Ítem
Acceso Abierto

Recuperación de la función renal en pacientes bogotanos con lesión renal aguda tratados con terapia de reemplazo renal continua versus diálisis intermitente

Mostrar el registro sencillo de la publicación
dc.contributor.advisorMoreno-Montoya, Jose
dc.creatorBuitrago Bejarano, Roberto José
dc.creatorHuérfano Castro, Manuel Alejandro
dc.creator.degreeMagíster en epidemiología
dc.date.accessioned2017-10-25T12:39:03Z
dc.date.available2017-10-25T12:39:03Z
dc.date.created2017-09-05
dc.date.issued2017
dc.descriptionIntroducción: la lesión renal aguda (LRA) es una patología que afecta millones de personas en el mundo, asociándose con alta morbi-mortalidad. En los pacientes críticos con LRA que requieren terapia de reemplazo renal (TRR) la mortalidad es alta (55,8%); mientras, la dependencia de diálisis crónica en los sobrevivientes es aproximadamente 10%; generando disminución en la calidad de vida y aumentando los costos en la atención en salud a largo plazo. El desarrollo de nuevas tecnologías, como la hemofiltración, se centra en la recuperación de la función renal; sin embargo, cuando se compara con la diálisis intermitente se encuentran resultados no concluyentes. Objetivos: demostrar que existe mayor incidencia acumulada de recuperación de la función renal en pacientes con LRA tratados con terapia de reemplazo renal continua (TRRC) versus los tratados con diálisis intermitente (DI), analizando los distintos factores que pueden influir en el desenlace. Metodología: se realizó un estudio de cohorte histórica, en donde se compararon pacientes adultos en cuidado crítico con LRA y que requirieron TRR entre los años 2013 y 2016 en el Hospital Universitario Mayor en Bogotá. Se calculó un tamaño de muestra de 71 pacientes para DI y 52 para TRRC. Se decidió trabajar con un mínimo de 71 pacientes en cada grupo. Se definió recuperación de la función renal como la dependencia o no de diálisis crónica. Resultados: se analizó un total de 161 pacientes (DI=80 y TRRC=81). El 64% hombres y una mediana de edad de 71 años. La patología más frecuente en la LRA fue sepsis. La causa de inicio de TRR más frecuente fue sobrecarga hídrica e hiperazoemia. Se encontró RR de 1,9 (IC95% 1,08-3,35) veces recuperación de la función renal en la TRRC en comparación con la DI. Las variables tipo de terapia, edad, sepsis, enfermedad cardiovascular, balance hídrico acumulado, tiempo hospitalario y ultrafiltración están asociadas estadísticamente la recuperación de la función renal en el modelo logístico predictivo. Discusión: La TRRC se asoció con mayor recuperación de la función renal frente a la DI en los pacientes con LRA que están críticamente enfermos. Se propone un modelo de predicción de recuperación de la función renal con base en los resultados del análisis multivariado. Los resultados del presente estudio muestran que el uso de la TRRC podría tener un impacto positivo en mejorar la calidad de vida de los pacientes y en disminuir los costos en la atención en salud.spa
dc.description.abstractIntroduction: Acute kidney injury (AKI) is a pathology affecting millions of people worldwide, associated with high morbidity and mortality. Criticall ill patients with AKI requiring renal replacement therapy (RRT), mortality is high (55. 8%); while chronic dialysis dependence, on survivors, is approximately 10%; generating a decrease in life quality and increasing the costs of long-term health care. The development of new technologies, such as hemofiltration, focuses on the recovery of renal function; However, when compared with intermittent dialysis, the results are inconclusive. Objectives: To demonstrate that there is a greater accumulated incidence of recovery of renal function in patients with AKI treated with continuous renal replacement therapy (CRRT) versus intermittent dialysis (ID), analyzing the various factors that may affect the outcome. Methodology: A historical cohort study was performed, comparing patients in critical care with AKI who required RRT, between the years 2013 and 2016 at the Hospital Universitario Mayor in Bogotá. A sample size of 71 patients was calculated for ID and 52 for CRRT. It was decided to work with a minimum of 71 patients in each group. Recovery of renal function was defined as dependence of chronic dialysis. Results: a total of 161 patients (ID = 80 and TRRC = 81) were analyzed. Men 64% and a median age of 71 years. The most frequent pathology in AKI was sepsis. The most frequent cause of RRT was fluid overload and hyperazoemia. We found RR of 1, 9 (95% CI 1, 08-3, 35) times renal recovery function in CRRT compared with ID. Therapy modality, age, sepsis, cardiovascular disease, accumulated fluid balance, hospitalization time and total ultrafiltration were statistically associated with recovery of renal function in the predictive logistic model. Discussion: CRRT was associated with greater recovery of renal function compared to ID in critically ill patients with AKI. A predictive model of recovery of renal function was proposed based on the results of the multivariate analysis. The results of the present study support that CRRT could have a positive impact on patients` quality of life and could reduce costs in health care. eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_13833
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/13833
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de medicinaspa
dc.publisher.programMaestría en Epidemiologíaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto completo)spa
dc.rights.ccAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
dc.rights.licenciaEL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.spa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.source.bibliographicCitationMehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): A human rights case for nephrology. Lancet. 2015;385(9987):2616–43
dc.source.bibliographicCitationSoliman IW, Frencken JF, Peelen LM, Slooter AJC, Cremer OL, van Delden JJ, et al. The predictive value of early acute kidney injury for long-term survival and quality of life of critically ill patients. Crit Care [Internet]. 2016;20(1):242. Available from: http://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1416-0
dc.source.bibliographicCitationChawla LS, Eggers PW, Star RA, Kimmel PL. Acute Kidney Injury and Chronic Kidney Disease as Interconnected Syndromes. N Engl J Med [Internet]. 2014;371(1):58–66. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMra1214243
dc.source.bibliographicCitationBedford M, Stevens PE, Wheeler TWK, Farmer CKT. What is the real impact of acute kidney injury ? BMC Nephrol. 2014;15:95
dc.source.bibliographicCitationFonseca Ruiz NJ, Castro DPC, Guerra AMM, Saldarriaga FM, Hernández JDM. Renal injury study in critical ill patients in accordance with the new definition given by the Acute Kidney Injury Network. J Crit Care [Internet]. 2011;26(2):206–12. Available from: http://dx.doi.org/10.1016/j.jcrc.2010.06.011
dc.source.bibliographicCitationKDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1).
dc.source.bibliographicCitationBellomo R, Kellum J a., Ronco C. Acute kidney injury. Lancet [Internet]. 2012;380(9843):756–66. Available from: http://dx.doi.org/10.1016/S0140-6736(11)61454-2
dc.source.bibliographicCitationRENAL Replacement Therapy Study Investigators. Intensity of Continuous Renal-Replacement Therapy in. N Engl J Med. 2009;361(17):1627–38.
dc.source.bibliographicCitationPalevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA PP. Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury. N Engl J Med. 2008;359(1):7–20.
dc.source.bibliographicCitationKarvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung A a, Wald R, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care [Internet]. 2011;15(1):R72. Available from: http://ccforum.com/content/15/1/R72
dc.source.bibliographicCitationEcheverri JE, Galindo LM, Huerfano M. General outcomes in elderly patients with acute kidney injury and renal support. Intensive Care Med. 2014;40 Suppl 1(October):173.
dc.source.bibliographicCitationKerr M, Bedford M, Matthews B, O’donoghue D. The economic impact of acute kidney injury in England. Nephrol Dial Transplant. 2014;29(7):1362–8.
dc.source.bibliographicCitationChawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int [Internet]. 2012;82(5):516–24. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0085253815555993
dc.source.bibliographicCitationForni LG, Darmon M, Ostermann M, Oudemans-van Straaten HM, Pettila V, Prowle JR, et al. Renal recovery after acute kidney injury. Intensive Care Med. 2017 May
dc.source.bibliographicCitationMacedo E, Mehta RL. Renal Recovery after Acute Kidney Injury. Contrib Nephrol. 2016;187:24–35.
dc.source.bibliographicCitationLombardi R, Rosa-Diez G, Ferreiro A, Greloni G, Yu L, Younes-Ibrahim M, et al. Acute kidney injury in Latin America: a view on renal replacement therapy resources. Nephrol Dial Transplant [Internet]. 2014;29(7):1369–76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24744281
dc.source.bibliographicCitationSchoenfelder T, Chen X, Bless H-H. Effects of continuous and intermittent renal replacement therapies among adult patients with acute kidney injury. GMS Health Technol Assess. 2017;13:Doc01.
dc.source.bibliographicCitationShingarev R, Wille K, Tolwani A. Management of complications in renal replacement therapy. Semin Dial. 2011;24(2):164–8.
dc.source.bibliographicCitationKellum JA. How can we define recovery after acute kidney injury? Considerations from epidemiology and clinical trial design. Nephron - Clin Pract. 2014;127(1–4):81–8.
dc.source.bibliographicCitationChawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol [Internet]. 2017 Apr;13(4):241–57. Available from: http://dx.doi.org/10.1038/nrneph.2017.2
dc.source.bibliographicCitationKellum JA, Chawla LS, Keener C, Singbartl K, Palevsky PM, Pike FL, et al. The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock. Am J Respir Crit Care Med [Internet]. 2015 Sep 23;193(3):281–7. Available from: http://dx.doi.org/10.1164/rccm.201505-0995OC
dc.source.bibliographicCitationKumar S, Liu J, McMahon AP. Defining the acute kidney injury and repair transcriptome. Semin Nephrol. 2014 Jul;34(4):404–17.
dc.source.bibliographicCitationCerdá J, Ronco C. Modalities of continuous renal replacement therapy: Technical and clinical considerations. Semin Dial. 2009;22(2):114–22.
dc.source.bibliographicCitationAntoun TA, Palevsky PM. Selection of modality of renal replacement therapy. Semin Dial. 2009;22(2):108–13.
dc.source.bibliographicCitationHeung M, Yessayan L. Renal Replacement Therapy in Acute Kidney Injury: Controversies and Consensus. Crit Care Clin. 2017 Apr;33(2):365–78.
dc.source.bibliographicCitationSchneider AG, Bellomo R, Bagshaw SM, Glassford NJ, Lo S, Jun M, et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: A systematic review and meta-analysis. Intensive Care Med. 2013;39(6):987–97.
dc.source.bibliographicCitationEthgen O, Schneider a. G, Bagshaw SM, Bellomo R, Kellum J a. Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients. Nephrol Dial Transplant [Internet]. 2014;30(1):54–61. Available from: http://ndt.oxfordjournals.org/cgi/doi/10.1093/ndt/gfu314
dc.source.bibliographicCitationPrimer Consenso Colombiano en Lesión Renal Aguda. Acta Colomb Cuid Intensivo. 2010;11(supl. 4):61.
dc.source.bibliographicCitationJames MT, Tonelli M. Financial aspects of renal replacement therapy in acute kidney injury. Semin Dial. 2011;24(2):215–9.
dc.source.bibliographicCitationBell M, Granath F, Schön S, Ekbom A, Martling CR. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med. 2007;33(5):773–80.
dc.source.bibliographicCitationAriza JG, Sanabria M, Echeverri J, Huerfano M, Arboleda A BA. Economic evaluation of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients. ISPOR Lat Am Conf [Internet]. 2017;Abstract #. Available from: https://www.ispor.org/Event/ProgramList/2017SaoPaulo?type=Poster&sess=I&acode=PMD
dc.source.bibliographicCitationZarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstädt H, et al. Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury. Jama [Internet]. 2016; Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.5828
dc.source.bibliographicCitationZhang L, Chen Z, Diao Y, Yang Y, Fu P. Associations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: a systematic review and meta-analysis. J Crit Care [Internet]. 2015; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0883944115001343
dc.source.bibliographicCitationTruche A-S, Darmon M, Bailly S, Clec’h C, Dupuis C, Misset B, et al. Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery. Intensive Care Med [Internet]. 2016; Available from: http://link.springer.com/10.1007/s00134-016-4404-6
dc.source.bibliographicCitationAbdel-Kader K, Palevsky PM. Acute kidney injury in the elderly. Clin Geriatr Med [Internet]. 2009;25(3):331–58. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2748997&tool=pmcentrez&rendertype=abstract
dc.source.bibliographicCitationSchmitt R, Coca S, Kanbay M, Tinetti ME, Cantley LG, Parikh CR. Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis [Internet]. 2008;52(2):262–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18511164
dc.source.bibliographicCitationIshani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20(1):223–8.
dc.source.bibliographicCitationThakar C V., Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 2011;6(11):2567–72.
dc.source.bibliographicCitationShum H-P, Kong HH-Y, Chan K-C, Yan W-W, Chan TM. Septic acute kidney injury in critically ill patients - a single-center study on its incidence, clinical characteristics, and outcome predictors. Ren Fail [Internet]. 2016;6049(March):1–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26981621
dc.source.bibliographicCitationWald R, Shariff SZ, Adhikari NKJ, Bagshaw SM, Burns KE a, Friedrich JO, et al. The Association Between Renal Replacement Therapy Modality and Long-Term Outcomes Among Critically Ill Adults With Acute Kidney Injury: A Retrospective Cohort Study. Crit Care Med. 2013;42(4):1–10.
dc.source.bibliographicCitationPajewski R, Gipson P, Heung M. Predictors of post-hospitalization recovery of renal function among patients with acute kidney injury requiring dialysis. Hemodial Int. 2017;1–8.
dc.source.bibliographicCitationConsellería de Sanidade - Xunta de Galicia DX de SP, Organización Panamericanada de la Salud Á de A de S y S de IS. EPIDAT 3,1. 2005.
dc.source.bibliographicCitationIBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
dc.source.bibliographicCitationPlackett RL. Karl Pearson and the Chi-Squared Test. Int Stat Rev [Internet]. 1983;51(1):59–72. Available from: http://www.jstor.org/stable/1402731
dc.source.bibliographicCitationFay MP, Proschan MA. Wilcoxon-Mann-Whitney or t-test? On assumptions for hypothesis tests and multiple interpretations of decision rules. Stat Surv [Internet]. 2010;4:1–39. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857732/
dc.source.bibliographicCitationHosmer DW. SL. Applied Logistic Regression. Wiley; 2000.
dc.source.bibliographicCitationBursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med [Internet]. 2008;3:17. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2633005&tool=pmcentrez&rendertype=abstract
dc.source.bibliographicCitationProtección MD La. Resolución No 8430 DE 1993 [Internet]. 1993 [cited 2016 Dec 10]. Available from: https://www.invima.gov.co/resoluciones-medicamentos/2977-resolucion-no-8430-del-4-de-octubre-de-1993.html
dc.source.bibliographicCitationDeclaración de Helsinki de la AMM – Principios Éticos para las Investigaciones Médicas en Seres Humanos [Internet]. Asociación Médica Mundial. 2013 [cited 2017 Sep 3]. Available from: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
dc.source.bibliographicCitationEducational UN, Organization S and C. Records of the General Conference [Internet]. 2005 [cited 2016 Dec 10]. p. 80. Available from: http://unesdoc.unesco.org/images/0014/001428/142825e.pdf#page=80
dc.source.bibliographicCitationFriedrich JO, Wald R, Bagshaw SM, Burns KE, Adhikari NK. Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis. Crit Care [Internet]. 2012;16(4):R146. Available from: http://ccforum.com/content/16/4/R146
dc.source.bibliographicCitationCho KC, Himmelfarb J, Paganini E, Ikizler TA, Soroko SH, Mehta RL, et al. Survival by dialysis modality in critically ill patients with acute kidney injury. J Am Soc Nephrol [Internet]. 2006;17(11):3132–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17021268
dc.source.bibliographicCitationWald R, Shariff SZ, Adhikari NKJ, Bagshaw SM, Burns KE a, Friedrich JO, et al. The Association Between Renal Replacement Therapy Modality and Long-Term Outcomes Among Critically Ill Adults With Acute Kidney Injury: A Retrospective Cohort Study. Crit Care Med. 2014;42(4):868–77.
dc.source.bibliographicCitationLiang K V., Sileanu FE, Clermont G, Murugan R, Pike F, Palevsky PM, et al. Modality of RRT and recovery of kidney function after AKI in patients surviving to hospital discharge. Clin J Am Soc Nephrol. 2016;11(1):30–8.
dc.source.bibliographicCitationZhang L, Chen Z, Diao Y, Yang Y, Fu P. Associations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: A systematic review and meta-analysis. J Crit Care [Internet]. 2015;30(4):860.e7-860.e13. Available from: http://dx.doi.org/10.1016/j.jcrc.2015.03.025
dc.source.bibliographicCitationKao C-C, Yang J-Y, Chen L, Chao C-T, Peng Y-S, Chiang C-K, et al. Factors associated with poor outcomes of continuous renal replacement therapy. PLoS One. 2017 May;12(5):e0177759.
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectHemofiltraciónspa
dc.subjectTerapia de reemplazo renalspa
dc.subjectHemodiafiltraciónspa
dc.subjectRecuperación de la funciónspa
dc.subjectLesión renal agudaspa
dc.subject.ddcEnfermedades
dc.subject.decsHemofiltraciónspa
dc.subject.decsTerapia de Reemplazo Renalspa
dc.subject.decsHemodiafiltraciónspa
dc.subject.decsRecuperación de la Funciónspa
dc.subject.decsLesión Renal Agudaspa
dc.subject.keywordRenal replacement therapyeng
dc.subject.keywordHemodiafiltrationeng
dc.subject.keywordRecovery of functioneng
dc.subject.keywordAcute kidney injuryeng
dc.titleRecuperación de la función renal en pacientes bogotanos con lesión renal aguda tratados con terapia de reemplazo renal continua versus diálisis intermitentespa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTesis de maestríaspa
Archivos
Bloque original
Mostrando1 - 1 de 1
Miniatura
Nombre:
BuitragoBejarano-RobertoJose-2017.pdf
Tamaño:
1.57 MB
Formato:
Adobe Portable Document Format
Descripción:
Descargar
Colecciones
Maestría en Epidemiología