RESUMO

INTRODUCTION: Diagnosis and staging of chronic kidney disease (CKD) is important for management and prevention of renal disease progression. It is unclear whether K/DOQI guidelines of the National Kidney Foundation are applicable to diagnosis of CKD in renal transplant recipients (RTRs) and which method is most appropriate for estimating glomerular filtration. OBJECTIVES: To determine the prevalence and staging of CKD in RTRs, according to K/DOQI guidelines, and the prevalence of complications of CKD. SUBJECTS AND METHODS: This cross-sectional study included RTRs at least six months post-transplantation followed at a single out-patient service. The glomerular filtration rate (GFR) was estimated with two different equations: the MDRD equation (Modification of Diet in Renal Disease) with four variables (age, creatinine level, gender, and race) and the Cockcroft-Gault (CG) formula. Patients with GFR more than 60 mL/min/1.73 m2 were diagnosed with CKD only in the presence of renal damage (hematuria, proteinuria, or evidence of injury in renal biopsy). CKD staging was compared to the two equations and the prevalence of complications was determined. RESULTS: The study evaluated 241 RTRs (average age: 40.6 +/- 12.5 yr, 62.2% male; 4.5% black, 50.6% from cadaveric donors). Average follow-up time was 6.8 +/- 6.1 yr and the average baseline creatinine level was 1.48 +/- 0.72 mg/dL. CKD was diagnosed in 70.5% of RTRs, of whom 52.9% (MDRD)/47.6% (CG) were classified as Stage III (GFR: 30-59 mL/min/1.73 m2). The agreement between the two methods was very close with regard to CKD diagnosis (kappa = 0.92) and close for stage-dependent prevalence (kappa = 0.68). The prevalence of anemia, hypocalcemia, hyperphosphatemia (HF), hyperuricemia (HU), and systemic arterial hypertension (SAH) was 10.6%, 7.6%, 10.3%, 54%, and 73.4% for patients with CKD. Significant differences were observed for HU, HF and SAH in patients without CKD. Anemia, HU and SAH were associated with CKD stage (p < 0.001). CONCLUSION: The prevalence of CKD in the study population was high (70.5%). The two equations tested correlated closely when used for GFR estimation. Routine CKD staging in RTRs would provide patients with safer and more appropriate management.

Assuntos

Falência Renal Crônica/classificação , Falência Renal Crônica/epidemiologia , Transplante de Rim/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Prevalência , Prognóstico , Resultado do Tratamento

RESUMO

JUSTIFICATICA E OBJETIVOS: O prognóstico dos pacientes admitidos em unidade de terapia intensiva (UTI) tem relação com sua gravidade nos momentos que precedem a internação. O objetivo deste estudo foi avaliar a gravidade dos pacientes 12, 24 e 72h antes da admissão na UTI, bem como qual o parâmetro mais prevalente nesses pacientes e correlacionar o Modified Early Warning Score (MEWS) no pré-UTI com o desfecho (sobrevivência versus óbito), respectivo. MÉTODO: Análise retrospectiva de 65 pacientes, nas 72 horas que antecederam a admissão na UTI, no perío-do de julho a outubro de 2006. RESULTADOS: O APACHE II médio foi 22,2 ± 7,9 pontos, a mortalidade real de 54,6 por cento e a taxa de mortalidade padronizada foi 1,24. O MEWS médio foi 3,7 ± 0,2; 4,0 ± 0,2 e 5,1 ± 0,2 pontos, calculado 72, 48 e 24h antes da admissão na UTI, respectivamente. Registrou-se um percentual crescente de pacientes com MEWS > 3 pontos nas 72, 48 e 24h antes da admissão - 43,8 por cento, 59,4 por cento e 73,4 por cento, respectivamente. Dentre os parâmetros fisiológicos, a freqüência respiratória foi a que mais contribuiu para a pontuação do MEWS. A mortalidade foi maior entre os pacientes com MEWS > 3 pontos já 72 horas antes da admissão. Entre os pacientes que faleceram, verificou-se um aumento significativo no MEWS médio, 24 horas antes da admissão à UTI (em relação ao registrado, 72 horas antes), fato não identificado nos sobreviventes. CONCLUSÕES: O MEWS identificou com fidelidade a gravidade dos pacientes admitidos na UTI, sugerindo ser um escore confiável à aplicação nas instancias que precedem a UTI.

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BACKGROUND AND OBJECTIVES: Prognosis of patients in the intensive care unit (ICU) has a relation with their severity just before admission. The Modified Early Warning Score (MEWS) was used to evaluate the severe condition of patients 12, 24 and 72 hours before admission in the ICU, assess the most prevalent parameters and correlate the MEWS before ICU with the outcome (survival versus death). METHODS: Retrospective analyses of 65 patients consecutively admitted to the ICU from July to October, 2006 evaluating the physiological parameters 72 hours prior to admission. RESULTS: APACHE II mean was 22.2 ± 7.9 points, mortality was 54.6 percent and standardized mortality ratio means was 1.24. MEWS means were 3.7 ± 0.2; 4.0 ± 0.2 and 5.1 ± 0.2 points, calculated 72, 48 and 24 hours previous to ICU admission, respectively. An increasing percentage of patients with MEWS > 3 points within 72, 48 and 24 hours before admission - 43.8 percent, 59.4 percent and 73.4 percent, respectively was recorded. Among the included physiological parameters respiratory rate contributed the most to the MEWS. Highest mortality was found in patients with MEWS > 3 points already found 72 hours before admission. Patients who died presented with a significant increase in the MEWS 24 hours prior to admission to the ICU (in relation to the MEWS recorded 72 hours before) but the situation was not identified in survivors. CONCLUSIONS: MEWS closely identified the severity of patients admitted to the ICU, suggesting that it can be a reliable score, useful in the situations preceding the ICU.

Assuntos

Humanos , Masculino , Feminino , Epidemiologia , Indicadores de Morbimortalidade , Índice de Gravidade de Doença , Unidades de Terapia Intensiva/normas

RESUMO

BACKGROUND AND OBJECTIVES: Prognosis of patients in the intensive care unit (ICU) has a relation with their severity just before admission. The Modified Early Warning Score (MEWS) was used to evaluate the severe condition of patients 12, 24 and 72 hours before admission in the ICU, assess the most prevalent parameters and correlate the MEWS before ICU with the outcome (survival versus death). METHODS: Retrospective analyses of 65 patients consecutively admitted to the ICU from July to October, 2006 evaluating the physiological parameters 72 hours prior to admission. RESULTS: APACHE II mean was 22.2 ± 7.9 points, mortality was 54.6% and standardized mortality ratio means was 1.24. MEWS means were 3.7 ± 0.2; 4.0 ± 0.2 and 5.1 ± 0.2 points, calculated 72, 48 and 24 hours previous to ICU admission, respectively. An increasing percentage of patients with MEWS > 3 points within 72, 48 and 24 hours before admission - 43.8%, 59.4% and 73.4%, respectively was recorded. Among the included physiological parameters respiratory rate contributed the most to the MEWS. Highest mortality was found in patients with MEWS > 3 points already found 72 hours before admission. Patients who died presented with a significant increase in the MEWS 24 hours prior to admission to the ICU (in relation to the MEWS recorded 72 hours before) but the situation was not identified in survivors. CONCLUSIONS: MEWS closely identified the severity of patients admitted to the ICU, suggesting that it can be a reliable score, useful in the situations preceding the ICU.