Impacto da insuficiência renal crônica associada à insuficiência cardíaca crônica sistólica em pacientes com cardiomiopatia chagásica: prevalência e prognóstico

• Ano de defesa: 2011
• Autor(a) principal: Ardito, Sabrina Queiroz
• Orientador(a): Bestetti, Reinaldo Bulgarelli
• Banca de defesa: Souza, Germano Emilio Conceicao , Nogueira, Paulo Roberto
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Faculdade de Medicina de São José do Rio Preto
• Programa de Pós-Graduação: Programa de Pós-Graduação em Ciências da Saúde::123123::600
• Departamento: Medicina Interna; Medicina e Ciências Correlatas::123123::600
• País: BR
• Palavras-chave em Português: Doença de Chagas; Insuficiência Cardíaca; Cardiomiopatia Chagásica; Insuficiência Renal Crônica; Prognóstico
• Palavras-chave em Inglês: Chagas disease; Chagas cardiomyopathy; heart failure; Chronic renal failure; outcome
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::MEDICINA::CIRURGIA::CIRURGIA CARDIOVASCULAR::123123::600
• Link de acesso: http://bdtd.famerp.br/handle/tede/116

This study aimed at determining the prevalence and the prognostic significance of chronic renal impairment in patients with chronic systolic heart failure secondary to Chagas cardiomyopathy. A total of 245 patients followed at the Cardiomyopathy Outpatient service from January, 2000 to December, 2008 with the diagnosis of chronic systolic heart failure secondary to Chagas cardiomyopathy were included. Chronic renal impairment was diagnosed in 42 (17%) patients. A Cox proportional hazards model was used to evaluate the role of chronic renal impairment as a prognostic index, and a Kaplan-Meier survival curve to study its association with all-cause mortality. Baseline characteristics of patients with and without chronic renal impairment were similar. Beta-Blocker therapy (Hazard ratio=0,42; 95% Confidence Interval 0,27 to 0,63, p value <0,005), left ventricular ejection fraction (Hazard Ratio=0,97; 95% Confidence Interval 0,95 to 0,99; p value=0,005), serum sodium levels (Hazard ratio=0,94; 95% Confidence Interval 0,90 to 0,98; p value=0,004), inotropic support (Hazard Ratio= 1,85; 95% Confidence Interval 1,21 to 2,64; p value= 0,03), and digoxin use (Hazard ratio=2,35; 95% Confidence Interval 1,15 to 4,81; p value=0,02) were independent predictors of all- cause mortality. Survival probability at 12, 24, 36, and 60 months was 74%, 60%, 52%, and 37%, respectively, in patients with chronic renal impairment, and 84%, 70%, 70%, and 35% ,respectively, in patients without (p>0,05). Chronic renal impairment has a low prevalence and no prognostic significance in patients with chronic systolic heart failure secondary to Chagas Cardiomyopathy.