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Previous issue date: 2012-06-22 / Introduction: Peritoneal dialysis ultrafiltration failure is a functional abnormality associated with increased risk of death and technique failure. Daily ultrafiltration volume early on therapy may predict patient and technique survival. Objective: to determine the relationship between to presence of risk factors, daily ultrafiltration volume, patient and technique survival. Patients and Method: Data were extracted from the observational, multicenter, BRAZPD cohort study. From a population of 2419 suitable patients, 977 incident patients were selected. At the three-month therapy interval, demographic, clinical and technical variables were appraised and daily ultrafiltration volume was analyzed by quartiles (1st: ≤ 700 ml; 2nd: > 700 ml up to ≤ 1100 ml; 3rd: > 1100 ml up to < 1600 ml; 4th: ≥ 1600 ml), as were its changes at the sixth and twelfth follow-up months. Two outcomes were considered : death and technique failure, which were analyzed till the 30th therapy month. Comparison between groups, correlations, patient and technique uni and multivariate survival analyses, using Kaplan-Meier technique and Cox regression analysis, were performed. Results: Age (HR=1.038; 95% CI: 1.027-1.049; P<0.01), diabetes (HR=1.416; 95% CI: 1.043-1.922; P=0.03) and number of co-morbidities (HR=2.687; 95% CI: 1.336-5.407; P<0,01) were directly associated with increased patient mortality. The 4th ultrafiltration quartile related with higher patient and technique survival (P=0.02 and P=0.10, respectively); peritonitis had a strong negative effect upon therapy maintenance (HR=3.459; 95% CI: 2.218-5.394; P<0.01). Conclusion: young, non-diabetic patients had increased chance for survival. High ultrafiltration volumes promoted patient and technique survival. Peritonitis significantly reduced the likelihood of technical success. / Introdu??o: A falha de ultrafiltra??o na di?lise peritoneal ? uma anormalidade funcional associada a risco aumentado para morte e para falha t?cnica. O volume di?rio de ultrafiltra??o, aos tr?s meses de terapia, pode ser fator de risco e preditor precoce para sobrevida de paciente e t?cnica. Objetivo: determinar a rela??o entre a presen?a de fatores de risco, volume di?rio ultrafiltrado e sobrevida de paciente e terapia. Pacientes e M?todo: estudo de coorte baseado em dados do estudo BRAZPD, multic?ntrico, observacional. Foram inclu?dos 977 pacientes incidentes, dentre 2419 eleg?veis. Aos tr?s meses de terapia analisaram-se vari?veis demogr?ficas, cl?nicas e t?cnicas. O volume di?rio de ultrafiltra??o foi analisado por quartis, (1? quartil: ≤ 700 ml; 2? quartil: > 700 ml e ≤ 1100 ml; 3? quartil: > 1100 ml e < 1600 ml; 4? quartil: ≥ 1600 ml, assim como sua varia??o aos seis e doze meses de seguimento. Dois desfechos foram contemplados: morte e falha t?cnica, analisados at? 30 meses de terapia. Compara??es entre grupos, correla??es bem como an?lise univariada de sobrevida - de paciente e t?cnica - foi feita pela t?cnica de Kaplan-Meier e multivariada por regress?o de Cox. Resultados: idade (HR=1,038; IC 95%: 1,027-1,049; P<0,001), Diabetes Mellitus (HR=1,416; IC 95%: 1,043-1,922; P<0,026) e n?mero de comorbidades (HR=2,687; IC 95% -1,336-5,407; P<0,01) foram diretamente associados com mortalidade aumentada do paciente. O quarto quartil de ultrafiltra??o associou-se a maior sobrevida do paciente e da t?cnica (P=0,02 e P=0,10, respectivamente); a ocorr?ncia de peritonite teve impacto negativo para manuten??o da terapia (HR=3,459; IC 95%: 2,218-5,394; P<0,01). Conclus?o: pacientes jovens, sem diabetes tiveram maior chance de sobrevida. Ter alto volume de ultrafiltra??o foi favor?vel ? sobrevida de pacientes e da t?cnica. A ocorr?ncia de peritonite reduziu significativamente a chance de sucesso da t?cnica.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1700 |
| Date | 22 June 2012 |
| Creators | Marian, Maria Vianei |
| Contributors | D'avila, Domingos Otavio Lorenzoni |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, BR, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 500, 600, -8624664729441623247 |
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