Influence of early hemodialysis on the septic acute kidney injury outcome

Alves de Queiroz, Cléria; Rodrigues Bacci, Marcelo

doi:10.1590/1980-220X-REEUSP-2022-0109en

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2022-0109en copy

Influence of early hemodialysis on the septic acute kidney injury outcome^* *Extracted from the dissertation: “Influência da hemodiálise precoce no desfecho da lesão renal aguda séptica”, Centro Universitário Faculdade de Medicina ABC, Santo André, 2021.

Influencia de la hemodiálisis temprana en el resultado de la lesión renal aguda séptica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the influence of early hemodialysis on the outcome of acute septic kidney injury.

Method:

this is an observational, analytical, prospective study with patients diagnosed with acute septic kidney injury on hemodialysis. A questionnaire for data collection was used as an instrument. We used the Shapiro-Wilk, nonparametric Kruskal-Wallis, Mann-Whitney U, Student t and chi-square tests for analysis.

Results:

of the 40 patients analyzed, 60% were male, with a mean age of 55 (±16.8) years, and length of hospital stay of 43 (±26.2) days. When separating patients undergoing early and late hemodialysis into two groups, an increase in serum creatinine (p = 0.001) was observed in those who underwent late hemodialysis, however, creatinine ≥ 4mg/dl is one of the characteristics of this group. In both groups, there was a high mortality: 62.5% (10) in the early hemodialysis group and 41.7% (10) in the late hemodialysis group, with vasopressor use (p = 0.001) being the main risk factor.

Conclusion:

early onset of hemodialysis in acute septic kidney injury based on KDIGO definitions did not influence the outcome. However, vasopressor use associated with hemodialysis in septic patients was a predictor of death.

DESCRIPTORS
Kidney Diseases; Sepsis; Renal Dialysis

Variables	n (%) or Mean ± SD
Sex
Female	16.0 (40.0)
Male	24.0 (60.0)
Age (years)	55.0 ± 16.8
Focus of sepsis
Pulmonary	23.0 (57.5)
Soft tissues	4.0 (10.0)
Abdominal	11.0 (27.5)
Urinary	2.0 (5.0)
Comorbidities
Stroke	10.0 (25.0)
Hypertension	29 (72.5)
Diabetes	22 (55.0)
CHF	4.0 (10.0)
MV (days)	22.9 ± 18.7
MV up to 28 days	26.0 (65.0)
Time between admission and HD (days)	1.30 ± 6.80
Death	20.0 (50.0)

Variables	Early HD 16 (40.0%)	Late HD 24 (60.0%)	p
Length of hospital stay (days)	41.4 ± 24.3	45.3 ± 24.1	0.642*
ICU length of stay (days)	30.8 ± 19.3	29.1 ± 19.8	0.628**
Focus of sepsis
Pulmonary	8.0 (50.0)	15.0 (62.5)	0.323⁺
Soft tissues	3.0 (18.7)	1.0 (4.20)	0.167⁺
Abdominal	4.0 (25.0)	7.0 (29.2)	0.533⁺
Urinary	1.0 (6.3)	1.0 (4.20)	0.646⁺
MV	16.0 (100.0)	24.0 (100.0)	–
Time under MV	22.9 ± 18.7	24.1 ± 18.9	0.081**
MV <28 days	13.0 (81.3)	13.0 (54.2)	0.079**
Urinary output at admission (ml/kg/h)	0.5 ± 0.6	0.4 ± 0.7	0.567***
Diuresis at admission (24 hours)	437.3 ± 541.1	408.9 ± 587.4	0.224***
Creatinine value (mg/dL)
At recommendation	4.4 ± 1.7	4.6 ± 1.6	<0.001**
Death	10.0 (62.5)	10.0 (41.7)	0.167⁺

Vasopressors	Early HD 16.0 (40.0%)	Late HD 24.0 (60.0%)	p*
Noradrenaline	13.0 (81.0)	18.0 (75.0)
Adrenaline	1.0 (6.0)	0.0 (0.0)
Others	2.0 (12.0)	1.0 (4.0)	0.246
None	3.0 (19.0)	6.0 (25.0)
>1 vasopressor	2.0 (12.0)	0.0 (0.0)
Only 1 vasopressor	11.0 (69.0)	18.0 (75.0)

Outcomes	Early HD 16.0 (40.0%)	Late HD 24.0 (60.0%)	p*
Death <28 days after admission	10.0 (63.0)	8.0 (33.0)	0.423
Death ≥28 days after admission	0.0 (0.0)	2.0 (8.5)
End-stage kidney disease	5.0 (31.0)	12.0 (50.0)
Kidney disease reversal	1.0 (6.0)	2.0 (8.5)

	Outcome		p
	Death n = 20	Survival n = 20	p
Sex			0.519**
Female	7.0 (35.0)	9.0 (45.0)
Male	13.0 (15)	11.0 (55)
Age (years)	58 ± 16.9	62 ± 17.2	0.356*
Focus of sepsis			0.323**
Pulmonary	13.0 (65.0)	10.0 (50.0)
Soft tissues	1.0 (5.0)	3.0 (15.0)
Abdominal	6.0 (30.0)	5.0 (25.0)
Urinary	0.0 (0.0)	2.0 (10.0)
MV (days)	18.7 ± 19.0	21.0 ± 18.9	0.053*
MV up to 28 days	15.0 (75)	11.0 (55)	0.185**
Length of hospital stay (days)	30.0 ± 21.3	57.0 ± 24.3	0.008*
ICU length of stay (days)	18.0 ± 14.4	37 ± 18.9	0.001*
Urinary output at admission (ml/kg/h)	0.2 ± 0.6	0.2 ± 0.7	0.187*
Diuresis at admission (24 hours)	237.5 ± 541.1	220 ± 548.0	0.589*
Creatinine value (mg/dL)
At hospitalization	9.4 ± 29.3	3.0 ± 1.7	0.337*
At hemodialysis	4.1 ± 1.8	4.8 ± 1.5	0.179*
Vasopressor use	20.0 (100.0)	11.0 (55%)	0.001**
Noradrenaline	19.0 (95)	10.0 (50)
Adrenaline	1.0 (5.0)	0.0 (0.0)
Other	3.0 (15.0)	1.0 (5%)
>1 vasopressor	2.0 (10)	0.0 (0.0)
Only 1 vasopressor	15.0 (75)	11.0 (55.0)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Marcelo Rodrigues Bacci Avenida Aldino Pinotti, 500, ap 264 T 1, Centro 09750-220 – São Bernardo do Campo, SP, Brazil mrbacci@yahoo.com

Brasil

Brasil

Influence of early hemodialysis on the septic acute kidney injury outcome* *Extracted from the dissertation: “Influência da hemodiálise precoce no desfecho da lesão renal aguda séptica”, Centro Universitário Faculdade de Medicina ABC, Santo André, 2021.

Influencia de la hemodiálisis temprana en el resultado de la lesión renal aguda séptica

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Influence of early hemodialysis on the septic acute kidney injury outcome^* *Extracted from the dissertation: “Influência da hemodiálise precoce no desfecho da lesão renal aguda séptica”, Centro Universitário Faculdade de Medicina ABC, Santo André, 2021.