Ultrafiltration and critical acute kidney patients associated with clinical complications due to hemodialysis1
Abstract
Objective: To analyze the association between ultrafiltration and severity of patients diagnosed with acute renal injury with clinical complications resulting from hemodialysis. Method: A cross-sectional study was conducted in a teaching hospital in southern Brazil. We included all daily records of hemodialysis sessions of patients with acute kidney injury who underwent hemodialysis between September and November 2017. For data collection, an instrument was developed. A significance level of less than 5% was adopted. Results:The 103 patients under studywent through a total of 519 hemodialysis sessions. Most were male patients (66.7%) aged 60 years or older (51.5%). About half of the patients had mean ultrafiltration volume >1501ml (51.5%). Most were considered critical (72.8%). Among the complications, hypotension (69.9%) was the most prevalent. The performance of a higher volume of ultrafiltration was not associated with the studied complications. Patients with severity showed a higher chance of hypotension (p<0.001 and OR: 33.73). Conclusion: Hypotension during hemodialysis was a frequent complication, presented by nearly half of the patients. As it was not associated with larger ultrafiltration volumes, it is concluded that, possibly, the greater severity of the patient is an explanatory factor for the onset of this complication.
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References
- Sociedade Brasileira de Nefrologia. Insuficiência renal aguda [Internet]. São Paulo: SBN; Associação Médica Brasileira, 2007 [acesso 2018 Nov 1]. Disponível em: https://sbn.org.br/app/uploads/Diretrizes_Insuficiencia_Renal_Aguda.pdf
-Cattai GBP, Rocha FA, Junior NN, Pimentel GGA. Qualidade de vida em pacientes com insuficiência renal crônica - SF-36. Cienc. cuid. saúde. 2008;6:460-467. Doi: https://doi.org/10.4025/cienccuidsaude.v6i0.5357
- Cardoso BG, Carneiro TA, Magro MCS. Recuperação de pacientes com lesão renal aguda dialítica e não dialítica. CogitareEnferm. 2017jan/mar;22(1):1-9. Doi: http://dx.doi.org/10.5380/ce.v22i1.48041
- Guedes JR, Silva ES, Carvalho ILN, Oliveira MD. Incidência e fatores predisponentes de insuficiência renal aguda em unidade de terapia intensiva. CogitareEnferm. 2017;22(2): e49035. Doi: http://dx.doi.org/10.5380/ce.v22i2.49035
- Luft J, Boes AA, Lazzari DD, Nascimento ERP, Busana JA, Canever BP. Lesão renal aguda em unidade de tratamento intensivo: características clínicas e desfechos. CogitareEnferm. 2016 abr/jun;21(2):1-9. Doi: http://dx.doi.org/10.5380/ce.v21i2.43822
- Pereira NM. Lesão renal aguda em unidade de terapia intensiva: perfil dos pacientes e carga de trabalho de enfermagem. 2017 [trabalho de conclusão de curso]. Curso de Enfermagem. Universidade de Santa Cruz do Sul (RS).2017. Disponível em: https://repositorio.unisc.br/jspui/bitstream/11624/1679/1/Nat%C3%A1lia%20Medeiros%20Pereira.pdf
- Souza NR, Freire DA, Souza AMFL, Lima DS, Brandão CS, Lima VSB. Caracterização dos pacientes com insuficiência renal aguda de uma unidade de terapia intensiva submetidos à hemodiálise. Veredas - Rev Eletrônica de Ciênc [Internet]. 2017[acesso 2018 nov 1];2(10):51-64. Disponível em:
http://veredas.favip.edu.br/ojs/index.php/veredas1/article/view/489/pdf
- Li PKT,Burdmann EA, Mehta RL. Injúria renal aguda: um alerta global. J BrasNefrol.2013;35(1):1-5.Doi:https://doi.org/10.5935/01012800.20130001
-Alcântara Alencar Melo G, Fernandes de Oliveira CV, Fernandes Pereira FG, Lins de Alencar Filho W, Gomes de Melo D, Borges de Morais J, et al. Enfermagem em nefrologia: percepções sobre as competências no manejo da injúria renal aguda. Cienc. cuid. saúde. 2020; 19:e50245. Doi: https://doi.org/10.4025/cienccuidsaude.v19i0.50245
- Silva AFS, Magalhães DM, Rocha PRS, Silva RF. Principais complicações apresentadas durante a hemodiálise em pacientes críticos e propostas de intervenções de enfermagem. RevEnf Centro-Oeste Mineiro. 2018;8:e2327. Doi: https://doi.org/10.19175/recom.v8i0.2327
- Gonçalves VLC. A ultrafiltração no tratamento da síndrome cardio-renal. 2014 [dissertação]. Mestrado Integrado em Medicina. Universidade do Porto. 2014. Disponível em: https://repositorio-aberto.up.pt/bitstream/10216/76532/2/32629.pdf
- Douvris A, Zeid K, Hiremath S, Bagshaw SM, Wald R, Beaubien-Souligny W, et al.Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review. Intensive Care Med. 2019 Oct;45:1333-1346. Doi: 10.1007/s00134-019-05707-w.
- Douvris A, Malhi G, Hiremath S, McIntyre L, Silver SA, Bagshaw SM, et al.Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review.Crit Care. 2018 Feb 22;22:41. Doi: 10.1186/s13054-018-1965-5
- Albino BB,Balbi AL, Ponce D. Dialysis complications in AKI patients treated with extended daily dialysis: Is the duration of therapy important? Biomed Res Int. 2014; 2014:1-9. Doi: https://doi.org/10.1155/2014/153626
- Morón Rodriguez M, Machado VRN, VázquezCedeño JL. Caracterización clínico-analítica de pacientes conlesión renal aguda en una unidad de cuidados intensivos de adulto, Cienfuegos.RevCubMedIntEmerg. [Internet] 2016[acesso 2018 nov 1];15(3):55-69. Disponível em: https://www.medigraphic.com/pdfs/revcubmedinteme/cie-2016/cie163h.pdf
- Tejera D, Varela F, Acosta D, Figueroa S, Benencio S, Verdaguer C, et al. Epidemiología de la injuria renal aguda y enfermedad renal crónica enlaunidad de cuidados intensivos. RevBras Ter Intensiva. 2017;29(4):444-452. Doi: 10.5935/0103-507X.20170061
- Kim TW, Chang TI, Kim TH, Chou JA, Soohoo M, Ravel VA, et al. Association of Ultrafiltration Rate with Mortality in Incident Hemodialysis Patients. Nephron. 2018;139:13-22. Doi: https://doi.org/10.1159/000486323
- Custodio FB, Lima EQ. Hemodiálise estendida em lesão renal aguda. J BrasNefrol.2013;35(2):142-146. Doi: https://doi.org/10.5935/0101-2800.20130023
- Lumlertgul N, Murugan R, Seylanova N, McCready P, Ostermann M.Net ultrafiltration prescription survey in Europe.BMC Nephrol. 2020 Dec 1;21(1):522. Doi: 10.1186/s12882-020-02184-y.
-Girling BJ, Channon SW, Haines RW, Prowle JR.Acute kidney injury and adverse outcomes of critical illness: correlation or causation?Clin Kidney J. 2019 Nov 18;13(2):133-141. Doi: 10.1093/ckj/sfz158
- Murugan R, Balakumar V, Kerti SJ, Priyanka P, Chang CH, Clermont G, et al.Net ultrafiltration intensity and mortality in critically ill patients with fluid overload.Crit Care. 2018 Sep 24;22(1):223. Doi: 10.1186/s13054-018-2163-1.
- Hall A, Crichton S, Dixon A, Skorniakov I, Kellum JA, Ostermann M. Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: a cohort study.Crit Care. 2020 Jun 1;24(1):279. Doi: 10.1186/s13054-020-02986-4.
- Murugan R, Bellomo R, Palevsky PM, Kellum JA.Ultrafiltration in critically ill patients treated with kidney replacement therapy.NatRevNephrol. 2021 Apr;17(4):262-276. Doi: 10.1038/s41581-020-00358-3.
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