Rani početak primene metoda zamene funkcije bubrega poboljšava preživljavanje bolesnika sa akutnim oštećenjem bubrega
Sažetak
Uvod/Cilj. Definisanje početka primene metoda zamene funkcije bubrega kod kritično obolelih sa akutnim oštećenjem bubrega postaje imperativ nefrolozima i intezivistima. Primarni cilj studije je bio ustanoviti preživljavanje bolesnika 28-og dana od prijema, a sekundarni cilj oporavak funkcije bubrega. Metode. U Urgentnom centru Kliničkog centra Vojvodine (Novi Sad, Srbija) sprovedeno je retrospektivno ispitivanje koje je uključilo 385 hiruških i nehirurških bolesnika sa akutnim oštećenjem bubrega i akutizacijom hronične bubrežne insuficijencije u periodu od 2014. do 2017. godine, kojima su primenjene metode zamene funkcije bubrega. Bolesnici sa Kidney Disease Improving Global Outcomes (KDIGO) stadijumom 2 i/ili hipervolemijom unutar 24 h od potvrđenog akutnog oštećenja bubrega imali su “rani” početak dijalize, dok su “kasni” početak imali bolesnici sa slabijim odgovorom na konzervativnu terapiju ili kliničkim komplikacijama povezanim sa akutnim oštećenjem bubrega. Rezultati. Retrospektivnom analizom je utvrđeno da je kod 241 bolesnika (62,6%) dijaliza rano započeta, unutar 24 h. Bolesnici koji su „rano” započeli dijalizu imali su značajno bolje preživljavanje u poređenju sa bolesnicima koji su imali „kasni” početak dijalize (63.9% vs. 36.1%; p = 0.001). Kod nešto većeg broja bolesnika sa „ranim” početkom dijalize došlo je do oporavka funkcije bubrega (56,8%), ali razlike nisu bile značajne (p = 0.514). Bolesnici sa „ranim” početkom dijalize i Sequential Organ Failure Assessment (SOFA) skorom 1–3 imali su 2 puta veću šansu da oporave funkciju bubrega u odnosu na bolesnike sa SOFA skorom ≥ 4 [odds ratio (OR) = 2,01; 95% confidence interval (CI): 1,37–2,95; p < 0,001], dok su bolesnici sa sepsom imali za 62% manju šansu oporavka funkcije bubrega u odnosu na bolesnike bez sepse (OR = 0,38; 95% CI: 0,18–0,82; p = 0,013). U grupi sa „kasnim” početkom dijalize utvrđeno je da bolesnici koji nemaju dijabetes imaju 3,8 puta veću šansu za oporavak funkcije bubrega u odnosu na obolele od dijabetesa (OR = 3,53; 95% CI: 1,27–9,83; p = 0,016). Zaključak. Značajno bolje preživljavanje 28-dana imali su bolesnici kojima je zamena funkcije bubrega dijalizom „rano“ započeta.
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