Relação do volume de ultrafiltração e sobrevida em pacientes incidentes em diálise peritoneal

• Ano de defesa: 2012
• Autor(a) principal: Marian, Maria Vianei
• Orientador(a): D'avila, Domingos Otavio Lorenzoni
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de Pós-Graduação em Medicina e Ciências da Saúde
• Departamento: Faculdade de Medicina
• País: BR
• Palavras-chave em Português: MEDICINA; NEFROLOGIA; DIÁLISE PERITONEAL; ULTRAFILTRAÇÃO; SOBREVIDA; FATORES DE RISCO
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/1700

Introduction: Peritoneal dialysis ultrafiltration failure is a functional abnormality associated with increased risk of death and technique failure. Daily ultrafiltration volume early on therapy may predict patient and technique survival. Objective: to determine the relationship between to presence of risk factors, daily ultrafiltration volume, patient and technique survival. Patients and Method: Data were extracted from the observational, multicenter, BRAZPD cohort study. From a population of 2419 suitable patients, 977 incident patients were selected. At the three-month therapy interval, demographic, clinical and technical variables were appraised and daily ultrafiltration volume was analyzed by quartiles (1st: &#8804; 700 ml; 2nd: > 700 ml up to &#8804; 1100 ml; 3rd: > 1100 ml up to < 1600 ml; 4th: &#8805; 1600 ml), as were its changes at the sixth and twelfth follow-up months. Two outcomes were considered : death and technique failure, which were analyzed till the 30th therapy month. Comparison between groups, correlations, patient and technique uni and multivariate survival analyses, using Kaplan-Meier technique and Cox regression analysis, were performed. Results: Age (HR=1.038; 95% CI: 1.027-1.049; P<0.01), diabetes (HR=1.416; 95% CI: 1.043-1.922; P=0.03) and number of co-morbidities (HR=2.687; 95% CI: 1.336-5.407; P<0,01) were directly associated with increased patient mortality. The 4th ultrafiltration quartile related with higher patient and technique survival (P=0.02 and P=0.10, respectively); peritonitis had a strong negative effect upon therapy maintenance (HR=3.459; 95% CI: 2.218-5.394; P<0.01). Conclusion: young, non-diabetic patients had increased chance for survival. High ultrafiltration volumes promoted patient and technique survival. Peritonitis significantly reduced the likelihood of technical success.