill COVID-19 patients treated with acute kidney replacement therapy (AKRT). Methods: Retrospective descriptive cohort study. We included all patients treated with AKRT at an intensive care unit in a single tertiary hospital over a 15-month period. We excluded patients under the age of 18 years, patients with chronic kidney disease on maintenance dialysis, and cases in which AKI preceded COVID-19 infection. Results: A total of 100 out of 1479 (6.7%) hospitalized COVID-19 patients were enrolled in this study. The median age was 74.5 years (IQR 64 - 82) and 59% were male. Hypertension (76%) and diabetes mellitus (56%) were common. At the first KRT prescription, 85% of the patients were on invasive mechanical ventilation and 71% were using vasoactive drugs. Continuous veno-venous hemodiafiltration (CVVHDF) was the preferred KRT modality (82%). CFR was 93% and 81 out of 93 deaths (87%) occurred within the first 10 days of KRT onset. Conclusion: AKRT in hospitalized COVID-19 patients resulted in a CFR of 93%. Patients treated with AKRT were typically older, critically ill, and most died within 10 days of diagnosis. Better strategies to address this issue are urgently needed.
Resumo Introdução: Injúria renal aguda (IRA) é uma complicação frequente da COVID-19 grave e está associada a alta taxa de letalidade (TL). Entretanto, há escassez de dados referentes à TL de pacientes com IRA submetidos a suporte renal artificial (SRA) no Brasil. O objetivo principal deste estudo foi descrever a TL de pacientes graves com IRA por COVID-19 tratados com SRA. Métodos: Estudo de coorte descritivo retrospectivo. Incluímos todos os pacientes tratados com SRA em unidade de terapia intensiva de um único hospital terciário por 15 meses. Excluímos pacientes menores de 18 anos, pacientes com doença renal crônica em diálise de manutenção e casos nos quais a IRA precedeu a infeção por COVID-19. Resultados: Incluímos neste estudo um total de 100 dos 1479 (6,7%) pacientes hospitalizados com COVID-19. A mediana de idade foi 74,5 anos (IIQ 64 - 82) e 59% eram homens. Hipertensão (76%) e diabetes mellitus (56%) foram comuns. Na primeira prescrição de SRA, 85% dos pacientes estavam em ventilação mecânica invasiva e 71% em uso de drogas vasoativas. A hemodiafiltração contínua foi a modalidade de SRA preferida (82%). A TL foi de 93% e 81 dos 93 óbitos (87%) ocorreram nos primeiros 10 dias do início da SRA. Conclusão: O SRA em pacientes hospitalizados com IRA por COVID-19 resultou em TL de 93%. Os pacientes tratados com SRA eram geralmente idosos, gravemente enfermos e a maioria foi a óbito em até 10 dias após o diagnóstico. Estratégias melhores para abordar esse problema são urgentemente necessárias.
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ABSTRACT BACKGROUND: Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke. OBJECTIVE: To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis. DESIGN AND SETTING: Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil. METHODS: A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke. CONCLUSIONS: Patients on hemodialysis, especially women and older people, have little knowledge about stroke.
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Acute kidney injury (AKI) is common in critically ill patients, afecting almost one in four critically ill children and one in three neonates. Higher stages of AKI portend worse outcomes. Identifying AKI timely and instituting appropriate measures to prevent and manage severe AKI is important, since it is independently associated with mortality. Methods to predict severe AKI should be applied to all critically ill patients. Assessment of volume status to prevent the development of fuid overload is useful to prevent adverse outcomes. Patients with metabolic or clinical complications of AKI need prompt kidney replacement therapy (KRT). Various modes of KRT are available, and the choice of modality depends most on the technical competence of the center, patient size, and hemodynamic stability. Given the signifcant risk of chronic kidney disease, patients with AKI require long-term follow-up. It is important to focus on improving awareness about AKI, incorporate AKI prevention as a quality initiative, and improve detection, prevention, and management of AKI with the aim of reducing acute and long-term morbidity and mortality
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Resumen: Introducción: La sobrecarga hídrica es un fenómeno frecuente cuyo manejo es un elemento clave, ya que se ha relacionado con disfunción orgánica y mayor mortalidad. A la fecha no existe un consenso sobre el manejo óptimo de fluidos para pacientes con lesión renal aguda asociada con complicaciones obstétricas (PR-AKI). Objetivo: Evaluar la sobrecarga hídrica en las pacientes con PR-AKI que requieren terapia de reemplazo renal continua (TRRC). Material y métodos: Se llevó a cabo un estudio observacional, retrospectivo, transversal, comparativo. Se realizó una revisión de expedientes de pacientes con PR-AKI y que requirieron TRRC durante el periodo de enero de 2013-diciembre de 2019 en el Hospital de la Mujer de Morelia. Resultados: Ingresaron a la UCI del Hospital de la Mujer 15 pacientes de 2013-2019. La edad promedio fue de 26.15 años. El peso promedio a su ingreso fue de 75.71 kg con un porcentaje de sobrecarga hídrica de 13.7%. La gravedad de las pacientes según la clasificación APACHE II fue de 23.6 puntos. El promedio de la estancia intrahospitalaria dentro de la UCI fue de 13.1 días, mientras que el promedio de ventilación mecánica asistida fue de 7.5 días. Conclusiones: La sobrecarga hídrica de las pacientes con PR-AKI fue de 13.7%; se asocia a mayores días de estancia dentro de la unidad de cuidados intensivos y más días de ventilación mecánica asistida; sin embargo, no es un factor que indique progresión a enfermedad renal crónica o a la muerte en este grupo de pacientes.
Abstract: Introduction: Water overload is a frequent phenomenon whose management is a key element since it has been related to organ dysfunction and higher mortality. To date, there is no consensus on the optimal fluid management for patients with acute kidney injury associated with obstetric complications (PR-AKI). Objective: To evaluate fluid overload in patients with PR-AKI who require continuous renal replacement therapy (CRRT). Material and methods: An observational, retrospective, cross-sectional, comparative study was carried out. A review of the records of patients with PR-AKI and who required CRRT was carried out during the period of January 2013-December 2019 at the Hospital de la Mujer de Morelia. Results: 15 patients from 2013-2019 were admitted to the ICU of the Women's Hospital. The average age of the patients was 26.15 years. The average weight of the patients upon admission was 75.71 kg with a percentage of fluid overload of 13.7%. The severity of the patients according to the APACHE II classification was 23.6 points. The average hospital stay within the ICU was 13.1 days, while the average assisted mechanical ventilation was 7.5 days. Conclusions: The fluid overload of the patients with PR-AKI was 13.7%; It is associated with longer days of stay within the Intensive Care Unit and more days of assisted mechanical ventilation, however, it is not a factor that indicates progression to chronic kidney disease or death in this group of patients.
Resumo: Introdução: A sobrecarga de água é um fenômeno frequente cujo manejo é um elemento chave, uma vez que tem sido relacionado a disfunções orgânicas e maiores mortalidade. Até o momento, não há consenso sobre o manejo ideal de fluidos para pacientes com lesão renal aguda associada a complicações obstétricas (PR-AKI). Objetivo: Avaliar a sobrecarga de fluidos em pacientes com PR-AKI que requerem terapia de substituição renal contínua (CRRT). Material e métodos: Foi realizado um estudo observacional retrospectivo, transversal, comparativo. Uma revisão dos prontuários dos pacientes foi realizada com PR-AKI e que exigiu TRRC durante o período de janeiro de 2013 a dezembro 2019 no Hospital Feminino de Morelia. Resultados: 15 pacientes de 2013 foram admitidos na UTI do Hospital de la Mujer- 2019. A idade média era de 26,15 anos. O peso médio na admissão era de 75,71 kg com um percentual de sobrecarga hídrica de 13,7%. A gravidade de os pacientes pela classificação APACHE II foi de 23,6 pontos. A média de internação na UTI foi de 13,1 dias, enquanto a média de ventilação mecânica assistida foi de 7,5 dias. Conclusões: A sobrecarga hídrica dos pacientes com PR-LRA foi13.7%; está associado a dias mais longos passados na unidade de cuidados ventilação mecânica intensiva e mais dias assistida; no entanto, não é um fator que indica progressão para doença renal crônica ou morte neste grupo de pacientes.
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Objective:To investigate the effect of the timing of continuous renal replacement therapy (CRRT) administration on the prognosis of acute kidney injury (AKI) in children.Methods:The medical records of children with AKI who were admitted to the Intensive Care Unit of Hunan Children′s Hospital from March 2015 to February 2020 and underwent CRRT were prospectively analyzed.The children who met the criteria were divided into early group (defined as AKI 1 and 2) and delayed group (defined as AKI 3) according to AKI stage.The general conditions, indicators when CRRT was initiated, and prognosis of the children in two groups were recorded.Results:(1) A total of 39 children were included in the study, including 23 in the early group and 16 in the delayed group.There were no significant differences in age, gender, body weight and proportion of mechanical ventilation between two groups ( P>0.05). The score of critical cases in the early group was higher than that in the delayed group ( P=0.008). (2) There were no significant differences in serum potassium and bicarbonate when CRRT was initiated between two groups ( P>0.05). The urine output in the early group was higher than that in the delayed group ( P>0.001). The serum creatinine and urea nitrogen in the early group were lower than those in the delayed group ( P>0.05). (3) The 28-day survival rate and proportion of renal function recovery at 28 days in the early group were significantly higher than those in the delayed group ( P>0.05). The duration of CRRT, ICU stay and duration of mechanical ventilation in the early group were shorter than those in the delayed group ( P>0.05). Conclusion:Early initiation of CRRT at AKI stage 1 and 2 can improve the 28-day survival rate and renal function recovery of survivors when critically ill children are complicated with AKI.