Primer estudio epidemiológico de injuria renal aguda con requerimiento de terapia de reemplazo renal en Argentina. Sobrevida general y renal a mediano plazo
Palabras clave:
injuria renal aguda; epidemiología; base poblacional; mortalidad; dependencia de diálisis; diálisis renal; terapia de reemplazo renal; PAIER-CUDAIO
Resumen
Introducción: La injuria renal aguda es un trastorno complejo, multicausal, asociado con alta mortalidad y ocasional dependencia de diálisis crónica. Se desconoce la evolución de los pacientes que requieren terapia de reemplazo renal por injuria renal aguda en Argentina. Material y métodos: Estudio prospectivo, observacional, longitudinal y multicéntrico, en mayores de 14 años, ingresados en hospitales públicos de la provincia de Santa Fe, con diagnóstico de injuria renal aguda y necesidad de terapia de reemplazo renal, durante dos años (2017 y 2018). Resultados: Total 255 pacientes. Frecuencia 164 ppm/año, 1.85/1000 internaciones por año, varones 70,98%, edad 46-66 años, comorbilidades en 71,37%, internación en unidad de cuidados críticos 89.02%, compromiso extrarrenal 82.52%. Causas más frecuentes: hipotensión arterial 62.35%, infecciones 52.73%, nefrotóxicos 17.65%. Terapia de reemplazo renal: hemodiálisis intermitente 74.51%, diálisis lenta 11.76%, terapia continua 13.73%. Evolución: vivos a 30 días 116 (45.49%), dependencia de diálisis crónica 12 (10.34%). Mortalidad: 54.51% a 30 días, progresando al 65.88% a los 420 días. Sin diferencia significativa en mortalidad a 30 días según edad, sexo, terapia de reemplazo renal, comorbilidades ni creatininemia en primera diálisis. Hubo diferencia significativa (p <0.05) en mortalidad en injuria renal aguda aislada versus compromiso extrarrenal (RR: 1.55), Unidad de Cuidados Críticos versus Sala (RR: 3.31) e hipotensión arterial (RR: 1.79) como causa. Los pacientes con dependencia de diálisis crónica presentaron mayor mortalidad a 420 días que aquellos que recuperaron función renal (50% vs 22%, RR: 2.26). Conclusiones: Este es el primer estudio epidemiológico de injuria renal aguda, con seguimiento de la población que requirió terapia de reemplazo renal en Argentina. Está compuesto por pacientes jóvenes, graves y con alta proporción de compromiso de órganos extrarrenales. La mortalidad es elevada y se prolonga más allá del inicio de la terapia de reemplazo renal, la dependencia de diálisis crónica conlleva un peor pronóstico vital.
Citas
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27) Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17(4):1135-42. doi: 10.1681/ASN.2005060668.
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32) Srisawat N, Sileanu FE, Murugan R, Bellomod R, Calzavacca P, Cartin-Ceba R, et al. Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study. Am J Nephrol. 2015;41(1):81-8. doi: 10.1159/000371748.
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34) Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365-70.
35) Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43-51.
36) Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment, and outcomes in heart failure. Systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(10):1987-96.
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2) Mehta 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. doi:10.1016/S0140-6736(15)60126-X.
3) Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;53(6):961‐73. doi:10.1053/j.ajkd.2008.11.034.
4) Ishani 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. doi: 10.1681/ASN.2007080837.
5) Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17(4):1135‐42. doi: 10.1681/ASN.2005060668.
6) Estados Unidos. Renal Data System. USRDS 2007 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States [Internet]. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2007. Disponible en:
7) Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int. 2012;82(5):516‐24. doi:10.1038/ki.2012.208.
8) Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365‐70. doi: 10.1681/ASN.2004090740.
9) Kidney Disease: Improving Global Outcomes (KDIGO), Acute Kidney Injury Work Group. Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1-138.
10) Kane-Gill SL, Sileanu FE, Murugan R, Trietley GS, Handler SM, Kellum JA. Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2015;65(6):860‐9. doi: 10.1053/j.ajkd.2014.10.018.
11) Kirwan CJ, Blunden MJ, Dobbie H, James A, Nedungadi A, Prowle JR. Critically ill patients requiring acute renal replacement therapy are at an increased risk of long-term renal dysfunction, but rarely receive specialist nephrology follow-up. Nephron. 2015;129(3):164‐70. doi:10.1159/000371448.
12) Joannidis M, Metnitz B, Bauer P, Schusters χ² tz N, Moreno R, Druml W, et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35(10):1692‐702. doi:10.1007/s00134-009-1530-4.
13) Romeo FJ, Varela CF, Vulcano N, Pizarro R, Greloni G, Posatini R, et al. Acute kidney injury after cardiac transplantation: foe or common innocent bystander? Transplant Proc. 2018;50(5):1489‐95. doi: 10.1016/j.transproceed.2018.03.106.
14) Salgado G, Landa M, Masevicius D, Gianassi S, San-Román JE, Silva L, et al. Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study. Med Intensiva. 2014;38(5):271-7. doi: 10.1016/j.medin.2013.04.007.
15) Trimarchi H, Nozieres C, Cámpolo Girard V, Lombi F, Smith C, et al. Acute kidney injury in severe sepsis. Medicina (B Aires). 2009;69(3):321-6.
16) Acosta F, Alles A, Alonso C, Arriola M, Carlino MC, Feuli R, et al. Epidemiología de la insuficiencia renal aguda tratada con hemodiálisis: estudio prospectivo multicéntrico de la provincia de Santa Fe. Presentado en el XIII Congreso Argentino de Nefrología (Tucumán, abril 2013).
17) Mehta RL, Burdmann EA, Cerdá J, Feehally J, Finkelstein F, García-García G, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet. 2016; 387(10032):2017-25. doi: 10.1016/S0140-6736(16)30240-9.
18) Santa Fe, Dirección Provincial del Instituto Provincial de Estadística y Censos de la Provincia de Santa Fe. Censo Nacional Población, Hogares y Viviendas 2010. Departamento y total de la provincia de Santa Fe [Internet]. Disponible en:
19) Hsu RK, McCulloch CE, Adams Dudley R, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2012;24(1):37-42. doi: 10.1681/ASN.2012080800.
20) Wald R, McArthur E, Adhikari NK, Bagshaw SM, Burns KEA, Garg AX, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis. 2015;65(6):870-877. doi: 10.1053/j.ajkd.2014.10.017.
21) Siddiqui NF, Coca SG, Devereaux PJ, Jain AK, Li L, Luo J, et al. Secular trends in acute dialysis after elective major surgery, 1995 to 2009. CMAJ. 2012;184(11):1237-1245. doi: 10.1503/cmaj.110895.
22) Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Improved survival in acute kidney injury after cardiac surgery. Am J Kidney Dis. 2007;50(5):703-11. doi: 10.1053/j.ajkd.2007.07.021.
23) Nicoara A, Patel UD, Phillips-Bute BG, Shaw AD, Stafford-Smith M, Milano CA, et al. Mortality trends associated with acute renal failure requiring dialysis after CABG surgery in the United States. Blood Purif. 2009;28(4):359-363. doi: 10.1159/000235856.
24) Hsu RK, McCulloch CE, Heung M, Saran R, Shahinian BV, Pavkov ME, et al. Exploring potential reasons for the temporal trend in dialysis-requiring AKI in the United States. Clin J Am Soc Nephrol. 2016;11(1):14-20. doi: 10.2215/CJN.04520415.
25) Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43-51. doi: 10.2215/CJN.00220605.
26) Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(10):1987-96. doi: 10.1016/j.jacc.2005.11.084.
27) Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17(4):1135-42. doi: 10.1681/ASN.2005060668.
28) Hsu CY, McCulloch CE, Fan D, Ordoñez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int. 2007;72(2):208-212. doi: 10.1038/sj.ki.5002297.
29) Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23. doi: 10.1007/s00134-015-3934-7.
30) Kane-Gill SL, Sileanu FE, Murugan R, Trietley GS, Handler SM, Kellum JA. Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2015;65(6):860-9. doi: 10.1053/j.ajkd.2014.10.018.
31) Piccinni P, Cruz DN, Gramaticopolo S, Garzotto F, Dal Santo M, Aneloni G, et al. Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiol. 2011;77(11):1072-83.
32) Srisawat N, Sileanu FE, Murugan R, Bellomod R, Calzavacca P, Cartin-Ceba R, et al. Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study. Am J Nephrol. 2015;41(1):81-8. doi: 10.1159/000371748.
33) Harris DG, McCrone MP, Koo G, Weltz AS, Chiu WC, Scalea TM, et al. Epidemiology and outcomes of acute kidney injury in critically ill surgical patients. J Crit Care. 2015;30(1):102-6. doi: 10.1016/j.jcrc.2014.07.028.
34) Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365-70.
35) Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43-51.
36) Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment, and outcomes in heart failure. Systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(10):1987-96.
37) Argentina, Instituto Nacional Central Unico Coordinador de Ablación e Implante. Sistema Nacional de Información de Procuración y Trasplante de la República Argentina [Internet]. Buenos Aires: SINTRA. Disponible en:
38) Argentina, Ministerio del Interior. Registro Nacional de las Personas [Internet]. Buenos Aires: RENAPER. Disponible en:
39) Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442-8. doi: 10.1038/ki.2011.379.
40) Schiffl H, Lang SM, Fischer R. Long-term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: a 10-year prospective cohort study. Clin Kidney J. 2012;5(4):297-302. doi: 10.1093/ckj/sfs070.
41) Sawhney S, Mitchell M, Marks A, Fluck N, Black C. Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review [published correction appears in BMJ Open. 2015;5(1):e006497corr1]. BMJ Open. 2015;5(1):e006497. doi: 10.1136/bmjopen-2014-006497.
42) See EJ, Jayasinghe K, Glassford N, Bailey M, Johnson DW, Polkinghorne KR, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019;95(1):160-72. doi: 10.1016/j.kint.2018.08.036.
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Publicado
2020-09-16
Cómo citar
1.
Carlino C, Ávila R, Monje L, Mantello C, Taurizano N, Urretavizcaya V, Costantini MS, Ferragut N, Fernández M, Della Rosa G, Josa P, De Prato J, Bragado J, Cuestas M, Alles A. Primer estudio epidemiológico de injuria renal aguda con requerimiento de terapia de reemplazo renal en Argentina. Sobrevida general y renal a mediano plazo. Rev Nefrol Dial Traspl. [Internet]. 16 de septiembre de 2020 [citado 21 de diciembre de 2024];40(3):200-9. Disponible en: http://revistarenal.org.ar/index.php/rndt/article/view/533
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Artículo Original
Derechos de autor 2020 Revista de Nefrología, Diálisis y Trasplante
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0.
