Linares-Linares Mariela Alejandra, Figueroa-Tarrillo Jorge Arturo, Cerna Viacava Renato, Carreazo Nilton Yhuri, Valdivia-Vega Renzo P
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú. Address: Batallón Tarma 428, Santiago de Surco, Lima, Perú. Email:
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
Medwave. 2017 Mar 6;17(2):e6879. doi: 10.5867/medwave.2017.02.6879.
The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients.
To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients.
This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis.
We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97).
Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients.
急性肾损伤的全球发病率为18%，总体医院死亡率可超过50%。在秘鲁，关于血液透析患者急性肾损伤死亡率的系列研究较少。
确定血液透析患者急性肾损伤医院死亡率的相关危险因素。
这是一项对2013年1月至2015年12月期间在国家埃加尔多·雷瓦利亚蒂·马丁斯医院接受血液透析的急性肾损伤患者进行的回顾性队列研究。样本量为154例患者，检验效能为80%，置信区间为95%。使用国际疾病分类第十版（ICD - 10）编码来识别急性肾损伤（N.17）和血液透析（Z.49）患者的病历。自变量为少尿，主要结局为医院死亡率。采用泊松回归进行多变量分析。
我们共识别出285例患者；分析了212份病历，排除了44份。在这168份病历中，129份属于存活患者，39份属于死亡患者。总体死亡率为17.2%。血液透析期间急性肾损伤的主要病因是脓毒症（39.2%）和严重脱水（10.8%）。在调整模型中，血液透析期间急性肾损伤医院死亡率的相关危险因素为血清乳酸升高（相对危险度1.09）、血清钾升高（相对危险度0.93）和平均动脉压（相对危险度0.97）。
乳酸是一个可以预测预后的客观参数，有助于更好地管理血液透析患者的急性肾损伤。
