Liječenje akutnog zatajenja bubrega u starijih osoba

master's thesis

• Title (english): Treatment of acute kidney injury in elderly people
• Author: Lana Gellineo
• Mentor: Petar Kes (mentor)
• Committee member: Draško Pavlović (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Petar Kes (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Starenjem dolazi do degenerativnih promjena u bubregu koje povećavaju rizik od
akutnog bubrežnog zatajenja (ABZ). Stariji od 80 godina su 5 puta skloniji razviti ABZ
od mlađe populacije (Pascual J, Liano F 2009). U starijih od 65 godina postoji 28%
manja vjerojatnost za oporavak bubrežne funkcije nakon epizode ABZ (Schmitt i sur.
2008). Općenito je zabilježen porast incidencije ABZ kao i prosječne dobi pacijenata
s pojavom epizode ABZ (Turney JH i sur. 1990)( Baraldi A i sur. 1998). Većina starijih
pacijenata s ABZ imaju istovremeno disfunkciju i drugih organskih sustava što
povećava mortalitet ove skupine. Takvim pacijentima je često potrebna kontinuirana
metoda dijalize koja donekle oponaša funkciju zdravog bubrega. Cilj ovog rada bio je
istražiti odnos primjene različitih metoda dijalize i ishoda liječenja u pacijenata ≥65
godina s ABZ bez prethodne dijagnoze kroničnog bubrežnog zatajenja (KBZ)
liječenog dijalizom te usporediti razultate s mlađom dobnom skupinom (18-64
godina) akutno dijaliziranih pacijenata, također bez prethodne dijagnoze KBZ. Iz BISa
i Centralnog arhiva prikupljeni su podaci o dobi, dijagnozama i ishodima liječenja
za akutno dijalizirane pacijente bez prethodne dijagnoze KBZ u razdoblju 2009.-
2013. godine (uključujući i 2013. g.). Iz obrazaca dijalize su prikupljeni podaci o vrsti i
trajanju dijalize te komplikacijama i antikoagulantnoj terapiji. Skupinu ≥65 godina
činilo je 121 pacijenata (61%) i 77 pacijenata dobi 18-64 g. (39%). U starijoj dobnoj
skupini umrlo je 64 (53%), a u mlađoj dobnoj skupini 35 pacijenata (45%) (p=0.31).
125 umrlih su bili muškarci (63%), a 73 žene (37%) (p=0.88). Najmanji udio umrlih po
metodi bio je kod IHD (2.2%), a najveći kod CVVHDF (21.7%) što se pripisuje dijelom
broju dijaliza tim metodama i općem stanju pacijenta (p=0.007, V=0.145). Najveća
učestalost komplikacija je bila kod trajanja dijalize >48 sati (54.7%) (p<0.001,
V=0.267). CVVH metoda je imala najveću učestalost komplikacija (68.5%), dok IHD
najmanju (13.0 %).

Abstract (english)

People >80 yrs are 5 times more prone to developing AKI than the younger
population due to ageing of the kidney (Pascual J, Liano 2009). In people ≥65 yrs
there is 28% less chance of kidney function recovery after an AKI episode (Schmitt et
al. 2008). An increased incidence of AKI has been recorded as well as an increase in
the average age of patients with AKI (Turney JH i sur. 1990)( Baraldi A i sur. 1998).
The majority of older patients with AKI have a previous dysfunction in other organ
systems which increases the risk of AKI. These patients benefit from CRRT which
somewhat imitates the function of a healthy kidney. The aim of this study was to
determine the relationship between various dialysis methods and outcomes in
patients ≥65 yrs of age with AKI without a pre-existing chronic renal insufficiency
(CRI) previously treated with dialysis and to compare the findings with the younger
age (18-64 yrs) group with AKI. The data for age, diagnosis and tretament outcomes
in patients with AKI (without previous CRI) were gathered from the Central hospital
archive and the Hospital informatic system for the period 2009 - 2013 (including year
2013). Information about complications, anticoagulation therapy, duration and type of
dialysis was acquired from the dialysis forms. There were 121 patients (61%) in the
group aged ≥65 yrs and 77 patients (39%) in group aged 18-64 yrs. 64 patients
(53%) died in the older age group and 35 patients (45%) in the younger age group
(p=0.31). 125 male (63%) and 73 female (37%) patients died (p=0.88). The least
proportion of deaths was in IHD group (2.2%) and the biggest was in CVVHDF group
(21.7%) which can partially be attributed to the amount of patients in each group and
patient's health status at the moment (p=0.007, V=0.145). The biggest proportion of
complications was in dialysis lenght >48 hrs (54.7%) (p<0.001, V=0.267). The
biggest proportion of complications was in the CVVH group (68.5%) while the IHD
group had the least proportion (13.0%).

• Keywords: akutno bubrežno zatajenje; dijaliza; starije osobe
• Keywords (english): acute kidney injury; acute renal failure; dialysis; elderly patien
• Language: croatian
• URN:NBN: urn:nbn:hr:105:698672
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-10-12 09:50:02