Geriatrik Nefroloji

EnglishTürkçe

BÖLÜM


DOI :10.26650/B/CH12CH47.2023.014.21   IUP :10.26650/B/CH12CH47.2023.014.21    Tam Metin (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



Referanslar

  • 1. Schmitt, R, Coca S, Kanbay M, Tinetti ME, Contley LG, Parakh CR. Recovery of kidney function after acu-te kidney injury in the elderly a systematic review and meta-analysis. Am. J. Kidney Dis. 2008;52:262-271. google scholar
  • 2. Hoste EAJ, Kellum JA, Selby NM, Zarbock A, Palevsky PM, Bagshaw SM, Goldstein SL, et al. Global epidemiology and outcomes of acute kidney injury. Nat Rev Nephrol. 2018;14(10):607-625. google scholar
  • 3. Laake JH, Dybwik K, Flaatten HK, Fonneland IL, Kvâle R, Strand K. Impact of the post-World War II generation on intensive care needs in Norway. Acta Anaesthesiol Scand. 2010;54(4):479-84. google scholar
  • 4. Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: an incre-asing global concern. Lancet. 2013;13;382(9887):170-9. google scholar
  • 5. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;17;294(7):813-8. google scholar
  • 6. Bolignano D, Mattace-Raso F, Sijbrands EJ, Zoccali C. The aging kidney revisited: a systematic review. Ageing Res Rev.2014;14:65-80. google scholar
  • 7. O’Sullivan ED, Hughes J, Ferenbach DA. Renal aging: causes and consequences. J Am Soc Nephrol 2017;28(02):407-420. google scholar
  • 8. Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 4;17(1):204. google scholar
  • 9. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31. google scholar
  • 10. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute Dialysis Quality Initiative workgroup. Acute renal failure- definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-12. google scholar
  • 11. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930-6. google scholar
  • 12. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23. google scholar
  • 13. Pascual J, Liano F, Ortuno J. The elderly patient with acute renal failure. J Am Soc Nephrol. 1995;6(2):144-53. google scholar
  • 14. Lâmeire N, Matthys E, Vanholder R, De Keyser K, Pauwels W, Nachtergaele H, et al. Causes and prognosis of acute renal failure in elderly patients. Nephrol Dial Transplant. 1987;2(5):316-22. google scholar
  • 15. Scolari F, Ravani P, Pola A, Guerini S, Zubani R, Movilli E, et al. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. J Am Soc Nephrol.2003;14(6):1584-90. google scholar
  • 16. Faubel S, Shah PB. Immediate Consequences of Acute Kidney Injury: The Impact of Traditional and Nont-raditional Complications on Mortality in Acute Kidney Injury. Adv Chronic Kidney Dis. 2016;23(3):179-85. google scholar
  • 17. Schrier RW. Fluid administration in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol. 2010;5(4):733-9. google scholar
  • 18. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ. 2019;9;364:k4891 google scholar
  • 19. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophsiology and tre-atment. Nat Rev Nephrol. 2017;13(11):697-711. google scholar
  • 20. Leventhal TM, Liu KD. What a Nephrologist Needs to Know About Acute Liver Failure. Adv Chronic Kidney Dis. 2015;22(5):376-81. google scholar
  • 21. Mohmand H, Goldfarb S. Renal dysfunction associated with intra-abdominal hypertension and the abdo-minal compartment syndrome. J Am Soc Nephrol. 2011;22(4):615-21. google scholar
  • 22. Gonwa TA, Wadei HM. Kidney disease in the setting of liver failure: core curriculum 2013. Am J Kidney Dis. 2013;62(6):1198-212. google scholar
  • 23. Cohen EP, Krzesinski JM, Launay-Vacher V, Sprangers B. Onco-nephrology: Core Curriculum 2015. Am J Kidney Dis. 2015;66(5):869-83. google scholar
  • 24. House AA. Management of Heart Failure in Advancing CKD: Core Curriculum 2018. Am J Kidney Dis. 2018;72(2):284-295. google scholar
  • 25. Kohli HS, Bhaskaran MC, Muthukumar T, Thennarasu K, Sud K, Jha V, et al. Treatment-related acute renal failure in the elderly: a hospital-based prospective study. Nephrol Dial Transplant. 2000;15(2):212-7. google scholar
  • 26. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et. Al. The Third Interna-tional Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;23;315(8):801-10 google scholar
  • 27. Fani F, Regolisti G, Delsante M, Cantaluppi V, Castellano G, Gesualdo L, et al. Recent advances in the pathogenetic mechanisms of sepsis-associated acute kidney injury. J Nephrol. 2018;31(3):351 359. google scholar
  • 28. PRISM Investigators, Rowan KM, Angus DC, Bailey M, Barnato AE, Bellomo R, Canter RR, et al. Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. N Engl J Med. 2017; 8;376(23):2223-2234. google scholar
  • 29. Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstadt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: The ELAIN Randomized Clinical Trial. JAMA. 2016;24-31;315(20):2190-9. google scholar
  • 30. Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyere R, et al. IDEAL-ICU Trial Investi-gators and the CRICS TRIGGERSEP Network. timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018;11;379(15):1431-1442 google scholar
  • 31. McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, Tumlin J; CIN Consensus Wor-king Panel. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol. 2006;18;98(6A):5K-13K. google scholar
  • 32. Swartz RD, Crofford LJ, Phan SH, Ike RW, Su LD. Nephrogenic fibrosing dermopathy: a novel cutaneous fibrosing disorder in patients with renal failure. Am J Med. 2003;114(7):563-72. google scholar
  • 33. Bock JS, Gottlieb SS. Cardiorenal syndrome: new perspectives. Circulation. 2010; 15; 121(23): 2592-600. google scholar
  • 34. Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, Krumholz HM. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;16;47(10):1987-96. google scholar
  • 35. Noor S, Usmani A. Postoperative renal failure. Clin Geriatr Med. 2008;24(4):721-9. google scholar
  • 36. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol. 2017;13(11):697-711. google scholar
  • 37. Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A. Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomar-kers: the PrevAKI randomized controlled trial. Intensive Care Med.2017;43(11):1551-1561. google scholar
  • 38. Razo-Vazquez AO, Thornton K. Extracorporeal Membrane Oxygenation-What the Nephrologist Needs to Know. Adv Chronic Kidney Dis. 2016;23(3):146-51 google scholar
  • 39. Roehm B, Vest AR, Weiner DE. Left Ventricular Assist Devices, Kidney Disease, and Dialysis. Am J Kidney Dis. 2018;71(2):257-266. google scholar
  • 40. De Waele JJ, De Laet I, Kirkpatrick AW, Hoste E. Intra-abdominal Hypertension and Abdominal Compart-ment Syndrome. Am J Kidney Dis.2011;57(1):159-69. google scholar
  • 41. Murphy N, Auzinger G, Bernel W, Wendon J. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology. 2004;39(2):464-70. google scholar
  • 42. Teixeira JP, Ambruso S, Griffin BR, Faubel S. Pulmonary Consequences of Acute Kidney Injury. Semin Nephrol. 2019;39(1):3-16. google scholar
  • 43. Thompson BT, Chambers RC, Liu KD. Acute Respiratory Distress Syndrome. N Engl J Med. 2017;10;377(6):562-572. google scholar
  • 44. Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al. Mount Sinai COVID Informatics Center (MSCIC). AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):151-160. google scholar
  • 45. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Northwell COVID-19 Research Consor-tium; Northwell Nephrology COVID-19 Research Consortium. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-218. google scholar
  • 46. Chan L, Coca SG. Acute Kidney Injury in the Time of COVID-19. Kidney360. 2020;11;1(7):588-590. google scholar
  • 47. Bernier-Jean A, Beaubien-Souligny W, Goupil R, Madore F, Paquette F, Troyanov S, Bouchard J. Diagnosis and outcomes of acute kidney injury using surrogate and imputation methods for missing preadmission creatinine values. BMC Nephrol. 2017; 28;18(1):14. google scholar
  • 48. Soni SS, Ronco C, Katz N, Cruz DN. Early diagnosis of acute kidney injury: the promise of novel biomar-kers. Blood Purif. 2009;28(3):165-74. google scholar
  • 49. Moore PK, Hsu RK, Liu KD. Management of Acute Kidney Injury: Core Curriculum 2018. Am J Kidney Dis. 2018;72(1):136-148. google scholar
  • 50. STARRT-AKI Investigators; Canadian Critical Care Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group; United Kingdom Critical Care Research Group; Canadian Nephrology Trials Network; Irish Critical Care Trials Group, Bagshaw SM, Wald R, Adhikari NKJ, Bellomo R, da Costa BR, Dreyfuss D, et al. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020;16;383(3):240-251. google scholar
  • 51. Gaudry S, Hajage D, Benichou N, Chaıbi K, Barbar S, Zarbock A, et al. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials. Lancet. 2020;9;395(10235):1506-1515. google scholar
  • 52. Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. AKIKI Study Group. Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. N Engl J Med.2016; 14;375(2):122-33. google scholar
  • 53. Jamale TE, Hase NK, Kulkarni M, Pradeep KJ, Keskar V, Jawale S, Mahajan D. Earlier-start versus usu-al-start dialysis in patients with community-acquired acute kidney injury: a randomized controlled trial. Am J Kidney Dis. 2013 Dec;62(6):1116-21. google scholar
  • 54. Tonelli M, Manns B, Feller-Kopman D. Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis. 2002;40(5):875-85. google scholar
  • 55. Nash DM, Przech S, Wald R, O’Reilly D. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017;41:138-144. google scholar
  • 56. Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, et al. Hemodiafe Study Group. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute re-nal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2006;29;368(9533):379-85. google scholar
  • 57. Augustine JJ, Sandy D, Seifert TH, Paganini EP. A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis. 2004;44(6):1000-7. google scholar
  • 58. Schefold JC, von Haehling S, Pschowski R, Bender T, Berkmann C, Briegel S, et al. The effect of continuous versus intermittent renal replacement therapy on the outcome of critically ill patients with acute renal failure (CONVINT): a prospective randomized controlled trial. Crit Care. 2014;10;18(1):R11. google scholar
  • 59. Zhang L, Yang J, Eastwood GM, Zhu G, Tanaka A, Bellomo R. Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis. Am J Kidney Dis. 2015;66(2):322-30. google scholar
  • 60. Nolph KD. Peritoneal dialysis for acute renal failure. ASAIO Trans. 1988;34(1):54-5. google scholar
  • 61. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7. google scholar


PAYLAŞ




İstanbul Üniversitesi Yayınları, uluslararası yayıncılık standartları ve etiğine uygun olarak, yüksek kalitede bilimsel dergi ve kitapların yayınlanmasıyla giderek artan bilimsel bilginin yayılmasına katkıda bulunmayı amaçlamaktadır. İstanbul Üniversitesi Yayınları açık erişimli, ticari olmayan, bilimsel yayıncılığı takip etmektedir.