Cássia Maria Frediani Morsch

Health-Related Quality of Life and Dialysis Dependence in Critically Ill Patient Survivors of Acute Kidney Injury

Background: Acute kidney injury is a common disorder in critical ill patients and it is associated with high mortality. Few studies focus on long-term perspectives such as health-related quality of life (HRQOL) and dialysis dependence. Methods: Prospective cohort study at the intensive care unit (ICU) of a Brazilian tertiary hospital. All patients requiring dialysis over a 2-year enrollment period were included. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) assessed the HRQOL along with patient status and dialysis dependence. Results: 408 patients (11%) required dialysis. ICU, hospital, and after-hospital cumulative fatality rates were 70%, 74%, and 80%, respectively. A total of 68 of 82 eligible patients were interviewed in an average of 256 days after hospital discharge, while 8 patients (11.8%) were in regular dialysis. There was no association between Acute Physiology and Chronic Health Evaluation II score, use of vasopressors, mechanical ventilation, creatinine, number of dialysis, and SF-36 scores. Better HRQOL was associated with previous conditions, as younger age and no chronic kidney disease; condition related to severity of acute illness, as have not had sepsis, short period at ICU, and hospital; and conditions after discharge, considered working currently. Conclusions: Previous chronic kidney disease was strongly associated with permanence in dialysis and lower further HRQOL. Younger survivors who have not had sepsis or long stays at hospitals, able to return to their jobs, had better HRQOL.

Índice de gravidade da doença renal, indicadores assistenciais e mortalidade em pacientes em hemodiálise

OBJECTIVE Comorbidity is a major factor influencing mortality in hemodialysis patients. Kt/V, hematocrit and albumin levels have also been associated with mortality in these patients. The purpose of this study was to evaluate the severity of comorbidity, Kt/V, hematocrit and albumin levels as predictors of mortality in patients on hemodialysis therapy. METHODS Forty patients were followed up during 12 months and assessed in relation to social demographic characteristics, time on dialysis therapy, presence of diabetes, Kt/V, hematocrit and albumin levels, also comorbidities. The impact of comorbidity on mortality was assessed by the end-stage renal disease severity index (ESRD-SI). RESULTS Mean ESRD-SI scores for survivals (85%) and deaths (15%) were 22 +/- 14.8 vs. 44 +/- 12.4 (p < 0.001), and for diabetic (29%) and non-diabetic patients (71%), 40 +/- 15.1 vs. 19 +/- 12.5 (p < 0.001). An inverse correlation was observed between ESRD-SI scores and albumin (r = -0.475; p < 0.005). Albumin levels = 3.6 g/dL were mostly observed (82%) in patients without diabetes (p = 0.021). A correlation was observed between hematocrit and albumin levels (r = 0.544; p < 0.001). For each 1-point increase in the ESRD-SI scores, there was a 10% increase in the risk of death (p = 0.0093). CONCLUSION The ESRD-SI is useful to assess the severity of comorbidities and to predict mortality in hemodialysis patients.OBJECTIVE: Comorbidity is a major factor influencing mortality in hemodialysis patients. Kt/V, hematocrit and albumin levels have also been associated with mortality in these patients. The purpose of this study was to evaluate the severity of comorbidity, Kt/V, hematocrit and albumin levels as predictors of mortality in patients on hemodialysis therapy. METHODS: Forty patients were followed up during 12 months and assessed in relation to social demographic characteristics, time on dialysis therapy, presence of diabetes, Kt/V, hematocrit and albumin levels, also comorbidities. The impact of comorbidity on mortality was assessed by the end-stage renal disease severity index (ESRD-SI). RESULTS: Mean ESRD-SI scores for survivals (85%) and deaths (15%) were 22±14.8 vs. 44±12.4 (p<0.001), and for diabetic (29%) and non-diabetic patients (71%), 40±15.1 vs. 19±12.5 (p<0.001). An inverse correlation was observed between ESRD-SI scores and albumin (r=-0.475; p<0.005). Albumin levels =3.6 g/dL were mostly observed (82%) in patients without diabetes (p=0.021). A correlation was observed between hematocrit and albumin levels (r=0.544; p<0.001). For each 1-point increase in the ESRD-SI scores, there was a 10% increase in the risk of death (p=0.0093). CONCLUSION: The ESRD-SI is useful to assess the severity of comorbidities and to predict mortality in hemodialysis patients.