Impactos clínicos e fatores prognósticos em pacientes com doença renal crônica em hemodiálise: uma análise retrospectiva

Abstract

Introdução: A doença renal crônica (DRC) afeta milhões de brasileiros, sendo a hemodiálise a principal modalidade da terapia renal substitutiva. Este estudo descreveu desfechos clínicos em pacientes com DRC em hemodiálise e a associação entre óbitos e as variáveis sociodemográficas e clínicas. Metodologia: Estudo de coorte retrospectiva, com análise de prontuários físicos de pacientes em hemodiálise entre 2022 e 2024 no Hospital Regional de Araranguá (SC, Brasil). Resultados: A amostra foi composta por 143 pacientes, majoritariamente brancos (63,64%), do sexo masculino (63,03%) e com idade igual ou superior a 60 anos (52,45%). A maioria residia fora de Araranguá (55,24%) e estava em tratamento há um e três anos (47,55%). As principais doenças de base foram hipertensão arterial sistêmica (HAS, 71,33%) e diabetes mellitus (DM, 33,26%), que também se destacaram como comorbidades frequentes (54,44% possuindo duas a três). Complicações foram comuns (61,54% apresentaram duas a três), sendo a anemia a mais prevalente (84,4%). O desfecho mais frequente foi o óbito (41,96%), seguido da manutenção do tratamento (28,67%). Idade, tempo de hemodiálise e hiperparatireoidismo apresentaram associação estatística significativa com o óbito (p < 0,05, especialmente em pacientes com 60 anos ou mais (58,67% dos óbitos), com mais de quatro anos de tratamento (54,17%) e com diagnóstico de hiperparatireoidismo (31,03%). Conclusão: O óbito foi o desfecho mais prevalente, principalmente entre idosos e em tratamentos prolongados. Comorbidades como HAS, DM e Insuficiência Cardíaca Congestiva foram frequentes, assim como a anemia e o hiperparatireoidismo. Os resultados deste estudo reforçam a importância da atenção primária na prevenção e manejo precoce da DRC.

Introduction: Chronic kidney disease (CKD) affects millions of Brazilians, with hemodialysis being the main modality of renal replacement therapy. This study described clinical outcomes in patients with CKD undergoing hemodialysis and the association between deaths and sociodemographic and clinical variables. Methodology: This is a retrospective cohort study based on the analysis of physical medical records of patients on hemodialysis between 2022 and 2024 at the Regional Hospital of Araranguá (SC, Brazil). Results: The sample included 143 patients, mostly white (63%), male (63%), and aged 60 years or older (52%). Most lived outside Araranguá (55%) and had been undergoing treatment for one to three years (47%). The main underlying diseases were systemic arterial hypertension (SAH, 71%) and diabetes mellitus (DM, 33%), which also stood out as frequent comorbidities. More than half (54%) had two to three comorbidities. Complications were common (61% with two to three), with anemia being the most prevalent (84%). The most frequent outcome was death (41%), followed by continuation of treatment (28%). Age and duration of hemodialysis showed significant statistical association with death (p < 0.001), especially among patients aged 60 or older (58% of deaths) and those undergoing treatment for more than four years (54%). Conclusion: Death was the most prevalent outcome, particularly among elderly patients and those in prolonged therapy. Comorbidities such as SAH, DM, and CHF were frequent, as well as complications like anemia and hyperparathyroidism. The findings reinforce the importance of primary care in the prevention and early management of CKD.Chronic kidney disease (CKD) affects millions of Brazilians, with hemodialysis being the main modality of renal replacement therapy. This study analyzed clinical outcomes in CKD patients undergoing hemodialysis, relating them to sociodemographic and clinical variables. Methodology: This is a retrospective cohort study based on the analysis of physical medical records of patients on hemodialysis between 2022 and 2024 at the Regional Hospital of Araranguá (SC, Brazil). Results: The sample consisted of 143 patients, mostly white (63,64%), male (63,03%), and aged 60 years or older (52,45%). The majority lived outside Araranguá (55,24%) and had been undergoing treatment for one to three years (47,55%). The main underlying diseases were systemic arterial hypertension (SAH, 71,33%) and diabetes mellitus (DM, 33,26%), which were also common comorbidities (54,44% had two to three). Complications were frequent (61,54% presented two to three), with anemia being the most prevalent (84,4%). The most frequent outcome was death (41,96%), followed by continued treatment (28,67%). Age, hemodialysis duration, and hyperparathyroidism showed a statistically significant association with death (p < 0,05), especially in patients aged 60 or older (58,67% of deaths), with more than four years of treatment (54,17%), and diagnosed with hyperparathyroidism (31,03%). Conclusion: Death was the most prevalent outcome, particularly among elderly patients and those in prolonged therapy. Comorbidities such as SAH, DM, and Congestive Heart Failure were frequent, as well as complications like anemia and hyperparathyroidism. The findings reinforce the importance of primary care in the prevention and early management of CKD.