Prevalência e fatores associados à progressão da doença renal crônica em idosos
Arquivos
Data
2018-09-27
Autores
Totoli, Claudia 
Orientadores
Canziani, Maria Eugenia Fernandes
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A doença renal crônica (DRC) é um problema de saúde pública mundial.
Sua prevalência está crescendo principalmente na população idosa, em consequência
do envelhecimento populacional, impulsionado pela melhora das condições
socioeconômicas e pelo aumento da expectativa de vida. Existem poucos estudos
sobre a perda de função renal em pacientes idosos. Assim, o objetivo desse estudo
foi avaliar os fatores associados à progressão da DRC nessa população.
Métodos: Este estudo retrospectivo observacional incluiu 340 pacientes com 65 anos
ou mais, com DRC estágios 3a5ND
(não diálise), incidentes no ambulatório de uremia
e que foram acompanhados pelo período médio de 2,1 anos. A progressão da DRC
foi avaliada pela variação da taxa de filtração glomerular estimada (TFGe), obtida
pelas fórmulas CKDEPI
e BIS1,
ao longo do tempo. Os pacientes foram divididos em
progressores e não progressores (variação da TFGe < 0 ou ≥ 0 mL/min/ano,
respectivamente).
Resultados: Houve declínio da função renal em 193 (57%) pacientes. Neste grupo a
taxa de progressão foi de 2,83
(5,1/
1,1)
mL/min/ano. Comparado aos não
progressores, os progressores eram mais jovens [72 (6978)
vs. 76 (6980)
anos;
p=0,02]; apresentavam, na admissão, fósforo sérico mais elevado [3,8 (3,34,1)
vs.
3,5 (3,94,1)
mg/dL; p=0,04] e maior proteinúria [0,10 (00,9
vs. 0 (00,3)
g/L;
p=0,007)]. Na análise de regressão logística ajustada para gênero e TFGe inicial, a
presença de proteinúria, mas não idade e fósforo, esteve independentemente
associada à progressão da DRC [Odds Ratio 2,07; 95% IC (1,383,17)
; p < 0,001].
Conclusão: A progressão da DRC foi observada na maioria dos idosos, sendo a
proteinúria, o mais importante fator associado ao declínio da função renal nesta
população.
Background: Chronic Kidney Disease (CKD) is a worldwide public health problem. The prevalence of CKD is rising especially in elderly, as consequence of populationageing related to socioeconomic development and better life expectancy. There are scarce studies evaluating CKD progression in elderly patients. The aim of this study was to assess the factors associated with CKD progression in this population. Methods: This is a retrospective observational study including 340 patients (≥ 65 years old) CKD stages 3a–5 nondialysis, incidents in an outpatient CKD clinic, followed by 2.1 years. CKD progression was assessed by the slope of eGFR calculated by CKDEPI and BIS 1 equations. The patients were divided in progressor and nonprogressor groups (eGFR slope < or ≥ 0 mL/min/1.73 m2/year, respectively). Results: Kidney function declined in 193 (57%) patients. In this group, the progression rate was 2.83 (5.1 / 1.1) mL /min /1.73 m2 /year. Compared to nonprogressor, the progressor patients were younger [72 (6978) vs. 76 (6980) years; p=0.02]; had higher serum phosphorus [3.8 (3.34.1) vs. 3.5 (3.94.1) mg/dL; p=0.04] and proteinuria [0.10 (00.9 vs. 0 (00.3) g/L; p=0.007] at the admission. In the logistic regression analysis, adjusted for gender and eGFR, proteinuria, but not age and phosphorus, was independently associated with CKD progression [Odds Ratio 2.07; 95% CI (1.383.17) ; p < 0.001]. Conclusion: CKD progression was observed in the majority of elderly patients and proteinuria was the most important factor associated to kidney function decline in this population.
Background: Chronic Kidney Disease (CKD) is a worldwide public health problem. The prevalence of CKD is rising especially in elderly, as consequence of populationageing related to socioeconomic development and better life expectancy. There are scarce studies evaluating CKD progression in elderly patients. The aim of this study was to assess the factors associated with CKD progression in this population. Methods: This is a retrospective observational study including 340 patients (≥ 65 years old) CKD stages 3a–5 nondialysis, incidents in an outpatient CKD clinic, followed by 2.1 years. CKD progression was assessed by the slope of eGFR calculated by CKDEPI and BIS 1 equations. The patients were divided in progressor and nonprogressor groups (eGFR slope < or ≥ 0 mL/min/1.73 m2/year, respectively). Results: Kidney function declined in 193 (57%) patients. In this group, the progression rate was 2.83 (5.1 / 1.1) mL /min /1.73 m2 /year. Compared to nonprogressor, the progressor patients were younger [72 (6978) vs. 76 (6980) years; p=0.02]; had higher serum phosphorus [3.8 (3.34.1) vs. 3.5 (3.94.1) mg/dL; p=0.04] and proteinuria [0.10 (00.9 vs. 0 (00.3) g/L; p=0.007] at the admission. In the logistic regression analysis, adjusted for gender and eGFR, proteinuria, but not age and phosphorus, was independently associated with CKD progression [Odds Ratio 2.07; 95% CI (1.383.17) ; p < 0.001]. Conclusion: CKD progression was observed in the majority of elderly patients and proteinuria was the most important factor associated to kidney function decline in this population.