RESUMO
The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72% were males, 59% had been HIV-infected for >5 years, 72% had CD4 counts <200 cells/mm(3), 87% developed electrolyte disturbances, 33% recovered renal function, and 56% survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.
Assuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Injúria Renal Aguda/mortalidade , Deficiência de Magnésio/mortalidade , Desequilíbrio Hidroeletrolítico/mortalidade , Síndrome da Imunodeficiência Adquirida/complicações , Injúria Renal Aguda/etiologia , Adolescente , Adulto , Estado Terminal , Métodos Epidemiológicos , Feminino , Humanos , Deficiência de Magnésio/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Desequilíbrio Hidroeletrolítico/etiologia , Adulto JovemRESUMO
The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72 percent were males, 59 percent had been HIV-infected for >5 years, 72 percent had CD4 counts <200 cells/mm³, 87 percent developed electrolyte disturbances, 33 percent recovered renal function, and 56 percent survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Síndrome da Imunodeficiência Adquirida/mortalidade , Injúria Renal Aguda/mortalidade , Deficiência de Magnésio/mortalidade , Desequilíbrio Hidroeletrolítico/mortalidade , Síndrome da Imunodeficiência Adquirida/complicações , Injúria Renal Aguda/etiologia , Estado Terminal , Métodos Epidemiológicos , Deficiência de Magnésio/etiologia , Prognóstico , Recuperação de Função Fisiológica , Desequilíbrio Hidroeletrolítico/etiologia , Adulto JovemRESUMO
To evaluate if hypomagnesemia, at the time of admission in the Intensive care Unit (ICU), is associated with a higher mortality in critically ill patients with type 2 diabetes. Fourteen consecutive critically ill patients with type 2 diabetes admitted in the ICU of a teaching General Hospital serving an inner city population were enrolled in a follow-up study. Parenteral or enteral nutritional support, surgical procedures, malignancy, traumatism or physical injury, pulmonary and/or cardiovascular diseases, chronic renal failure, hepatic cirrhosis, cerebrovascular disease, and disorders of the thyroid gland, were exclusion criteria. Hypomagnesemia was defined by serum magnesium levels < 0.66 mmol/L (1.6 mg/dL). At the time of admission in the ICU, 10 (71.4%) individuals had hypomagnesemia. Mortality rates in the hypomagnesemic and normomagnesemic individuals were 80 and 25%, respectively. Serum magnesium levels were significantly lower in the subjects who died (0.51 [0.41, 0.62] mmol/L) compared with those who survived (0.85 [0.65, 1.11], mmol/L), p = 0.01. The logistic regression model adjusted by APACHE II score and hsCRP levels showed that hypomagnesemia is independently associated with mortality (OR 1.9, CI95% 1.2-14.7). Hypomagnesemia at the time of admission in the ICU seems to be associated with high mortality in critically ill patients with type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2 , Deficiência de Magnésio/sangue , Magnésio/sangue , Adulto , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/mortalidade , Seguimentos , Humanos , Unidades de Terapia Intensiva , Deficiência de Magnésio/mortalidade , Pessoa de Meia-IdadeRESUMO
En el presente estudio, se determinó la relación entre hipomagnesio y mortalidad, en pacientes pediátricos, ingresados en la UCIP, del Hospital JM de los Ríos, entre los meses de septiembre-noviembre de 1995, se cuantificaron los niveles séricos de Mg++ y su asociación con la mortalidad; así como, se determinó el puntaje promedio del TISS, correlacionando el grado de severidad de la enfermedad, encontrando que, la hipomagnésemia es frecuente al ingresar los pacientes a la UCIP (40,63 por ciento); el valor predictivo de mortalidad de los niveles séricos de Mg++, fué baja probablemente porque el tamaño de la muestra fué pequeña; la hipomagnésemia se relacionó con mayor mortalidad (38,46 por ciento); el 71,43 por ciento de los que fallecieron estaban hipomagnesémicos, 28,57 por ciento normomagnésicos, y pertenecían ambos grupos a la clase III-IV del TISS; los que evolucionaron satisfactoriamente, a la clase I-II; la mayoría de los pacientes que ingresó, fueron lactantes, y no hubo diferencia en la mortalidad entre los grupos etarios; todos los pacientes que evolucionaron satisfactoriamente, egresaron con Mg++ sérico en el paciente pediátrico críticamente enfermo, con su concomitante restitución y mantenimiento en la nutrición y fluidoterapia parenteral