Risk factors associated to hospital mortality in patients with acute kidney injury on hemodialysis.

INTRODUCTION: The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. OBJECTIVES: To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients. METHODS: This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis. RESULTS: We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97). CONCLUSIONS: Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients. INTRODUCCIÓN: La incidencia de insuficiencia renal aguda a nivel mundial es 18% y la mortalidad intrahospitalaria puede alcanzar más del 50%. En Perú, existen escasos estudios acerca de la mortalidad en pacientes con insuficiencia renal aguda en hemodiálisis. OBJETIVOS: Identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda en hemodiálisis. MÉTODOS: Es una cohorte retrospectiva, en la cual se estudió a los pacientes con insuficiencia renal aguda en hemodiálisis en el Hospital Nacional Edgardo Rebagliati Martins entre enero de 2013 y diciembre de 2015. Se halló un tamaño de muestra de 154 pacientes con una potencia de 80%, y un intervalo de confianza de 95%. Se utilizaron los códigos de la Clasificación Internacional de Enfermedades-10 para identificar las historias clínicas de pacientes con insuficiencia renal aguda (N.17) y hemodiálisis (Z.49). La variable independiente fue oliguria y la variable dependiente fue mortalidad intrahospitalaria. Para el análisis multivariado, se utilizó regresión de Poisson. RESULTADOS: El universo fue de 285 pacientes. Se revisaron 212 historias clínicas y se excluyeron 44. De las 168 historias clínicas estudiadas, 129 pertenecían a pacientes vivos y 39 a fallecidos. La incidencia de mortalidad fue de 17,2%. Las principales causas de insuficiencia renal aguda en hemodiálisis fueron sepsis (39,2%) y deshidratación severa (10,8%). En el modelo ajustado, los factores de riesgo asociados a mortalidad intrahospitalaria de insuficiencia renal aguda en hemodiálisis fueron lactato (riesgo relativo 1,09), potasio (riesgo relativo 0,93), y presión arterial media (riesgo relativo 0,97). CONCLUSIONES: El lactato es un parámetro objetivo que permite predecir el pronóstico y contribuye a un mejor manejo de los pacientes con insuficiencia renal aguda en hemodiálisis.Revisión por paresRevisión por pare

Prevalencia de mortalidad intrahospitalaria en pacientes con injuria renal Aguda en hemodiálisis en Lima, Perú

TesisIntroduction: The worldwide incidence of acute kidney injury is 18% and the overall mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. Objectives: To identify the hospital mortality prevalence of acute kidney injury in hemodialysis patients. Methods: This is a cross-sectional study of patients with acute kidney injury in hemodialysis of Hospital Edgardo Rebagliati Martins gathered between January 2013 and December 2016. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). Results: There were 285 medical records. 73 of them weren’t available. 212 medical records were analyzed and 44 were excluded. 168 medical records were taken into consideration for the analysis and 59 of the alive patients whose medical records were unavailable were added only for the prevalence calculation. The overall hospital mortality prevalence found was 17.2%. The principal etiologies of acute kidney injury that required hemodialysis were sepsis (39.2%) and severe dehydration (10.8%). Conclusions: The mortality prevalence was 17.2% in patients with acute kidney injury that required hemodialysis

Misclassification of Acute Kidney Injury and Its Impact on Hospital Survival.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Cartas al editorRevisión por pare

Síndrome de shock tóxico fulminante: reporte de un caso

An 11-year-old scholar arrives in the emergency room with right-knee monoarthritis due to local trauma, fever, sensory loss, and dyspnea. He is hospitalized and receives empiric antibiotic therapy. The blood culture set is positive for Streptococcus pyogenes and the antibiotic spectrum is changed. However, the patient’s general status deteriorates, and he is admitted to the intensive care unit. Even with the treatment received, he develops septic shock and multiorganic failure, requiring hemodynamic and ventilatory support. Thirty-eight hours after his admission, the patient dies

Síndrome de shock tóxico fulminante: reporte de un caso

An 11-year-old scholar arrives in the emergency room with right-knee monoarthritis due to local trauma, fever, sensory loss, and dyspnea. He is hospitalized and receives empiric antibiotic therapy. The blood culture set is positive for Streptococcus pyogenes and the antibiotic spectrum is changed. However, the patient’s general status deteriorates, and he is admitted to the intensive care unit. Even with the treatment received, he develops septic shock and multiorganic failure, requiring hemodynamic and ventilatory support. Thirty-eight hours after his admission, the patient dies

Biodiversidad 2018. Reporte de estado y tendencias de la biodiversidad continental de Colombia

Las cifras y temáticas contenidos en el presente Reporte, aunque no son el panorama completo del estado del conocimiento de la biodiversidad en Colombia, son un compendio seleccionado de los temas que, desde el Instituto Humboldt, consideramos son relevantes y merecen ser discutidos por el público general. En muchos de los casos, las cifras no son esperanzadoras u son un llamado urgente a la acción. En otro casos son la evidencia de que se requieren acciones a nivel nacional, y más allá de esto, son muchas las iniciativas que están germinando desde los territorios, cada vez desde una mayor variedad de actores.Bogotá, D. C., Colombi