Incidencia de lesión renal aguda y el requerimiento de terapia de soporte renal en el postoperatorio de cirugía cardiovascular en una clínica de IV nivel en el periodo 2020-2023
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Fecha
2023
Autores
Ospina Herrera, Daniel
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
La lesión renal aguda (LRA) se considera un síndrome y se define como un rápido aumento de la creatinina sérica, y/o una disminución de la producción de orina (1) las principales causas son sepsis, cirugía mayor, shock cardiogénico, hipovolemia, inducido por fármacos, síndrome hepatorrenal y uropatía obstructiva. Dentro de las cirugías mayores se destaca la cirugía cardiovascular.
Objetivo: Evaluar la incidencia de lesión renal aguda y el requerimiento de terapia de soporte renal en el postoperatorio de cirugía cardiovascular en una clínica de iv nivel en el periodo 2020-2023
Metodología: Se realizó un estudio analítico, de corte transversal retrospectivo. Se describieron las variables mediante sumarios estadísticos. Se utilizó la prueba Wilcox para comparar medianas entre dos grupos. Para analizar las variables categóricas, se utilizó la prueba exacta de Fisher o el Chisq. test. Se realizó un análisis de regresión logística multivariada, ajustada por método “Backward” y OR, IC95%. Se consideró un valor de p < 0.05 para significancia estadística.
Resultados: En un estudio de 137 pacientes sometidos a cirugía cardiovascular, la mayoría masculinos con mediana de edad de 62 años, la hipertensión arterial fue la comorbilidad más frecuente (60%). Pacientes con lesión renal aguda (LRA) mostraron mayor prevalencia de diabetes tipo 2 y cirugía de Bentall. En relación con la circulación extracorpórea (BCEC) y la tasa de filtración glomerular (TFG), el 80% de los pacientes con LRA habían sido sometidos a BCEC.
Conclusión: Estos resultados subrayan la importancia de considerar la LRA y el uso de BCEC como factores críticos al evaluar el riesgo de mortalidad en pacientes sometidos a cirugía cardiovascular.
Acute kidney injury (AKI) is considered a syndrome and is defined as a rapid increase in serum creatinine and/or a decrease in urine production. The main causes include sepsis, major surgery, cardiogenic shock, hypovolemia, drug-induced, hepatorenal syndrome, and obstructive uropathy. Major cardiovascular surgery stands out among the major surgeries. Objective: To evaluate the incidence of acute kidney injury and the need for renal support therapy in the postoperative period of cardiovascular surgery at a level IV clinic from 2020 to 2023. Methodology: A retrospective analytical cross-sectional study was conducted. Variables were described using statistical summaries. The Wilcox test was used to compare medians between two groups. The Fisher's exact test or the Chi-square test was used to analyze categorical variables. Multivariate logistic regression analysis, adjusted by the "Backward" method and presented as odds ratios (OR) with a 95% confidence interval (CI), was performed. A p-value < 0.05 was considered statistically significant. Results: In a study of 137 patients undergoing cardiovascular surgery, mostly male with a median age of 62 years, arterial hypertension was the most common comorbidity (60%). Patients with acute kidney injury (AKI) showed a higher prevalence of type 2 diabetes and Bentall surgery. Regarding extracorporeal circulation (ECC) and glomerular filtration rate (GFR), 80% of AKI patients had undergone ECC. Conclusion: These results emphasize the importance of considering AKI and ECC as critical factors when assessing the risk of mortality in patients undergoing cardiovascular surgery.
Acute kidney injury (AKI) is considered a syndrome and is defined as a rapid increase in serum creatinine and/or a decrease in urine production. The main causes include sepsis, major surgery, cardiogenic shock, hypovolemia, drug-induced, hepatorenal syndrome, and obstructive uropathy. Major cardiovascular surgery stands out among the major surgeries. Objective: To evaluate the incidence of acute kidney injury and the need for renal support therapy in the postoperative period of cardiovascular surgery at a level IV clinic from 2020 to 2023. Methodology: A retrospective analytical cross-sectional study was conducted. Variables were described using statistical summaries. The Wilcox test was used to compare medians between two groups. The Fisher's exact test or the Chi-square test was used to analyze categorical variables. Multivariate logistic regression analysis, adjusted by the "Backward" method and presented as odds ratios (OR) with a 95% confidence interval (CI), was performed. A p-value < 0.05 was considered statistically significant. Results: In a study of 137 patients undergoing cardiovascular surgery, mostly male with a median age of 62 years, arterial hypertension was the most common comorbidity (60%). Patients with acute kidney injury (AKI) showed a higher prevalence of type 2 diabetes and Bentall surgery. Regarding extracorporeal circulation (ECC) and glomerular filtration rate (GFR), 80% of AKI patients had undergone ECC. Conclusion: These results emphasize the importance of considering AKI and ECC as critical factors when assessing the risk of mortality in patients undergoing cardiovascular surgery.
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Palabras clave
Lesión renal aguda, Cirugía cardiovascular, Terapia de reemplazo renal, Acute kidney injury, Cardiovascular surgery, Renal replacement therapy
