Publicado

2015-04-01

Inicio de diálisis y mortalidad en una población con enfermedad renal crónica en Colombia

Dialysis initiation and mortality in a program for chronic kidney disease prevention in Colombia

Palabras clave:

Insuficiencia Renal, Mortalidad, Diálisis, Incidencia, Factores de Riesgo (es)
Kidney failure, Mortality, Dialysis, Incidence, Risk factors (en)

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Autores/as

  • Mauricio Sanabria-Arenas Renal Therapy Services RTS. Bogotá, D.C., Colombia.
  • Justo Paz-Wilches Mutual SER, EPS-S. Bogotá, D.C., Colombia.
  • Stefano Laganis-Valcarcel Renal Therapy Services RTS. Bogotá, D.C., Colombia.
  • Fabián Muñoz-Porras Renal Therapy Services RTS. Bogotá, D.C., Colombia.
  • Patricia López-Jaramillo Renal Therapy Services RTS. Bogotá, D.C., Colombia.
  • Jasmín Vesga-Gualdrón Renal Therapy Services RTS. Bogotá, D.C., Colombia.
  • Delia Perea-Buenaventura Renal Therapy Services RTS. Bogotá, D.C., Colombia.
  • Ricardo Sánchez-Pedraza Universidad Nacional de Colombia, Facultad de Medicina. Bogotá, D.C., Colombia.

Antecedentes. La enfermedad renal crónica (ERC) se asocia con una alta morbimortalidad. En todo el mundo, se han desarrollado programas preventivos con el fin de afrontar tal enfermedad, que han resultado eficaces para lograr mejores desenlaces clínicos. En Colombia, una red de centros clínicos renales comenzó un programa preventivo secundario donde los pacientes de ERC reciben cuidado multidisciplinario con el objetivo de controlar la mortalidad y retrasar el inicio de diálisis.

Objetivo. Determinar la frecuencia de inicio de diálisis y mortalidad en un grupo de adultos con ERC avanzada y evaluar qué variables clínicas y demográficas se asocian con estos desenlaces.

Materiales y métodos. Estudio de cohorte retrospectiva en el que se evaluaron 511 pacientes con ERC en estadios 3 a 5, admitidos en un programa de prevención entre abril 2010 y mayo 2013. Se calcularon tasas de densidad de incidencia. La asociación entre los factores clínicos y demográficos con los desenlaces se evaluó usando regresión de Cox.

Resultados. Los 551 pacientes evaluados contribuyeron con 1199 años-riesgo; tuvieron una mediana de 6 visitas durante el seguimiento. Del total de pacientes, 301 (54.6%) fueron mujeres; la media de edad fue de 75.8 años; las principales causas de ERC fueron hipertensión en 431 pacientes (78.2%) y diabetes en 101 (18.3%). En el momento de ingreso al estudio, la mediana de tasa de filtración glomerular (TFG) fue de 40.9 ml/min/1.73m² y la de índice de masa corporal (IMC) fue de 22.9 kg/m².

La tasa de inicio de diálisis fue 2.1 por 100 pacientes-año; se observó que otras causas de ERC (diferentes a hipertensión) y la diabetes predicen mayor riesgo de dicho desenlace; por el contrario, una mayor TFG y una mayor edad, menor riesgo.

La tasa de mortalidad fue 2.9 por 100 pacientes-año, los mejores predictores encontrados para este desenlace fueron TFG, IMC y sexo masculino; la elevación de la TFG y del IMC están asociadas con menor riesgo.La tasa de mortalidad fue mayor que la tasa de inicio de diálisis.

Conclusión. Una mayor TFG disminuye el riesgo para ambos desenlaces; a diferencia de otros estudios, la edad avanzada parece ser predictor de bajo riesgo de mortalidad y no fue un buen predictor de inicio de diálisis.

Background. Chronic kidney disease (CKD) has been associated with high mortality rate. Preventive programs have been developed to face the burden of this disease worldwide. These programs have proved efficient at achieving better outcomes. In Colombia, a renal facilities network began a secondary preventive program where CKD patients receive multidisciplinary care aimed at controlling mortality and delaying initiation of dialysis.

Objective. To determine the frequency of dialysis initiation and mortality in a group of patients older than 18 with advanced CKD, and to evaluate demographic and clinical factors associated with these outcomes.

Materials and Methods. In a retrospective cohort study, we evaluated 511 patients with advanced CKD stages 3 to 5, admitted in a preventive program between April 2010 and May 2013. Incidence density rates were calculated. Associations between clinical and demographic factors and outcomes were tested using Cox regression.

Results. A total of 551 patients contributed with 1199 years-in-risk; they had a median of 6 visits during follow-up. Out of the total of patients, 301(54.6%) were female; mean age was 75.8 years; main causes of CKD were hypertension for 431 patients (78.2%) and diabetes for 101 (18.3%). Baseline median of glomerular filtration rate (GFR) was 40.9 ml/min/1.73m² and body mass index (BMI) was 22.9 kg/m².

Rate of initiation of dialysis was 2.1 per 100 patient-years; other causes of CKD (different to hypertension) and diabetes were better predictors for this outcome; higher GFR and older age were associated with low risk of dialysis initiation. The mortality rate was 2.9 per 100 patient-years; high GFR and high BMI were predictors of low risk for this outcome. The mortality rate was higher than the rate of dialysis initiation.

Conclusions. This data confirms that higher GFR results in lower risk for both outcomes, unlike other reports, older age seems to indicate a low risk of mortality, and was not a good predictor for dialysis initiation.

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