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    Infecção de trato urinário em pacientes com doença renal crônica em tratamento conservador
    (Universidade Federal de São Paulo (UNIFESP), 2020-08-27) Moraes, Graciana Maria De [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo
    Introduction: After the increase of Brazilians’ life expectancy in the last decades, we have also seen an increase in the incidence and prevalence of chronic diseases like blood hypertension and diabetes, which are considered the main causes of kidney failure. This may result in end-stage renal disease with a burden for the patient, family, and society. The identification of risk factors for urinary infections in this population may decrease or reverse the kidney disease progression, besides preventing the need of renal replacement therapy. Objective: To assess the prevalence and risk factors for urinary tract infection in chronic kidney disease patients on conservative treatment. Method: This is a cross-sectional analytical study carried out in the Ambulatory of Conservative Treatment of Hospital do Rim e Hipertensão from Universidade Federal de São Paulo. We analyzed the registrations of medical records from patients aged ≥18 years, with urine culture tests collected (n=1,555) between 2010 and 2018. A total of 343 (22%) urine culture tests had a positive result, which was considered the first positive result (n=134) to form the study. We studied sociodemographic and clinical variables, comorbidities, and presence or not of urinary tract infection. Risk factors were identified by comparing patients with and without infection to the same inclusion criteria for the study. We applied the logistic regression model to identify the risk factors for urinary tract infection occurrence in the study population. A 5% significance level was considered. Results: The urinary tract infection prevalence in the population was 22%. The Infection Group included 134 patients and the Non-Infection Group had 81 subjects. The Infection Group had a higher presence of female patients that concluded Elementary School and patients that ended High and Higher Schools had a lower percentage in this group. Patients from the Infection Group were older than those without the infection. Diabetics and hypertensive patients with heart disease and other medical history were more prevalent in the Infection Group. In addition, Infection Group patients presented higher body mass index compared to those of the Non-Infection Group. The mean values of urea, creatinine and creatinine clearance were significantly higher in the Infection Group. Most of the patients on conservative treatment was classified in stages 3, 4 and 5 of kidney disease, and the most frequent microorganisms in cultures were Escherichia coli (50.7%), Klebsiella pneumoniae (23.1%), and Enterococcus spp (9,7%) – E. coli and K. pneumoniae were mostly resistant. In the multiple logistic regression model, the variables that best explained the occurrence of urinary tract infection in patients with chronic kidney disease on conservative treatment were advanced age, presence of other medical history, and increase of urea and creatinine values. Conclusion: The prevalence of urinary tract infection in patients with kidney disease on conservative treatment was high. The identified risk factors were age, presence of personal history, and urea and creatinine values.