Primena kontinuirane terapije zamene funkcije bubrega kod kritično obolelih sa akutnim oštećenjem bubrega povezanim sa COVID-19

  • Violeta Knežević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology Novi Sad, Serbia https://orcid.org/0000-0001-7482-2945
  • Tijana Azaševac University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology Novi Sad, Serbia https://orcid.org/0000-0001-8432-0578
  • Bojana Ljubičić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Emergency Center, Department of Emergency Internal Medicine, Novi Sad, Serbia https://orcid.org/0000-0001-8317-6156
  • Ana Lazarević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Emergency Center, Department of Emergency Internal Medicine, Novi Sad, Serbia https://orcid.org/0000-0001-8310-3088
  • Dragana Milijašević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Public Health of Vojvodina, Novi Sad, Serbia https://orcid.org/0000-0003-1917-5567
  • Dušan Božić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia https://orcid.org/0000-0002-0556-4708
DOI: https://doi.org/10.2298/VSP230614070K
Ključne reči: bubreg, akutna insuficijencija;, bubreg, zamena funkcije, kontinuirana;, covid-19;, kritična stanja;, faktori rizika

Sažetak


Uvod/Cilj. Bolesnici sa teškom kliničkom slikom COVID-19 imaju viši rizik od razvoja akutnog oštećenja bubrega (AOB). Cilj rada bio je da se analiziraju faktori rizika od AOB/akutizacije bubrežne insuficijencije kod obolelih sa hroničnom bolešću bubrega (HBB), kao i rezultati lečenja primenom kontinuirane terapije zamene funkcije bubrega (KTZFB) kod kritično obolelih od COVID-19. Metode. Istraživanjem je obuhvaćen 101 COVID-19 bolesnik sa AOB, od ukupno 293 bolesnika lečenih primenom KTZFB. Istraživanje je sprovedeno od marta 2020. do jula 2021. godine u Univerzitetskom Kliničkom centru Vojvodine, Srbija. Rezultati. Prosečna starost bolesnika bila je 64,69 ± 9,71 godina. Od ukupnog broja bolesnika, 82,2% bilo je muškog pola, od kojih je 75,2% bilo obolelih od hipertenzije. Na invanzivnoj mehaničkoj ventilaciji (IMV) bila su 93,7% bolesnika, a 92,1% na vazopresornoj terapiji. Prosečna dužina IMV do početka KTZFB bila je 4,65 ± 4,57 dana. U prva 24 sata od početka IMV, 60% bolesnika je zahtevalo KTZFB. Pre KTZFB, prosečna vrednost Simplified Acute Physiology Score II iznosila je 39,13 ± 14,45, kreatinina 312 µmol/L [Interquartile Range (IQR) 208,0–437,5], prokalcitonina 2,70 ng/L (IQR 0,62–7,20), dok je 10,9% bolesnika imalo indeks SpO2/FiO2 > 200 i njih 41,6% anuriju. Prosečan broj procedura iznosio je 2,01 ± 1,36. Najčešći modalitet bio je hemodijafiltracija kod 67,3% bolesnika, a 46% je  koristilo oXiris® membranu. Korišćenjem binarne logističke regresije, uključujući demografske parametre, komorbiditete i kliničke parametre pre KTZFB, utvrđeno je da su bolesnici sa prethodnim oboljenjem bubrega imali 3,43 puta veće šanse da razviju AOB, a bolesnici sa indeksom SpO2/FiO2 ≥ 200 su imali 69% manje šanse za AOB/akutizaciju bubrežne insuficijencije u miljeu HBB, zavisne od KTZFB, u prva 24 sata od početka IMV. Zaključak. Utvrđivanje faktora rizika od AOB/akutizacije bubrežne insuficijencije kod obolelih sa HBB značajno je za planiranje njihove prevencije, koja zahteva i primenu KTZFB uz pravilan izbor modaliteta i doze dijalize, vrste membrane/filtera i doze antikoagulansa.

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2024/02/29
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Vol. 81 Br. 02 (2024): Vojnosanitetski pregled
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