Prognosis of patients with heart disease with acute kidney injury undergoing dialysis treatment

Ferreira, Daniela; Gonçalves, Maria Aparecida Batistão; Fram, Dayana Souza; Grandi, João Luiz; Barbosa, Dulce Aparecida

doi:10.1590/0034-7167-2022-0022

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (06) • 2022 • https://doi.org/10.1590/0034-7167-2022-0022 copy

Prognosis of patients with heart disease with acute kidney injury undergoing dialysis treatment

Pronóstico de los pacientes con cardiopatías con insuficiencia renal aguda en tratamiento de diálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to verify the relationship of cardiovascular diseases with acute kidney injury and assess the prognosis of patients in renal replacement therapy.

Methods:

a cohort study, carried out in a public hospital specialized in cardiology. Treatment, comorbidities, duration of treatment, laboratory tests, discharge and deaths were analyzed.

Results:

of the 101 patients, 75 (74.3%) received non-dialysis treatment. The most frequent cardiological diagnoses were hypertension, cardiomyopathies and coronary syndrome. Hospitalization in patients undergoing dialysis was 18 days, hemoglobin <10.5g/dl and anuria in the first days of hospitalization contributed to the type of treatment. Each increase in hemoglobin units from the first day of hospitalization decreases the chance of dialysis by 19.2%. There was no difference in mortality.

Conclusions:

the main cardiological diseases were not predictive of dialysis indication, and clinical treatment was the most frequent. Anuria and anemia were predictors for dialysis treatment.

Descriptors:
Acute Kidney Injury; Patients; Heart Diseases; Prognosis; Dialysis.

Variables	Dialytic		Non-dialytic		Total		p value
Variables	No.	%	No.	%	No.	%	p value
Male	18	69.2	38	50.7	56	55.0	0.101
Female	8	30.7	37	49.3	45	45.0
Total	26	25.7	75	74.3	101	100.0
Age ^ Student’s t-test. (years)	61		65				0.339
Standard deviation	14		16				0.339

Variables	Dialytic		Non-dialytic		Total		p value
Variables	No.	%	No.	%	No.	%	p value
Observed comorbidities
Acute coronary syndrome	11	42.3%	37	49.3%	48	47.5	0.536 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Myocardiopathy	12	46.2%	32	42.7%	44	43.5	0.757 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Heart failure	12	46.2%	32	42.7%	44	43.5	0.017 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Myocardial revascularization	2	7.7%	16	21.3%	18	17.8	0.146 ²2 Benichel CR, Meneguin S. Fatores de risco para lesão renal aguda em pacientes clínicos intensivos. Acta Paul Enferm. 2020;33:e-APE20190064. https://doi.org/10.37689/acta-ape/2020AO0064 https://doi.org/10.37689/acta-ape/2020AO...
Hypertension	13	50.0%	47	62.7%	60	59.4	0.257 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Diabetes mellitus	7	26.9%	26	34.7%	33	32.6	0.468 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Dyslipidemia	5	19.2%	26	34.7%	31	30.6	0.141 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Sepsis	9	34.6%	15	20.0%	24	23.7	0.131 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Chagas disease	3	11.5%	9	12.0%	12	11.8	1.000 ²2 Benichel CR, Meneguin S. Fatores de risco para lesão renal aguda em pacientes clínicos intensivos. Acta Paul Enferm. 2020;33:e-APE20190064. https://doi.org/10.37689/acta-ape/2020AO0064 https://doi.org/10.37689/acta-ape/2020AO...
Obesity	3	11.5%	11	14.7%	14	13.8	1.000 ²2 Benichel CR, Meneguin S. Fatores de risco para lesão renal aguda em pacientes clínicos intensivos. Acta Paul Enferm. 2020;33:e-APE20190064. https://doi.org/10.37689/acta-ape/2020AO0064 https://doi.org/10.37689/acta-ape/2020AO...
Smoking	4	15.4%	9	12.0%	13	12.8	0.736 ²2 Benichel CR, Meneguin S. Fatores de risco para lesão renal aguda em pacientes clínicos intensivos. Acta Paul Enferm. 2020;33:e-APE20190064. https://doi.org/10.37689/acta-ape/2020AO0064 https://doi.org/10.37689/acta-ape/2020AO...
Main therapeutic methods observed
Use of vasoactive drugs	22	84.6%	56	74.7%	78	77.2	0.297 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Use of antibiotics	20	76.9%	53	72.6%	73	72.2	0.667 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Use of diuretics	19	73.1%	46	61.3%	65	64.3	0.281 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Stent	7	26.9%	28	37.3%	35	34.6	0.336 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Use of contrast	9	34.6%	22	29.3%	31	30.6	0.615 ¹ 1 Pearson’s chi-square test; 2Fischer’s exact test.
Use of renal protector	7	87.5%	17	73.9%	24	23.7	0.642²
Post-contrast hydration	4	57.1%	17	77.3%	21	20.7	0.357 ²2 Benichel CR, Meneguin S. Fatores de risco para lesão renal aguda em pacientes clínicos intensivos. Acta Paul Enferm. 2020;33:e-APE20190064. https://doi.org/10.37689/acta-ape/2020AO0064 https://doi.org/10.37689/acta-ape/2020AO...

Variables	Dialytic			Non-dialytic			p value
Variables	No.	Mean	SD	No.	Mean	SD	t-student
	25	34	16	72	39	17	0. 160
Urea - Day 1	26	104	76	75	77	36	0. 093
Urea - Day 2	14	97	75	27	73	37	0. 271
Urea - Day 3	12	102	80	17	69	40	0. 203
Creatinine - Day 1	26	2.29	1.55	75	1.78	0.71	0. 120
Creatinine - Day 2	14	2.47	2.23	27	1.66	0.93	0. 212
Creatinine - Day 3	12	2.72	2.74	17	1.52	0.87	0. 167
Potassium - Day 1	26	4.88	1.19	75	4.55	0.95	0. 156
Potassium - Day 2	14	4.05	0.60	27	4.26	0.82	0. 411
Potassium - Day 2	12	4.23	0.98	17	3.94	0.57	0. 325
Sodium - Day 1	26	1.36	8	75	1.38	5	0. 408
Sodium - Day 2	14	1.36	6	27	1.39	6	0. 127
Sodium - Day 3	12	1.36	5	17	1.40	6	0. 068
Hemoglobin - Day 1	24	11.0	3.10	73	12.80	2.59	0.006
Hemoglobin - Day 2	14	-10.96	1.67	27	11.79	2.10	0.003
Hemoglobin - Day 3	12	-10.30	1.76	17	12.06	2.44	0.003
Hematocrit - Day 1	24	34.2	23	73	17.7	7.1	0.035
Hematocrit - Day 2	14	30.3	11	27	4.0	5.9	0.002
Hematocrit - Day 3	12	17.9	5	17	6.6	7.1	0.003

Variables	Dialytic	Non-dialytic	Não dialíticos		Total		p value
Variables	No.	%	No.	%	No.	%	p value
Anuria ¹ 1 Anuria - Fischer’s exact test.							0. 002^*
Yes	9	34.6	6	8.0	15	14.9
No	17	65.4	69	92.0	86	85.1
Total	26	25.7	75	74.3	101	100.0
Clinical outcome							0. 123
Discharge	13	50.0	28	32.9	41	40.6
Death	13	50.0	47	67.1	60	59.4
Total	26	25.7	75	74.3	101	100.0
Length of stay in the ICU (days)	26		75				0. 001^*
Median	18		10
Interquartile variation	(10-31)		(7-21)				0. 014

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[1] Corresponding author: Daniela Ferreira E-mail: danica_epm@hotmail.com