Geriatrik Nefroloji

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DOI :10.26650/B/CH12CH47.2023.014.21   IUP :10.26650/B/CH12CH47.2023.014.21    Full Text (PDF)

Yaşlı Yoğun Bakım Hastalarında Renal Sorunlar

Dilek Torun

Yaşlı terimi, yaş ve deneyime bağlı olarak bilgelik ifade eden kelimelerin kökünü oluşturan Anglosakson kökenli ‘eld’ kelimesinden gelmektedir. İleri yaş, fizyolojik olarak çoğu fonksiyonların durduğu ve yaşam beklentisinin kısaldığı durum olarak tanımlanmıştır. Bireyin ileri yaş olarak kabul edildiği belirli yaş sınırları zamanla ve toplumdan topluma değişiklik gösterir. Bireyin kronolojik yaşının fizyolojik ve sağlık durumunu yansıtmadığının anlaşılmasıyla birlikte ileri yaş kesin bir tanımdan ziyade subjektif bir terim olarak kabul edilmektedir. İleri yaş için çoğunlukla 65 yaş üstü kabul edilmekle birlikte literatürde yaşlı teriminin tanımları büyük farklılıklar göstermektedir. En yaygın kullanılan sınırlar 60, 65, 70, 75 ve 80 yaştır.1 Dünyada ve ülkemizde doğum hızı ve ölüm hızındaki azalmaya bağlı olarak nüfus giderek yaşlanmaktadır. Avrupa’da 2018’de %6 olan 80 yaş üstü popülasyonun 2050’de %12’e çıkması beklenmektedir.2 Yaşlı popülasyondaki bu artış göz önüne alındığında gelecek 30 yılda 80 ve 90’lı yaşlarda yoğun bakım ünitesinde (YBÜ) tedavi edilecek hasta sayısının 2 katına çıkacağı öngörülmektedir. Yoğun bakım ünitesindeki hastaların yaklaşık %15’ini 80 yaş üstü bireylerin oluşturduğu dikkate alındığında 2050’de YBÜ kohortunun %30’unun 80 yaşın üzerinde olacağı anlamına gelir.3 Yoğun bakım ünitelerinde akut böbrek hasarı (ABH) başta olmak üzere renal problemler yaygındır ve artmış morbidite, mortalite ve maliyet ile ilişkilidir. İleri yaş ABH için bir risk faktörüdür. Yaşlı hastalarda, kronik böbrek hastalığı, kardiyovasküler hastalık, hipertansiyon, diyabet, obstrüktif üropati veya enfeksiyon gibi ko-morbid hastalıklar, dehidratasyon, hipovolemi, ilaçlara bağlı toksisiteler, kontrast nefropati, ameliyatla ilgili sorunlar, sepsis ve kardiyorenal sendrom ilişkili ABH, sıvı elektrolit ve asit baz metabolizma bozuklukları sık görülen durumlardır.4,5



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