Complicaciones tempranas relacionadas con el primer acceso para diálisis en pacientes con enfermedad renal crónica estadio 5 en un hospital de cuarto nivel en Bogotá
Thesis
Introduction: The time of initiation of renal replacement therapy (RRT) in patients with stage 5 CKD can be programmed: attending a predialysis program or urgent in an unscheduled manner, as happens in 93.7% of cases. Among the two existing dialysis modalities, peritoneal dialysis favors a better quality of life, early achievement of permanent access to therapy, maintenance of residual kidney function, and control of fluid overload. Despite this, at the national and global level, the vast majority of unplanned admissions are made in the hemodialysis modality; This is due to the ease in placing the hemodialysis catheter vs peritoneal dialysis, the fear of early perioperative complications with the early use of the peritoneal dialysis catheter and the prevention by the patient and the family to train in a therapy where self-care and self-management are essential. Objective To describe the frequency of early complications related to the first access for dialysis in patients with stage 5 chronic kidney disease who require the start of unplanned renal replacement therapy, in a fourth-level IPS in the city of Bogotá. Methodology: A historical cohort study was carried out, in which adult patients who required the start of unplanned renal replacement therapy on hemodialysis and peritoneal dialysis at the Hospital Universitario Mayor Méderi Bogotá were compared. A sample of 317 patients who were admitted during a period of 30 months, 2016-2019 was taken. Results: 317 patients were included in this analysis. with a mean age of 64 years, 40.4% type 2 diabetics, the most frequent mode of admission was 64% hemodialysis and 36% on peritoneal dialysis. Early complications (30 days) occurred in 65 patients (20.2% in hemodialysis and 21.1% in peritoneal), with infectious complications being the most frequent, for hemodialysis: device-associated bacteremia in 14.8% and in the case of PD the presence of peritonitis in 10.5%, the percentage of primary failure for vascular access (transient CVC of HD) is 2% and in the case of the PD catheter 14%, with a low need for surgical reintervention: 2 patients ( 1.8%). Survival at one year was 87.1%, with no differences between both groups and when analyzing which risk factors could be associated with the development of complications, only the primary failure of access was a significant OR 4.95 (CI 1.77 - 13.77). Conclusions Emergency peritoneal dialysis as a starting option for renal replacement therapy is a safe, efficient method and without major complications compared to hemodialysis.
