Características clínicas de la población con lesión renal aguda que requirió terapia de soporte renal, estudio de la sobrevida renal y propuesta de protocolo para la prevención y atención de estos pacientes
Fecha
2023-11-23
Tipo
tesis
Autores
Masís Mejía, Rodrigo Alonso
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Resumen
La presente investigación tiene como finalidad analizar las características clínicas de los pacientes con lesión renal aguda que requieren terapia de sustitución renal. Esto incluye la definición de lesión renal, las escalas disponibles para estratificar del daño renal, la fisiología y fisiopatología, así como el manejo médico y terapias de sustitución renal. Además, se realizó una revisión de la estadística local y se compararon los resultados de desenlace renal y mortalidad con lo descrito en la literatura.
Los objetivos específicos de esta investigación buscan describir los factores de riesgo de los pacientes que presentan lesión renal y que requieren diálisis aguda, analizar la mortalidad asociada a esta condición, analizar la sobrevida renal y desarrollar un protocolo de atención que permita a los médicos no especializados en nefrología prevenir, tratar y manejar pacientes con lesión renal aguda. Se desarrollaron dos flujogramas que incluyen la identificación temprana, el enfoque diagnóstico, medidas médicas generales, las recomendaciones para inicio de terapia de sustitución renal y la terapéutica recomendada durante hemodiálisis aguda y diálisis peritoneal aguda.
La metodología empleada para la investigación incluye una revisión sistemática de los artículos más relevantes, así como el análisis de resultados de estudios clínicos aleatorizados e investigaciones observacionales e intervencionales. Estos resultados se compararon con la estadística local del Hospital San Juan de Dios.
Este estudio concluye que la lesión renal aguda es una condición con alta mortalidad y describe sus principales factores de riesgo. Uno de los principales determinantes es la identificación y estratificación temprana mediante escalas validadas internacionalmente. Es fundamental comprender la fisiopatología renal con el fin de brindar medidas terapéuticas adecuadas y conocer los criterios de diálisis aguda que requieran un abordaje temprano por nefrología o cuidados intensivos.
En cuanto a la mortalidad, este estudio incluyó el periodo de la pandemia de COVID-19 y demostró un aumento tres veces mayor en la necesidad de sustitución renal. Además, se encontró que la mortalidad era comparable con lo observado en la literatura internacional.
The purpose of this research is to analyze the clinical characteristics of patients with acute kidney injury requiring renal replacement therapy through a review of national and international literature. This includes definition, available scales for stratifying renal damage, renal physiology, and pathophysiology, as well as medical management and renal replacement therapies. Furthermore, local statistics were reviewed, and the renal outcomes and mortality results were compared to those described in the literature. The specific objectives of this research seek to describe the risk factors in patients with acute kidney injury requiring acute dialysis, analyze the associated mortality, assess renal survival, and develop a care protocol that enables non-specialized physicians in nephrology to prevent, treat, and manage acute kidney injury patients. Following literature recommendations, two management flowcharts were developed for the prevention, care, and management. These flowcharts include early identification, diagnostic focus, general medical measures, recommendations for initiating renal replacement therapy, and the recommended therapy during acute hemodialysis and acute peritoneal dialysis. The research methodology employed includes a systematic review of the most relevant articles, as well as an analysis of results from randomized clinical trials and observational and interventional studies. These results were compared to the local statistics from San Juan de Dios Hospital. This study concludes that acute kidney injury is a condition with high mortality and describes its primary risk factors. One of the key determinants is early identification and stratification through internationally validated scales. A fundamental understanding of renal pathophysiology is necessary to provide appropriate therapeutic measures and to be aware of the criteria for acute dialysis that require early intervention by nephrology or intensive care. Regarding mortality, this study included the period of the COVID-19 pandemic and demonstrated a threefold increase in the need for renal replacement therapy. Furthermore, it was found that mortality was comparable to what is observed in international literature.
The purpose of this research is to analyze the clinical characteristics of patients with acute kidney injury requiring renal replacement therapy through a review of national and international literature. This includes definition, available scales for stratifying renal damage, renal physiology, and pathophysiology, as well as medical management and renal replacement therapies. Furthermore, local statistics were reviewed, and the renal outcomes and mortality results were compared to those described in the literature. The specific objectives of this research seek to describe the risk factors in patients with acute kidney injury requiring acute dialysis, analyze the associated mortality, assess renal survival, and develop a care protocol that enables non-specialized physicians in nephrology to prevent, treat, and manage acute kidney injury patients. Following literature recommendations, two management flowcharts were developed for the prevention, care, and management. These flowcharts include early identification, diagnostic focus, general medical measures, recommendations for initiating renal replacement therapy, and the recommended therapy during acute hemodialysis and acute peritoneal dialysis. The research methodology employed includes a systematic review of the most relevant articles, as well as an analysis of results from randomized clinical trials and observational and interventional studies. These results were compared to the local statistics from San Juan de Dios Hospital. This study concludes that acute kidney injury is a condition with high mortality and describes its primary risk factors. One of the key determinants is early identification and stratification through internationally validated scales. A fundamental understanding of renal pathophysiology is necessary to provide appropriate therapeutic measures and to be aware of the criteria for acute dialysis that require early intervention by nephrology or intensive care. Regarding mortality, this study included the period of the COVID-19 pandemic and demonstrated a threefold increase in the need for renal replacement therapy. Furthermore, it was found that mortality was comparable to what is observed in international literature.
Descripción
Palabras clave
lesión renal aguda, terapia de sustitución renal, factores de riesgo, mortalidad, protocolo de atención en nefrología