Fatores de risco para mortalidade em um ano na doença renal crônica em diálise

Abstract

Introduction: Dialytic chronic kidney disease (CKD) has high morbidity and mortality. Patients with CKD also have a high burden of symptoms, comparable to cancer patients, as well as greater vulnerability and susceptibility to falls than the general population, regardless of age. Objectives: To evaluate risk factors for one-year mortality in chronic kidney disease on dialysis. Methods: Prospective cohort study, which included patients aged 18 years old or more, with chronic kidney disease, on dialysis for more than 90 days and able to respond to the questionnaires used. Patients were followed up for one year in person and/or by telephone contact. The collection of sociodemographic, clinical, and mortality outcome data was carried out at Taguatinga Regional Hospital, a reference public hospital in dialysis treatment in the Federal District, from September 2019 to February 2020. For patients on hemodialysis, the data collection took place on the days of the mid-week sessions. For patients on peritoneal dialysis, the data collection took place on the day of the routine consultation, after signing the informed consent form. The validated questionnaires used were the Edmonton Symptom Assessment System – ESAS-r RENAL Portuguese version, the Charlson Comorbidity Index (CCI) and the Vulnerable Elders Survey (VES-13). The outcome was mortality and related factors. Results: There were included 127 patients, with a mean age of 55.65 ± 15.15 years, male dominance with 50 out of 127 patients (60.63%); 64 patients on hemodialysis (50.39%) and 63 on peritoneal dialysis (49.61%). There was a predominance of diabetes mellitus as the cause of kidney disease (55/127, 43.30 %). The mean in the ESAS symptom score was 30.84 ± 22.23, the CCI was 6.09 ± 2.80 and the mean VES-13 in the vulnerability analysis was 4.25 ± 2.8. One-year mortality was 27.55%. In one-year survival, individuals who suffered two or more falls had a risk ratio 2.86 times higher for mortality compared to those who did not fall (CI: 1.23 - 6.25; p=0.01). Conclusion: Mortality in CKD on dialysis is high. The occurrence of falls was a risk factor for one-year mortality in chronic kidney disease on dialysis. The creation of protocols for reporting and preventing falls can contribute to decreasing mortality in this population.