Título:	Insuficiência renal aguda pós transplante cardíaco : preditores e prognóstico
Autor(es):	Biondi, Rodrigo Santos
E-mail do autor:	rodrigobiondi.md@gmail.com
Orientador(es):	Atik, Fernando Antibas
Assunto:	Insuficiência renal aguda Síndrome cardiorrenal Transplante cardíaco Diálise Cardiopatia chagásica
Data de publicação:	30-Set-2022
Data de defesa:	26-Mai-2022
Referência:	BIONDI, Rodrigo Santos. Insuficiência renal aguda pós transplante cardíaco: preditores e prognóstico. 2022. 49 f., il. Dissertação (Mestrado em Ciências da Saúde) — Universidade de Brasília, Brasília, 2022.
Abstract:	Objective: The aim of this study was to identify risk factors and predictors for Acute Kidney Injury (AKI) requiring renal replacement therapy (RRT), based on a retrospective data recording of patients undergoing heart transplantation at a referral center in Brazil. Methods: We performed an observational cohort study with retrospective data collection, in tertiary hospital, with 162 patients undergoing orthotopic heart transplantation. Results: Baseline data and main results after heart transplantation were 32% of patients required RRT. The mean age was 48.6 ± 6.4 years. 43.2% of the patients were female. Forty patients (24.7%) were in previous heart transplantation and 1 (0.6%) required ECMO. The most frequent cause of heart failure that led to heart transplantation was Chagas cardiomyopathy (66%) followed by ischemic cardiomyopathy in 10.5% of patients. The duration of the waiting list for this group was 76 (IIQ 18 – 169) days. The median serum creatinine was 1.2 (IIQ: 1.0 - 1.6) mg/dL, and the median estimated glomerular filtration rate (eGFR) by Cockcroft-Gault equation was 60 (IIQ: 46.5 - 78.0) mg/mL/m2. It is emphasized that 8% were diabetic, 41.4% hypertensive and 66.7% used angiotensin-converter enzyme inhibitors (iACE) or angiotensin II receptor antagonists (ARB). 102 (56%) patients were untestable after transplantation. The mortality rate was 32.4% and the average survival time, considering the time from transplantation to June 30, 2018, is 933 (IIQ 365 – 1794) days. There was a significant relationship with the use of inotropic drugs (p-value: 0.004, OR: 2,97; CI95%: 1.40 - 6.31), chronic kidney disease (CKD) pre-transplantation (p-value < 0.0001, OR: 3,85; CI95%: 1.78 - 8, .28) and those with both systemic arterial hypertension and CKD (p-value: 0.032, OR: 2,23; CI95%: 1.06 - 4.68). Logistic regression was performed to verify the effects of inotropic drugs, the presence of pre-transplant chronic kidney disease (CKD), and the presence of SAH+CKD on the likelihood of patients requiring hemodialysis in the post-transplant period. These risk factors, except for the combination of patients with SAH+CKD, were independently associated with post-transplant dialysis. Conclusions: We concluded that our cohort's need for post-transplant RRT was high (32%). After logistic regression, the independent pre-transplant risk factors related to recent RRT were renal function (OR for low GET: 3. 19; CI5%: 1,38 – 7,38) and use of inotropic drugs (OR: 3,91; CI95%: 1,75 – 8,73). No other risk factors, while in the per-transplant or post-transplant period, were found statistically significant. Patients submitted to RRT after transplantation had a shorter survival time (920 vs 1,276 days, p: 0.019).
Unidade Acadêmica:	Faculdade de Ciências da Saúde (FS)
Informações adicionais:	Dissertação (mestrado) — Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2022.
Programa de pós-graduação:	Programa de Pós-Graduação em Ciências da Saúde
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