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Influencia de la enfermedad coexistente en la supervivencia en la terapia de reemplazo renal
Lancet (London, England)
|February 13, 1993
Resumen
La supervivencia de los pacientes en terapia de reemplazo renal (TRR) no está mejorando. La estratificación del riesgo por comorbilidad y edad tiene un impacto significativo en los resultados de los pacientes con RRT, destacando la necesidad de estrategias de tratamiento personalizadas.
Área de la Ciencia:
- Nefrología Nefrología.
- Epidemiología Clínica Epidemiología clínica.
- Medicina Geriátrica La medicina geriátrica es una especialidad de la medicina geriátrica.
Sus antecedentes:
- Las tasas de supervivencia de los pacientes en terapia de reemplazo renal (TRR) se han estancado.
- Cada vez más, los pacientes de RRT son ancianos con múltiples problemas de salud no relacionados con los riñones (comorbilidades).
Objetivo del estudio:
- Para analizar las tendencias de supervivencia en pacientes que inician RRT.
- Estratificar a los pacientes en grupos de riesgo basados en la edad y la comorbilidad.
- Para comparar las tasas de supervivencia entre diferentes grupos de riesgo y centros geográficos.
Principales métodos:
- Un estudio retrospectivo de 375 pacientes que comenzaron RRT durante 6.5 años en Aberdeen y Dundee, Reino Unido.
- Los pacientes se estratificaron en grupos de bajo, mediano y alto riesgo en función de la comorbilidad y la edad.
- Se calculó la supervivencia actuarial, con análisis realizados tanto incluyendo como excluyendo muertes prematuras (dentro de los 90 días).
Principales resultados:
- Se observaron diferencias significativas en la supervivencia a 2 años entre los grupos de riesgo (bajo: 86-90%, medio: 60-70%, alto: 35-46%).
- Las tasas generales de supervivencia fueron del 61% (Aberdeen) y del 68% (Dundee), pero convergieron al 73% y al 74% respectivamente después de excluir las muertes prematuras.
- La RRT demostró un alto éxito (86% de supervivencia a 2 años) en pacientes de bajo riesgo (menores de 70 años, sin comorbilidades).
Conclusiones:
- La terapia de reemplazo renal es altamente efectiva para pacientes de bajo riesgo.
- Las comorbilidades no renales influyen significativamente en la supervivencia de los pacientes sometidos a RRT.
- La estratificación del riesgo y el análisis cuidadoso de las muertes prematuras son cruciales para las comparaciones válidas entre los centros de RRT.
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