Types, Courses and Outcomes of Renal Failure in Hospitalized Patients: A Single Center Experience

Year 2019, , 218 - 222, 30.12.2019

Anıl Tombak , Ahmet Alper Kıykım , Mehmet Burak Yavuz Çimen Mehmet Ali Sungur

https://doi.org/10.18678/dtfd.531909

Abstract

Aim: The aim of this study was to determine how to eliminate the treatment uncertainties, and correct and prevent inappropriate treatment in patients with renal failure.

Material and Methods: We retrospectively evaluated the biochemistry department’s records of 438 patients with creatinine values >1.5 mg/dL that were followed-up at our hospital for the last five years. Demographics, type of renal dysfunction, related risk factors (use of nephrotoxic agents, surgical procedures, comorbidity, etc.), dialysis treatment, complications, and clinical outcome of these patients were recorded and analyzed.

Results: The most important result of the study is that the quality of the medical data recorded was very poor. The most common type of acute renal injury was prerenal acute renal injury. Among the cases, the most common etiological factors were dehydration and use of nephrotoxic agents. Surgical procedures and comorbid conditions facilitated the development of renal dysfunction, and all complications observed were more common and serious in the elderly patients. Among the patients with chronic renal injury, more of those with diabetic nephropathy required hospitalization. Interestingly, nosocomial infections were the most common cause of mortality in the patients hospitalized due to renal dysfunction.

Conclusion: Only a few medical records were suitable for retrospective evaluation. We think that if the quality of hospital data collection/storage systems could be improved, the quality of research data obtained in such studies would likewise improve and these data will bring preventive and corrective approach to mortality and morbidity.

Keywords

renal injury, morbidity, mortality

Yatan Hastalarda Böbrek Fonksiyon Bozukluğu Tipleri, Seyirleri ve Sonuçları: Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmanın amacı, böbrek hasarı olan hastalarda tedavi belirsizliklerinin nasıl giderileceğinin belirlenmesi ve tedavideki uygunsuzlukların düzeltilmesi ve önlenebilmesidir.

Gereç ve Yöntemler: Kreatinin değeri >1,5 mg/dL olan ve hastanemizde son beş yılda takip edilen 438 hastanın biyokimya anabilim dalı kayıtları geriye dönük olarak değerlendirilmiştir. Hastaların demografik özellikleri, böbrek fonksiyon bozukluğu tipleri, ilişkili risk faktörleri (nefrotoksik ajanların kullanımı, cerrahi prosedürler, komorbidite, vb.), diyaliz tedavisi, komplikasyonlar ve klinik sonuçları kayıt altına alındı ve analiz edildi.

Bulgular: Çalışmanın en önemli bulgusu, kaydedilmiş olan tıbbi verilerin kalitesinin çok düşük olmasıdır. En sık görülen akut böbrek hasarı tipi prerenal akut böbrek hasarı idi. Olgular arasında en yaygın etiyolojik faktörler dehidratasyon ve nefrotoksik ajanların kullanımı idi. Cerrahi işlemlerin ve eşlik eden hastalıkların böbrek fonksiyon bozukluğu gelişimini kolaylaştırdığı, gözlenen tüm komplikasyonların yaşlı hastalarda daha sık ve ciddi seyirli olduğu belirlendi. Kronik böbrek hasarı olan hastalar arasında, diyabetik nefropatisi olanların çoğunun hastaneye yatması gerekiyordu. İlginç olarak, böbrek fonksiyon bozukluğu ile izlenen yatan hastalarda en önemli mortalite nedeninin nozokomiyal infeksiyonlar olduğu belirlendi.

Sonuç: Retrospektif değerlendirme için sadece birkaç tıbbi kayıt uygundu. Hastane veri toplama/depolama sistemlerinin kalitesinin iyileştirilebilmesi durumunda, bu tür çalışmalarda elde edilen araştırma verilerinin kalitesinin de aynı şekilde gelişeceğini ve bu verilerin mortalite ve morbidite konusunda önleyici ve düzeltici bir yaklaşım getirmeyi kolaylaştıracağını düşünmekteyiz.

Keywords

böbrek hasarı, morbidite, mortalite

References

• Prescott GJ, Metcalfe W, Baharani J, Khan IH, Simpson K, Smith WC, et al. A prospective national study of acute renal failure treated with RRT: incidence, aetiology and outcomes. Nephrol Dial Transplant. 2007;22(9):2513-9.
• Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43-51.
• Imai E, Yamagata K, Iseki K, Iso H, Horio M, Mkino H, et al. Kidney disease screening program in Japan: history, outcome, and perspectives. Clin J Am Soc Nephrol. 2007;2(6):1360-6.
• Yeğenağa I. Acute renal injury in intensive care patients. Turkiye Klinikleri J Nephrol-Special Topics. 2014;7(1):31-6.
• Hilton R. Acute renal failure. BMJ. 2006;333(7572):786-90.
• Erek E, Sever MS, Akoglu E, Sariyar M, Bozfakioglu S, Apaydin S, et al. Cost of renal replacement therapy in Turkey. Nephrology (Carlton). 2004;9(1):33-8.
• Girndt M, Trocchi P, Scheidt-Nave C, Markau S, Stang A. The prevalence of renal failure. Results from the German Health Interview and Examination Survey for Adults, 2008-2011 (DEGS1). Dtsch Arztebl Int. 2016;113(6):85-91.
• Bagshaw SM, Culleton BF. Contrast-induced nephropathy: epidemiology and prevention. Minerva Cardioangiol. 2006;54(1):109-29.
• Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality. A prospective multicenter study. French Study Group of Acute Renal Failure. Crit Care Med. 1996;24(2):192-8.
• Baraldi A, Ballestri M, Rapanà R, Lucchi L, Borella P, Leonelli M, et al. Acute renal failure of medical type in an elderly population. Nephrol Dial Transplant. 1998;13(Suppl 7):25-9.
• Bagshaw SM, Bellomo R. Acute renal failure. Surgery (Oxford). 2007;25(9):391-8.
• Khan IH, Catto GR, Edward N, Macleod AM. Acute renal failure: factors influencing nephrology referral and outcome. QJM. 1997;90(12):781-5.
• Roderick P, Jones C, Drey N, Blakeley S, Webster P, Goddard J, et al. Late referral for end-stage renal disease: a region-wide survey in the south west of England. Nephrol Dial Transplant. 2002;17(7):1252-9.
• Levin A. Consequences of late referral on patient outcomes. Nephrol Dial Transplant. 2000;15(Suppl 3):8-13.
• Feest T. Epidemiology and causes of chronic renal failure. Medicine. 2007;35(8):438-41.
• Parmar MS. Chronic renal disease. BMJ. 2002;325(7355):85-90.
• Fu H, Liu S, Bastacky SI, Wang X, Tian XJ, Zhou D. Diabetic kidney diseases revisited: A new perspective for a new era. Mol Metab. 2019;30:250-63.
• Cimochowski GE, Worley E, Rutherford WE, Sartain J, Blondin J, Harter H. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron. 1990;54(2):154-61.
• Lindeman RD, Goldman R. Anatomic and physiologic age changes in the kidney. Exp Gerontol. 1986;21(4-5):379-406.
• Chonchol M. Neutrophil dysfunction and infection risk in end-stage renal disease. Semin Dial. 2006;19(4):291-6.
• Özdemir O, Süleymanlar G. National program for prevention of renal insufficiency: evaluation of the effectiveness of training of the physicians and development of follow-up and registry system based on risk factors for the prevention of renal insufficiency in Turkey. Turkiye Klinikleri J Int Med Sci. 2007;3(38):100-9.