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Avaliação de factores de risco cardiovascular após transplantação renal em idade pediátrica
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Em idade pediátrica, a transplantação renal é a terapêutica da doença renal terminal (DRCT) com melhor prognóstico. No entanto, estes doentes apresentam doença e mortalidade cardiovascular prematura, sendo esta 10 vezes superior à de controlos com a mesma idade. Os objectivos do presente estudo foram (1) Determinação da prevalência e estudo da evolução de alguns factores de risco cardiovasculares em crianças e adolescentes antes e após transplantação renal; (2) Averiguar as intervenções médicas efectuadas para o seu controlo; (3) Avaliar a influência de algumas características dos doentes na prevalência de factores de risco cardiovasculares actuais. Foi realizado um estudo longitudinal retrospectivo, de coorte, descritivo e analítico, através da consulta de processos clínicos e contactos telefónicos. Foram incluídos 49 doentes pediátricos transplantados renais (idade à data do transplante entre 3,1 e 17,3 anos; mediana 8,4 anos) e consideradas avaliações nos seguintes períodos pós transplantação: 1 mês, 3 meses, 6 meses, 1 ano, 2 anos, 5 anos, 10 anos e a mais próxima do dia 30/07/2017. À data da última observação, 61,2% dos doentes tinham hipertensão arterial, 10,5% hipertrofia do ventrículo esquerdo (HVE), 30,6% anemia, 29,2% dislipidemia, 4,3% NODAT, 8,2% excesso de peso/obesidade e 76,6% não praticavam exercício físico de forma regular. A transplantação renal permitiu uma diminuição da maioria dos factores de risco cardiovasculares, nomeadamente da HVE, hipercolesterolemia, anemia e hipoalbuminemia (p<0,05). A ausência de diurese residual no pré transplante foi um factor de risco para o desenvolvimento de HTA (p<0,05) e a uronefropatia como etiologia da DRC foi um factor protector para o desenvolvimento de HTA e dislipidemia (p<0,05).
Despite renal transplantation being the optimal treatment modality for children with end stage renal disease (ESRD), these patients have accelerated cardiovascular disease, leading to a 10 fold increase in cardiovascular (CV) mortality, compared with an age-matched population. The aims of this study were (1) Calculate the prevalence and study the evolution of some cardiovascular risk factors in children and adolescents before and after renal transplantation; (2) Ascertain the medical interventions performed to control the latter; (3) Study the influence of some of the patients characteristics in the prevalence of the CV risk factors, in the last appointment. An observational retrospective cohort study, descriptive and analytical was performed, through consultation of the clinical processes and phone interviews. The study included 49 kidney transplant recipients (age at transplant between 3,1 and 17,3 years; median 8,4 years) and the post transplant periods studied were: 1 month, 3 months, 6 months, 1 year, 2 years, 10 years and the closest to 30/07/2017. In the last appointment, 61,2% of the patients were hypertensive, 10,5% had LVH (left ventricular hypertrophy), 30,6% were anemic, 29,2% had hyperlipidemia, 4,3% had NODAT, 8,2% were overweight/obese and 76,6% did not engage in regular physical activity. Renal transplantation lead to a decrease in most of the cardiovascular risk factors, namely LVH, hyperlipidemia, anemia and hypoalbuminemia (p<0,05). The absence of residual diuresis prior to the transplantation was a risk factor for the development of hypertension (p<0,05) and uronephropathy as the ESRD etiology was a protective factor for the development of hypertension and hyperlipidemia (p<0,05).
Despite renal transplantation being the optimal treatment modality for children with end stage renal disease (ESRD), these patients have accelerated cardiovascular disease, leading to a 10 fold increase in cardiovascular (CV) mortality, compared with an age-matched population. The aims of this study were (1) Calculate the prevalence and study the evolution of some cardiovascular risk factors in children and adolescents before and after renal transplantation; (2) Ascertain the medical interventions performed to control the latter; (3) Study the influence of some of the patients characteristics in the prevalence of the CV risk factors, in the last appointment. An observational retrospective cohort study, descriptive and analytical was performed, through consultation of the clinical processes and phone interviews. The study included 49 kidney transplant recipients (age at transplant between 3,1 and 17,3 years; median 8,4 years) and the post transplant periods studied were: 1 month, 3 months, 6 months, 1 year, 2 years, 10 years and the closest to 30/07/2017. In the last appointment, 61,2% of the patients were hypertensive, 10,5% had LVH (left ventricular hypertrophy), 30,6% were anemic, 29,2% had hyperlipidemia, 4,3% had NODAT, 8,2% were overweight/obese and 76,6% did not engage in regular physical activity. Renal transplantation lead to a decrease in most of the cardiovascular risk factors, namely LVH, hyperlipidemia, anemia and hypoalbuminemia (p<0,05). The absence of residual diuresis prior to the transplantation was a risk factor for the development of hypertension (p<0,05) and uronephropathy as the ESRD etiology was a protective factor for the development of hypertension and hyperlipidemia (p<0,05).
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Transplantação renal Factores de risco cardiovasculares Pediatria