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2019, Número 1

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RCAN 2019; 29 (1)


Predictores bioquímicos de la Gran Crisis Ateroesclerótica en nefrópatas crónicos sujetos a hemodiálisis iterada

Dalas GM, Alonso RC, Torres MR, Fernández UY, Calvo MMM, Sanz GDM

Idioma: Español
Referencias bibliográficas: 100
Paginas: 128-149
Archivo PDF: 831.47 Kb.


RESUMEN

Introducción: El nefrópata crónico está en riesgo incrementado de sufrir alguna de las manifestaciones de la gran crisis ateroesclerótica (GCA). A ello contribuye la acidosis metabólica , la inflamación, la endotelitis sistémica y la ateroesclerosis. La inflamación puede ser reconoc ida mediante predictores bioquímicos selectos. Objetivo: Establecer las asociaciones entre la GCA y predictores bioquímicos selec t os de inflamación en nefrópatas sujetos a hemodiálisis ( HD iterada. Diseño del estudio: Prospectivo, longitudinal, analítico. Los nefrópatas en HD iterada fueron seguidos durante 12 meses para registrar la ocurrencia de alguno de los eventos comprendidos dentro de la GCA. Locación del estudio Programa de Hemodiálisis, Servicio de Nefrologí a, Hospital Clínico quirúrgico “Hermanos Ameijeiras” (La Habana, Cuba). Serie de estudio: Sesenta y uno pacientes Hombres : 39.3%; Edades ≥ 60 años : 42.6%; Fístula arterio venosa : 68.9%; Tiempo de permanencia en HD : 3.7 ± 4.3 años ; Escala de Karnofsky : Sin limitaciones para el desempeño cotidiano: 62.3% atendidos en el programa hospitalario de HD . El 36.1% de los nefrópatas refirió antecedentes de enfermedad cardiovascular (ECV) a l a inclusión en el estudio La hipertrofia ventricular izquierda (HVI) estaba presente en el 43.1% de ellos. Métodos: Se examinaron la naturaleza y la fuerza de la asociación entre la condición del paciente al cierre de la ventana de observación y las concentraciones séricas iniciales de h emoglobina (g.L -1 ), eritrosedimentación (m m.hora -1 ), proteínas totales (g.L -1 ), albúmina (g.L -1), c olesterol total (mmol.L -1 ), triglicéridos (mmol.L -1 ), proteína C reactiva (mg.dL -1), y fibrinógeno (ng.L -1 mediante el cálculo del riesgo relativo (RR). Resultados: La tasa de mortalidad por todas las causas fue del 34.4%. La mortalidad tras 12 meses de seguimiento fue dependiente de los antecedentes personales de ECV (RR = 1.94); las alteraciones electrocardiográficas (RR = 1.89) y ecocardiográficas (RR = 1.15); una VSG acelerada (RR = 1. 55); una PCR aumentada (RR = 1.55); la presencia de anemia (RR = 1.54); y la hipertrigliceridemia (RR = 1.59). Un puntaje disminuido en la escala de Karnofsky (RR = 2.08) también señaló a los nefrópatas en riesgo incrementado de fallecer durante la etapa d e observación. La maquinaria logística no encontró predictores independientes de la mortalidad a los 12 meses. La edad del paciente y la escala de Karnofsky se asociaron con varios de los predictores propuestos de la GCA. Conclusiones: La edad del paciente y la escala de Karnofsky pueden componer una parte importante de la influencia de los predictores bioquímicos de la GCA. Dalas Guibert M , Alonso Rodríguez C, Torres Martínez R, Fernández Uriarte Y, Calvo Montes MM, Sanz Guzmán DM . Pred ictores bioquímicos de la Gran Crisis Ateroesclerótica en nefrópatas crónicos sujetos a hemodiálisis iterada. RCAN Rev Cubana Aliment Nutr 2019;29(1): 1 28 1 4 9 RNPS: 2221. ISSN: 1561 2929.


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