Please use this identifier to cite or link to this item: https://app.uff.br/riuff/handle/1/11021
Title: Mortalidade nos primeiros dois anos em hemodiálise: influência da variação precoce na albumina sérica
Authors: Pereira, Giselly Rosa Modesto
metadata.dc.contributor.advisor: Lugon, Jocemir Ronaldo
metadata.dc.contributor.advisorco: Matos, Jorge Paulo Strogoff de
metadata.dc.contributor.members: Cardoso, Gilberto Perez
Almeida, Jorge Reis
Santos, Sérgio Fernando Ferreira dos
Issue Date: 2013
Citation: PEREIRA, Giselly Rosa Modesto. Mortalidade nos primeiros dois anos em hemodiálise: influência da variação precoce na albumina sérica. 2013. 52 f. Dissertação (Mestrado em Ciências Médicas) - Universidade Federal Fluminense, Niterói, 2019.
Abstract: Introdução. Hemodialisados têm mortalidade inaceitavelmente alta principalmente por causas cardiovasculares. Tanto fatores de risco tradicionais (do estudo de Framingham) como não-tradicionais (resultantes da própria doença renal crônica) têm sido implicados na patogênese da doença cardiovascular em tais pacientes. Nosso objetivo foi avaliar o impacto de alterações precoces na albumina sérica sobre a mortalidade de pacientes incidentes em hemodiálise. Métodos. Estudo observacional, longitudinal retrospectivo, com acompanhamento de 2 anos, realizado em pacientes em regime regular de hemodiálise utilizando o banco de dados da Fresenius Medical Care América Latina. Para este estudo, foram incluídos pacientes com idade superior a 20 anos, de 25 unidades de diálise no Brasil, distribuídas por 6 estados e o Distrito Federal. O período de estudo compreendeu de janeiro de 2000 a junho de 2004. A alteração na albumina sérica foi calculada como a variação percentual nos 3 primeiros meses. Os pacientes foram estratificados em dois grupos de acordo com a albumina inicial (abaixo ou acima da mediana) e acompanhados por 2 anos. O risco de morte associado com a mudança precoce na albumina foi calculado por um modelo de regressão de Cox, com ajuste por idade, gênero e diabetes. Resultados. Um total de 1.834 pacientes adultos incidentes em hemodiálise preencheu os critérios de inclusão. Homens representavam 59%; 22% eram diabéticos. A média de idade foi 52±15 anos e a mediana da albumina sérica, 3,8 g/dL. A mortalidade acumulada da amostra em 2 anos foi 14% sendo significativamente maior no grupo com albumina inicial abaixo da mediana (17% vs. 11%, P<0,001). Mais importante, as variações na albumina influenciaram significantemente a mortalidade. No grupo com albumina abaixo da mediana, cada 10% de elevação na albumina sérica inicial nos 3 primeiros meses em hemodiálise esteve associado a uma diminuição da mortalidade em cerca de 14% (H.R.=0,864, I.C. 0,762-0,979, P=0,022). Por outro lado, no grupo com albumina sérica acima da mediana, cada 10% de redução esteve associado a um aumento de cerca de 50% na chance de óbito em 2 anos (H.R.=1,502, I.C. 1,243-1,815, P<0,001). Conclusões. Alterações precoces na albumina sérica têm impacto significativo na sobrevida em 2 anos. Pacientes com albumina sérica inicial baixa podem ter melhor prognóstico se há elevação precoce da albumina, enquanto aqueles com níveis iniciais satisfatórios podem piorar seu prognóstico em caso de redução precoce na albumina.
metadata.dc.description.abstractother: Introduction. Hemodialysis patients have unacceptably high mortality mainly due to cardiovascular causes. Both traditional risk factors (from the Framingham study) and non-traditional ones (resulting from chronic kidney disease itself) have been implicated in the pathogenesis of cardiovascular disease in such patients. Our objective was to evaluate the impact of early changes in serum albumin on mortality of patients on hemodialysis. Methods. Observational, longitudinal retrospective study with 2 years follow-up, conducted in patients under regular hemodialysis using the database of Fresenius Medical Care of Latin America. For this study, patients ≥20 years, from 25 dialysis units in Brazil, spread across 6 states and the Federal District were included. The period of study was from January 2000 to June 2004. The variation in serum albumin was calculated as the percent change in the first 3 months. Patients were stratified into two groups according to the initial serum albumin (below or above the median) and followed for two years. The risk of death associated with early changes in serum albumin was calculated by a Cox regression model with adjustment for age, gender and diabetes. Results. A total of 1,834 adult patients on hemodialysis met the inclusion criteria. Men accounted for 59%, 22% were diabetic. The mean age was 52±15 years and the median albumin 3.8 g/dL. The cumulative mortality of the sample at 2 years was 14% and was significantly higher in the group with initial serum albumin below the median (17% vs. 11%, P <0.001). More importantly, changes in serum albumin significantly affected mortality. In the group with serum albumin below the median, each 10% increase in initial serum albumin in the first 3 months on dialysis was associated with a reduced mortality by about 14% (HR = 0.864, CI 0.762 to 0.979, P = 0.022). On the other hand, in the group with serum albumin above the average, each 10% reduction was associated with an increase of about 50% in the risk of death at 2 years (HR = 1.502, CI 1.243 to 1.815, P <0.001). Conclusions. Early changes in albumin have a significant impact on survival at 2 years. Patients with low initial serum albumin may have a better prognosis if there is early elevation in serum albumin, whereas those with satisfactory initial levels can worsen their prognosis in case of early reduction in serum albumin.Introduction. Hemodialysis patients have unacceptably high mortality mainly due to cardiovascular causes. Both traditional risk factors (from the Framingham study) and non-traditional ones (resulting from chronic kidney disease itself) have been implicated in the pathogenesis of cardiovascular disease in such patients. Our objective was to evaluate the impact of early changes in serum albumin on mortality of patients on hemodialysis. Methods. Observational, longitudinal retrospective study with 2 years follow-up, conducted in patients under regular hemodialysis using the database of Fresenius Medical Care of Latin America. For this study, patients ≥20 years, from 25 dialysis units in Brazil, spread across 6 states and the Federal District were included. The period of study was from January 2000 to June 2004. The variation in serum albumin was calculated as the percent change in the first 3 months. Patients were stratified into two groups according to the initial serum albumin (below or above the median) and followed for two years. The risk of death associated with early changes in serum albumin was calculated by a Cox regression model with adjustment for age, gender and diabetes. Results. A total of 1,834 adult patients on hemodialysis met the inclusion criteria. Men accounted for 59%, 22% were diabetic. The mean age was 52±15 years and the median albumin 3.8 g/dL. The cumulative mortality of the sample at 2 years was 14% and was significantly higher in the group with initial serum albumin below the median (17% vs. 11%, P <0.001). More importantly, changes in serum albumin significantly affected mortality. In the group with serum albumin below the median, each 10% increase in initial serum albumin in the first 3 months on dialysis was associated with a reduced mortality by about 14% (HR = 0.864, CI 0.762 to 0.979, P = 0.022). On the other hand, in the group with serum albumin above the average, each 10% reduction was associated with an increase of about 50% in the risk of death at 2 years (HR = 1.502, CI 1.243 to 1.815, P <0.001). Conclusions. Early changes in albumin have a significant impact on survival at 2 years. Patients with low initial serum albumin may have a better prognosis if there is early elevation in serum albumin, whereas those with satisfactory initial levels can worsen their prognosis in case of early reduction in serum albumin.
URI: https://app.uff.br/riuff/handle/1/11021
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