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Vol. 34. Núm. 1.Enero 2014
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Vol. 34. Núm. 1.Enero 2014
Páginas 0-138
DOI: 10.3265/Nefrologia.pre2013.Oct.11957
Acceso a texto completo
Tasa de filtrado glomerular inicial y supervivencia en hemodiálisis. El papel del acceso vascular permanente
Initial Glomerular Filtration Rate and Survival in Hemodialysis. The role of permanent vascular access
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7529
Sergio Marinovicha, Jaime Pérez-Loredob, Carlos Lavoratoa, Guillermo Rosa-Díeza, Liliana Bisignianoc, Víctor Fernándezc, Daniela Hansen-Kroghd
a Comit?? de Estad??sticas y Registros, Sociedad Argentina de Nefrolog??a, Ciudad Aut??noma de Buenos Aires, Argentina,
b C??tedra de Nefrolog??a, Universidad Cat??lica Argentina, Ciudad Aut??noma de Buenos Aires, Argentina,
c Comisi??n Cient??fico T??cnica, Instituto Central ??nico Coordinador de Ablaci??n e Implante, Ciudad Aut??noma de Buenos Aires, Argentina,
d Departamento de Inform??tica, Instituto Central ??nico Coordinador de Ablaci??n e Implante, Ciudad Aut??noma de Buenos Aires, Argentina,
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Información del artículo

Antecedentes: Entre 2004 y 2009, se observó en Argentina un aumento significativo del número de pacientes que iniciaban un tratamiento crónico de hemodiálisis (HD) con una tasa de filtrado glomerular estimada (TFGe) ≥ 10 ml/min/1,73 m2. Métodos: Para su estudio, calculamos las razones de riesgo (RR) de mortalidad en una cohorte de individuos incidentes en HD del Registro Argentino de Diálisis Crónica (2004-2009), que se agrupó, en función de la TFG inicial estimada por CKD-EPI (0-4,9; 5-9,9; 10-14,9; y ≥ 15 ml/min/1,73 m2, siendo 0-4,9 el grupo de referencia), en tres cohortes: «población total», «cohorte sana» (< 65 años sin diabetes ni ningún tipo de comorbilidad) y «cohorte con entrada prevista» (con acceso vascular permanente). Resultados: Tras ajustar los datos de la población (n = 16 931) en función de la edad, el sexo, las enfermedades coexistentes, la albúmina sérica, los ingresos y la existencia de un acceso vascular temporal, se observó una RR de 1,19 (95 % IC: 1,07-1,33) en el grupo con una TFGe ≥ 15 ml/min/1,73 m2. En la cohorte formada por 3897 individuos «sanos», se obtuvieron, tras ajustar las mismas covariables, unas RR de 1,44 (95 % IC: 1,08-1,65) y 1,65 (95 % IC: 1,06-2,55) para los grupos con TFGe iniciales de 10-14,9 y ≥ 15 ml/min/1,73 m2, respectivamente. En los pacientes con «entrada prevista» (n = 6280), tras ajustar los resultados en función de la edad, el sexo, la comorbilidad, el nivel de albúmina sérica y los ingresos, las RR de todos los grupos no difirieron significativamente de las del grupo de control. Conclusiones: Iniciar el tratamiento de HD con una TFGe > 10 ml/min/1,73 m2 no revela ninguna ventaja de supervivencia. La mayor mortalidad del grupo con mayor TFGe que inicia la diálisis es un «artefacto» que está relacionado con una mayor edad, la existencia de más comorbilidades, la hipoalbuminemia y el uso de accesos vasculares temporales.

Palabras clave:
Acceso vascular
Palabras clave:
Sobrevida
Palabras clave:
Hemodiálisis
Palabras clave:
Tasa de filtración glomerular
Palabras clave:
Enfermedad renal crónica terminal
Palabras clave:
Epidemiología

Background: A significant increase in the number of patients starting chronic hemodialysis (HD) with an estimated glomerular filtration rate (eGFR)≥10mL/min/1.73m2 was observed in Argentina between 2004 and 2009. Methods: In order to study this topic, we calculated the mortality hazard ratios (HR) in a cohort of incident HD individuals from the Argentine Registry of Chronic Dialysis [Registro Argentino de Diálisis Crónica] (2004-2009), grouped according to the initial eGFR (0-4.9, 5-9.9, 10-14.9 and ≥15mL/min/1.73m2 ; reference group 0-4.9) estimated by CKD-EPI; in three cohorts: “total population”, “healthy (<65 years, without diabetes or comorbidities) and “planned entry” (with permanent vascular access). Results: After adjusting the population (n=16,931) for age, gender, coexisting conditions, serum albumin, income, and temporary vascular access a HR of 1.19 (95%CI:1.07-1.33) was observed in the group with eGFR≥15mL/min/1.73m2. In the cohort of 3,897 “healthy” after adjusting for the same co-variates, HRs of 1.44 (95%CI: 1.08-1.65) and 1.65 (95%CI: 1.06-2.55) were obtained for the groups with baseline eGFR values of 10-14.9 and ≥15mL/min/1.73m2, respectively. In “planned entry” patients (n=6,280), after adjusting for age, gender, co-morbidities, serum albumin and income, HRs in all groups were not significantly different as compared to the control group. Conclusions: HD initiation with eGFR>10mL/min/1.73m2 shows no survival advantage. The higher mortality in the group with >eGFR starting dialysis looks like an “artifact” related to higher age, more co-morbidities, low albuminemia and the use of temporary vascular access.

Keywords:
Vascular access
Keywords:
Survival
Keywords:
Hemodialysis
Keywords:
Glomerular filtration rate
Keywords:
End-stage renal diseases
Keywords:
Clinical epidemiology
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