Yoğun Bakım Hastalarında Akut Böbrek Hasarı ve Mortalite İlişkisinin Belirlenmesinde RIFLE, AKIN ve KDIGO Kriterlerinin Yeri

Amaç: Akut böbrek hasarının (ABH) daha kesin biçimde tanımlanması ve takip sürecinin daha iyi yönetilmesi amacıyla çok sayıda sınıflama gündeme gelmiştir. Bunlar arasında en yaygın kabul görenler risk, injury, failure, loss, and end stage (RIFLE), acut kidney injury network (AKIN) ve kidney disease: Improving global outcomes (KDIGO) sınıflamaları olmuştur. Bu çalışmada, yoğun bakımda izlenen ve ABH tanısı alan hastalarda RIFLE, AKIN ve KDIGO kriterlerine göre ABH şiddeti ile mortalite arasındaki ilişkinin saptanması amaçlanmıştır. Gereç ve Yöntem: Dahiliye yoğun bakım ünitesinde izlenen 1.491 hastaya ait veriler retrospektif olarak incelendi ve ABH saptanan hastalar çalışmaya dahil edildi. Tüm hastalar için RIFLE, AKIN ve KDIGO kriterlerine kullanılarak ABH şiddeti belirlendi. Bulgular: Çalışmaya 155 hasta dahil edildi. RIFLE kriterlerine göre risk, hasar, yetmezlik evrelerinde yer alan hasta oranları sırasıyla; %14,8, %40,0, %45,2; AKIN kriterlerine göre evre 1, evre 2 ve evre 3’te yer alan hasta oranları sırasıyla; %45,6, %30,6, %23,8; KDIGO kriterlerine göre evre 1, evre 2 ve evre 3’te yer alan hasta oranları sırasıyla; %18,7, %21,7, %54,1 idi. AKIN ve RIFLE kriterlerine göre belirlenen ABH evreleri arasında mortalite oranları açısından farklılık saptanmazken, KDIGO evre 3’te yer alan hastalarda evre 1 ve evre 2 ABH gruplarına göre mortalite daha yüksek saptandı. Sonuç: Her üç tanı ve evreleme sistemi de ABH etiyolojisini dikkate almamaktadır. Bu nedenle mortalite ve ABH şiddeti arasındaki ilişkiyi doğru yansıtmamaları söz konusu olabilir. Bununla birlikte, kendisinden önce kullanılan evreleme sistemlerindeki eksikliklerden doğan ihtiyaçla ortaya çıkan KDIGO evreleme sistemi bu açıdan daha geçerli görünmektedir

Comparison of two different Kt/V methods in continuous ambulatory peritoneal dialysis patients

Dialysis adequacy has gained particular interest for the assessment of the quality of dialysis in patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Kt/V is used as a test of dialysis adequacy in HD and CAPD patients. The aim of this study was to compare two different Kt/V methods in CAPD patients. A practical method for the calculation of Kt/V will be suggested at the end of this prospective study. The study group included 28 patients. Each patient received CAPD therapy four times per day. During the study, CAPD dialysate samples for a period of 24 hours were obtained by two different methods. One is a modified method for obtaining samples by the patient at home; the other is the conventional method. For study purposes only, we told the patients using the modified method to bring all the bags to the center (contrary to the aim of the modified method). In the first method (modified method), CAPD patients collected 24-hour dialysate and urine samples at home and brought all of the materials to the hospital. A 10 mm3 dialysate sample was drawn from each CAPD dialysate bag, and then a total of 40 mm3 dialysate was mixed in a beaker. A sample of 10 mm3 of dialysate was taken from the mixture in the beaker, and then this dialysate sample, urine, and 5 mm3 venous blood were sent to the laboratory for urea nitrogen (UN) and creatinine level determinations. In addition to these tests, 24-hour dialysate and urine volumes and the patients' weight and height were measured, and Kt/V values were calculated. In the second method (classic method), all the bags from the 24-hour period were collected and mixed in a big bucket, and then a 10 mm3 sample was taken. The remaining procedures were the same as for the first method. Mean Kt/V values were calculated separately for the two methods and were found to be 2.48 by the modified method and 2.52 by the classic method. The results of the two methods were compared with the Wilcoxon paired t-test, which showed no statistically significant difference (p = 0.5228). In conclusion, two different Kt/V methods can be used in CAPD patients. However, the modified method is easily performed, and CAPD patients can collect and take the dialysate and urine samples at home, and bring these materials to the renal unit without transportation problems

Comparison of Hospitalization and Survival Between Patients Treated With Renal Replacement Therapy

AMAÇ: Böbrek yerine koyma tedavisi son dönem böbrek yetmezliği (SDBY) hastalarında yaşam süresini uzatmaktadır. Biz bu çalışmada, SDBY hastalarında böbrek yerine koyma tedavisi sağkalım, hastaneye yatış sıklığı ve hastanede kalış süresi üzerine olan etkilerini karşılaştırmayı amaçladık. GEREÇ ve YÖNTEMLER: İki yüz seksen yedi (87 hemodiyaliz (HD), 97 periton diyalizi (PD), 103 böbrek nakli (BN)) hastası çalışmaya alındı. Hasta verileri geriye dönük olarak hasta dosyalarından kaydedildi. BULGULAR: Hemodiyaliz hastalarının PD ve BN hastalarına oranla daha yaşlı ve daha fazla yandaş hastalığa sahip oldukları görüldü. Her 3 grupta mortalite oranları bakımından farklılık saptanmadı. PD grubunda hastaneye yatış sıklığı ve hastanede kalış süresi diğer iki gruba oranla daha düşüktü. 1, 5, 10 yıllık hasta sağ kalımları HD grubunda %84, %55, %30 iken, PD grubunda %93, %81, %59, BN grubunda ise %95, %81 ve %77 olarak bulundu. SONUÇ: PD ve RT hastaları HD hastalarına oranla daha genç, HD hastaları daha fazla ek hastalığa sahip, PD hastalarında hastaneye yatış oranı daha az iken en iyi hasta sağ kalımı ise BN grubundadır.AIM: Renal replacement therapy (RRT) prolongs survival in patients with end-stage-renal-disease (ESRD). We compared patient survival, number and duration of hospitalization in patients treated with RRT in this study. MATERIAL and METHODS: Two hundred and eighty seven patients (87 hemodialysis (HD), 97 peritoneal dialysis (PD), 103 renal transplant (RT) patients) were enrolled in this study. Patients' data were collected retrospectively from hospital records. RESULTS: HD patients were older and had more comorbid diseases compared to PD and RT patients. Mortality rates were not different between the modalitites. the number and duration of hospitalization episodes were significantly lower in the PD group than that of the other two groups. Survival rates of HD patients were 84%, 55% and 30% for the 1st, 5th and 10th years, respectively while these rates were 93%, 81% and 59% for PD and 95%, 81% and 77% for RT patients. CONCLUSION: PD and RT patients were younger than HD patients and had less comorbid diseases. As a result, the number and duration of hospitalization episodes were significantly lower in the PD group when compared to the others. Survival rates in the RT group were better than that of the HD and PD groups

Comparison of hospitalization and survival between patients treated with renal replacement therapy

AIM: Renal replacement therapy (RRT) prolongs survival in patients with end-stage-renal-disease (ESRD). We compared patient survival, number and duration of hospitalization in patients treated with RRT in this study. MATERIAL and METHODS: Two hundred and eighty seven patients (87 hemodialysis (HD), 97 peritoneal dialysis (PD), 103 renal transplant (RT) patients) were enrolled in this study. Patients' data were collected retrospectively from hospital records. RESULTS: HD patients were older and had more comorbid diseases compared to PD and RT patients. Mortality rates were not different between the modalitites. The number and duration of hospitalization episodes were significantly lower in the PD group than that of the other two groups. Survival rates of HD patients were 84%, 55% and 30% for the 1 st, 5 th and 10 th years, respectively while these rates were 93%, 81% and 59% for PD and 95%, 81% and 77% for RT patients. CONCLUSION: PD and RT patients were younger than HD patients and had less comorbid diseases. As a result, the number and duration of hospitalization episodes were significantly lower in the PD group when compared to the others. Survival rates in the RT group were better than that of the HD and PD groups