Características clínicas y mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda en hemodiálisis, en el Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, 2014-2015

Abstract

Introducción: No existen datos oficiales sobre los pacientes con insuficiencia renal aguda (IRA) en el Perú. La mayor parte de la información proviene de centros aislados en otros países. Objetivo: Describir las características clínicas y la mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda, en hemodiálisis, atendidos en un hospital de tercer nivel del Perú. Método: Estudio transversal, realizado en pacientes con diagnóstico de IRA en hemodiálisis, atendidos en el Hospital Guillermo Almenara Irigoyen, EsSalud, durante 2014-2015. Se evaluaron las características clínicas generales y se estimó la tasa de mortalidad intrahospitalaria. Resultados: Se evaluaron 183 pacientes. La edad media fue de 58 años y el 57% fueron varones. El 90% ingresaron al hospital a través de emergencia (EMG). Los pacientes fueron admitidos en la unidad de cuidados intensivos (UCI), EMG y otras áreas de hospitalización en el 40%, 27% y 33% de los casos, respectivamente. Las causas más frecuentes de IRA fueron: sepsis (59%), insuficiencia cardíaca (8%) y uropatía obstructiva (7%). La mortalidad intrahospitalaria fue de 55% (n=100). Los pacientes fallecidos mostraron una mayor frecuencia de sepsis (71 vs. 38; p = 0,001) y de compromiso multiorgánico (90 vs. 56; p < 0,001) en comparación con los vivos. Conclusiones: Los pacientes con IRA tuvieron una edad media de 59 años y la mayoría estuvieron hospitalizados en UCI. La causa más frecuente de IRA fue la sepsis. La mortalidad intrahospitalaria fue 55% y estuvo significativamente asociada a la presencia de sepsis y compromiso multiorgánico.

Global Perspectives in AKI: Peru

“…Those characteristics include older age, the presence of multiple comorbidities, sepsis as the cause of AKI, and the need for care in intensive care units. [8][9][10] However, it is necessary to point out that these studies used medical records or the International Classification of Diseases (ICD-10) coding to identify patients with AKI, so it is not known which criteria were used to establish the diagnosis. [8][9][10] A study on the basis of the registry of AKI cases reported by MINSA between 2005 and 2016 and the data reported from death certificates during the same period showed that AKI cases increased and AKI-related deaths decreased over time.…”

“…[8][9][10] However, it is necessary to point out that these studies used medical records or the International Classification of Diseases (ICD-10) coding to identify patients with AKI, so it is not known which criteria were used to establish the diagnosis. [8][9][10] A study on the basis of the registry of AKI cases reported by MINSA between 2005 and 2016 and the data reported from death certificates during the same period showed that AKI cases increased and AKI-related deaths decreased over time. 7 The agestandardized AKI incidence rate, regardless of severity, increased from 9.6 per 100,000 in 2005 to 14.0 per 100,000 in 2016, and the age-standardized mortality rate decreased from 2.3 per 100,000 in 2005 to 1.2 per 100,000 in 2016 7 (Figure 1).…”

“…Those characteristics include older age, the presence of multiple comorbidities, sepsis as the cause of AKI, and the need for care in intensive care units. 8 – 10 However, it is necessary to point out that these studies used medical records or the International Classification of Diseases (ICD-10) coding to identify patients with AKI, so it is not known which criteria were used to establish the diagnosis. 8 – 10 …”

“… 8 – 10 However, it is necessary to point out that these studies used medical records or the International Classification of Diseases (ICD-10) coding to identify patients with AKI, so it is not known which criteria were used to establish the diagnosis. 8 – 10 …”

“…Specifically in patients with AKI on HD, data from single-center studies in Peru showed that sepsis and other nonsurgical conditions, such as severe volume depletion, heart failure, and obstructive uropathy, were among the leading causes of in-hospital AKI. 8 – 10 Importantly, mortality rates were very variable, 40.2% in a MINSA hospital 10 and 17.2% and 55% in two EsSalud hospitals. 8 , 9 Although this heterogeneity may be due to differences in the acuity of illness of the patients represented in these studies, the indications and characteristics of patients requiring acute dialysis were similar to reports from high-income countries 8 – 10 .…”