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The acute renal failure (ARF) is a syndrome characterized by an abrupt decrease in renal function. One of the consequences of ARF is the incapacity to eliminate nitrogen excretory products, leading to azotemia, and diverse disorders. The pathology has 10 times more chance to occur in people above 65 years when compared to younger people (FORMICA et al., 2018). Hemodialysis is a strategy to decrease the mortality promoted by ARF in elderly people (KUSUMOTO et al., 2008), however, this type of renal substitution promotes side effects for the patients (SILVA; THOMÉ, 2009).
The objective of this work is to evaluate hemodialysis in a wide age range of patients in an intensive care unit (ICU) for a comparison of the data, mortality, and age to promote discussion about ARF dialysis in old people, a relevant, but still incipient theme.
This is a observational study that included 249 patients. Data (age, gender, APACHE II, hospital discharge or death, and creatinine and urea levels before and after hemodialysis) were obtained from patients of the Southwest Regional Hospital Walter Alberto Pecoits, Francisco Beltrão, PR, Brazil, from February/2011 to March/2019. Statistical analysis was performed using the R software, and data were split into three sets according to i) evaluation of all variables, except hospital discharge/death; ii) comparison of variables among three groups: Group 1 = below 60 years old (yr.), Group 2 > 60 yr. and under 79 yr., and G3 ≥ 80 yr. (57% of the patients were above 60 y); iii) hospital discharge or death. As data did not follow a normal distribution (significant Shapiro-Wilk test), we adopted the following tests: Chi-Squared, Kruskal-Wallis, and Mann-Whitney. The Dunn-Bonferroni correction was applied when deemed necessary. Results were compared with other studies on ICU dialysis published in the literature. This work was approved by ethical committee of the Universidade Estadual do Oeste do Paraná.
Among the 249 patients, 62.7% were male and 37.3% female. Average values of urea before and after dialysis were 198.51mg/dl and 114.32mg/dl, respectively (42.42% proportion of urea remotion) and the evaluation of creatinine levels showed a reduction of 42.12% after dialysis, i.e., 6.41mg/dl to 3.71mg/dl. The mean APACHE II score was 27.37.
The analysis of the results considering groups of different ages, Table 1, showed that urea levels decreased after dialysis, with a remotion of 38.04%, 44.9% and 47.3%, for G1, G2, and G3, respectively, without significant difference (at the 5% level). It is worth emphasizing the linear increase of the APACHE II score and the age and death of the patients.
There was a increased significant statistically in the absolute number of deaths according to the increased age of the patients, 78,8% of the patients above 80 yr. old died, otherwise patients less than 60 yr. old had a 49,5% mortality rates in the same period.
Xue et al. (2006) verified the increase of ARF incidence as age increases. Interestingly, the number of dialyses decreased in patients over 80 y compared to other ages. Those data corroborate our results, where the number of dialysis patients in G3 < G2, although G1 < G2.
Evaluating the patients according to hospital discharge/death numbers, it was observed that 60.64% of the patients died, differently from those reported by d’Avila et al. (1997), i.e., 81.45% deaths.
This work presented the overview of hemodialysis in ICU patients by evaluating mortality rates in different ages. It has been observed a statistically significant increased mortality in the elderly, 78,8 % in patients above 80 yr. age. The increase of APACHE II values is linear as age increases and is compatible with the increase of the numbers deaths. Comparisons with cases from literature are still challenging because of scarce data availability.