Marcadores renais na doença renal diabética em pacientes adultos e idosos
Data
2024-01-08
Autores
Fabre, Larissa 
Orientadores
Rangel, Érika Bevilaqua
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Diminuição da taxa de filtração glomerular e albuminúria são marcadores do diagnóstico e progressão da doença renal diabética (DRD). Objetivo: Essa pesquisa objetivou avaliar a evolução desses marcadores em faixas etárias diferentes e identificar os preditores positivos de declínio da taxa de filtração glomerular estimada (TFGe), variação da albuminúria, mortalidade e progressão para terapia renal substitutiva (TRS). Pacientes e Métodos: Realizamos um estudo de coorte retrospectiva que avaliou pacientes diabéticos tipo 2 (DM2) de duas diferentes faixas etárias: < 75 anos e ≥ 75 anos de idade. Ao longo de um seguimento ambulatorial de três anos, avaliamos a TFGe e a albuminúria de 24h. Análises uni e multivariadas foram realizadas a fim de identificar os fatores associados a piora funcional renal e mortalidade. Curvas de sobrevida renal e global foram construídas utilizando o método de Kaplan-Meier. Valores de P <0,05 foram considerados significantes. Resultados: Analisamos 304 pacientes, com uma média de idade de 64,1 ± 9,2 anos, sendo que 55,3% eram do sexo masculino, 45,4% estavam em uso inibidores da enzima conversora de angiotensina (IECA) e 43,9% em uso de bloqueadores do receptor de angiotensina (BRA). Observamos uma queda similar da TFGe, em ml/min/1,73 m², do 1º para o 2º ano (-4,6 [-11,5; 1,1] no grupo dos pacientes com < 75 anos vs. -3,7 [-8,6; 1,9] no grupo com idade ≥ 75 anos, p = 0,329) e do 2º para o 3º ano (-3,1 [-7,7; 2,0] no grupo com < 75 anos de idade vs. -0,8 [-5,0; 1,5] no grupo dos pacientes com idade ≥ 75 anos, p = 0,353). Quanto ao aumento da albuminúria, do 1º para o 2º ano, ocorreu com mais frequência no grupo dos indivíduos ≥ 75 anos (30,4% no grupo com < 75 anos vs. 50% no grupo dos ≥ 75 anos, p = 0,008). Na análise multivariada, a regressão logística revelou a medida da pressão arterial sistólica (PAS) no 1º ano como um preditor positivo de queda da TFGe (razão de probabilidades ou odds ratio [OR]=1,03, p = 0,005). Idade mostrou-se um preditor de aumento da albuminúria (OR=1,03, p = 0,024) e mortalidade (OR=1,09, p=0,002). Hospitalizações por causas cardiovasculares também foram preditoras de mortalidade (OR=15,34, p<0,001). Com relação à evolução para TRS, os preditores positivos foram hospitalizações por sepse (OR=3,28, p=0,038) e por causas cardiovasculares (OR=4,66, p=0,002) e a medida da PAS no 1º ano (OR=1,04, p=0,001). Conclusões: Observamos queda similar da TFGe entre as duas faixas etárias. A piora da albuminúria foi mais frequente nos pacientes com idade ≥ 75 anos do 1º ao 2º ano. Idade, hospitalizações e altos níveis pressóricos foram associados à piora funcional renal e/ou maior mortalidade no contexto da DRD.
Introduction: Decreased estimated glomerular filtration rate (eGFR) and albuminuria are hallmarks in the diagnosis and progression of diabetic kidney disease (DKD). Objective: We aimed to evaluate the evolution of these two markers according to age in individuals with DKD and determine the factors associated with a drop in eGFR, variation in albuminuria, mortality and evolution to renal replacement therapy (RRT). Patients and Methods: Analysis of a retrospective cohort including patients with type 2 diabetes stratified into < 75 and ≥ 75 years old. We evaluated eGFR (CKD-EPI) and 24-hour albuminuria along three years. Univariate and multivariate analyzes were performed to identify factors associated with worsening renal function and mortality. P<0.05 was considered significant. Renal and overall survival curves were constructed using the Kaplan-Meier method. Results: We analyzed 304 patients, with a mean age of 64.1 ± 9.2 years, 55.3% were male, 45.4% were using angiotensin-converting-enzyme inhibitors and 43.9% were using angiotensin-receptor blockers. We observed a similar drop in eGFR both from the 1st to the 2nd year (-4.6 [-11.5; 1.1] in the < 75 years group vs. -3.7 [-8.6; 1.9] in the ≥ 75 years group, p = 0.329) and from the 2nd to the 3rd year (-3.1 [-7.7; 2.0] in the < 75 years group vs. -0.8 [-5.0; 1.5] in the ≥ 75 years group, p = 0.353). As for the increased of albuminuria, from the 1st to the 2nd year, it occurred more frequently in the ≥ 75 years group (30.4% in the < 75 years group vs. 50% in the ≥ 75 years group, p = 0.008). In the multivariate analysis, logistic regression showed the measure of systolic blood pressure (SBP) in the 1st year as a positive predictor of eGFR drop (OR=1.03, p = 0.005). Age proved to be a predictor of increased albuminuria (OR=1.03, p = 0.024) and mortality (OR=1.09, p = 0.002). Hospitalizations for cardiovascular causes were also predictors of mortality (OR= 15.34, p<0.001). Concerning the evolution to RRT, the positive predictors were hospitalizations for sepsis (OR=3.28, p = 0.038) and for cardiovascular causes (OR=4.66, p = 0.002) and the measure of SBP in the 1st year (OR=1.04, p = 0.001). Conclusions: We observed a similar drop in eGFR between age groups and worsening of albuminuria, more frequent in those aged ≥ 75 years from the 1st to the 2nd year. Age, hospitalization and higher blood pressure levels were associated with worse renal function and/or higher mortality in the context of DKD.
Introduction: Decreased estimated glomerular filtration rate (eGFR) and albuminuria are hallmarks in the diagnosis and progression of diabetic kidney disease (DKD). Objective: We aimed to evaluate the evolution of these two markers according to age in individuals with DKD and determine the factors associated with a drop in eGFR, variation in albuminuria, mortality and evolution to renal replacement therapy (RRT). Patients and Methods: Analysis of a retrospective cohort including patients with type 2 diabetes stratified into < 75 and ≥ 75 years old. We evaluated eGFR (CKD-EPI) and 24-hour albuminuria along three years. Univariate and multivariate analyzes were performed to identify factors associated with worsening renal function and mortality. P<0.05 was considered significant. Renal and overall survival curves were constructed using the Kaplan-Meier method. Results: We analyzed 304 patients, with a mean age of 64.1 ± 9.2 years, 55.3% were male, 45.4% were using angiotensin-converting-enzyme inhibitors and 43.9% were using angiotensin-receptor blockers. We observed a similar drop in eGFR both from the 1st to the 2nd year (-4.6 [-11.5; 1.1] in the < 75 years group vs. -3.7 [-8.6; 1.9] in the ≥ 75 years group, p = 0.329) and from the 2nd to the 3rd year (-3.1 [-7.7; 2.0] in the < 75 years group vs. -0.8 [-5.0; 1.5] in the ≥ 75 years group, p = 0.353). As for the increased of albuminuria, from the 1st to the 2nd year, it occurred more frequently in the ≥ 75 years group (30.4% in the < 75 years group vs. 50% in the ≥ 75 years group, p = 0.008). In the multivariate analysis, logistic regression showed the measure of systolic blood pressure (SBP) in the 1st year as a positive predictor of eGFR drop (OR=1.03, p = 0.005). Age proved to be a predictor of increased albuminuria (OR=1.03, p = 0.024) and mortality (OR=1.09, p = 0.002). Hospitalizations for cardiovascular causes were also predictors of mortality (OR= 15.34, p<0.001). Concerning the evolution to RRT, the positive predictors were hospitalizations for sepsis (OR=3.28, p = 0.038) and for cardiovascular causes (OR=4.66, p = 0.002) and the measure of SBP in the 1st year (OR=1.04, p = 0.001). Conclusions: We observed a similar drop in eGFR between age groups and worsening of albuminuria, more frequent in those aged ≥ 75 years from the 1st to the 2nd year. Age, hospitalization and higher blood pressure levels were associated with worse renal function and/or higher mortality in the context of DKD.