Fatores associados à Lesão Renal Aguda em uma unidade de terapia intensiva de um hospital público em Belo Horizonte, Minas Gerais

Abstract

Acute kidney injury (AKI) is a well recognized complication in hospitalized and critically ill patients. It is associated with a significant increase in morbidity, mortality and health care costs. In intensive care units (ICU), the cause of AKI is commonly associated with multiple factors, among which the use of potentially nephrotoxic drugs is often neglected as a preventable cause of AKI. This is a prospective cohort study that evaluated the AKI as a primary outcome in ICU patients at a teaching hospital in Belo Horizonte, Brazil. Adult patients with ICU length of stay greater than 24 hours and hospital stay lower or equal to 7 days were evaluated for potential eligibility. Patients should not present any change on kidney function at the time of ICU admission. Data collection was performed from October 2014 to February 2015, including 122 patients, mostly originated from the surgical department (46.7%). An average of 22.0 ± 9.4 drugs was prescribed and from 2 to 24 potentially nephrotoxic drugs were used per patient. Mechanical ventilation was required for 67.2% of patients and at least one vasoactive drug was used in 68.0% of cases. An incidence of AKI was observed in 23.8% of patients, among them 10 required dialysis, seven reached the third stage of AKI and seven were referred to additional treatment after ICU discharge. Eleven (9%) patients died and seven of them developed AKI. The bivariate analysis showed that age (p = 0.006) and APACHE II score (p = 0.001) had higher median among patients who developed AKI compared to those who did not develop AKI. In the logistic regression, the number of medications (OR: 1.15; 95% CI: 1.05 to 1.27) presented a statistically significant correlation with the development of AKI. Understanding the factors associated with the occurrence of AKI in ICU patients is of great importance. Besides, the importance of pharmacists' role in the care of critically ill patients helps early identification of renal dysfunction induced by drugs, providing the prevention and appropriate management of these patients.