Avaliação do estado volêmico de pacientes transplantados renais utilizando bioimpedância elétrica

Abstract

Introduction: Kidney transplantation is the most effective therapy for chronic renal patients; complications as the delayed graft function (DGF) are common, generating long-term consequences for the prognosis of kidney transplant. The impact of total body volume immediate pre renal transplant in outcome of transplantation is unknown, as well as the influence of the dialysis modality pre transplantation in the occurrence of DGF. The body volume can be measured by bioimpedance, which helps to quantify body water, its distribution and consequent classification in euvolemic, hypovolemic or hypervolemic. Objective: To evaluate volume status by bioelectrical impedance method in patients on dialysis undergoing kidney transplantation and relate to the need for dialysis post operatively. Methods: A prospective longitudinal observational study included chronic renal patients, who underwent a kidney transplant at the Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul between October 2014 and December 2015. The evaluation of the body composition was performed using the body composition monitor - BCM (Fresenius Medical Care), pre renal transplantation, immediately before going to the operating room, and patients were followed during the first week of recovery. DGF was defined as the need of dialysis during the first week after transplantation. Student's t test to compare continuous variables and categorical we used the chi-square test or Fisher's exact test. The significance level was set at alpha = 0.05 and we used the statistical package SPSS version 17 for Windows. This study was approved by the ethics committee of the institution protocol number 826 866. Results: We studied 36 kidney transplant patients (50.3 +14.4 years; 22 male), classified according to body volume, mostly were hypervolemic (16, 44.4%), and euvolemic (15, 41.7 %). DGF was seen in 25 (69.4%) patients, hyperkalemia was the main indication for dialysis (19, 59.2%) and 27 (75%) were discharged with a gain of renal function. The volemic status showed no significant association with the occurrence of DGF (P = 0.610), while peritoneal dialysis (PD) was associated with reduced need for dialysis in the first week after surgery (P = 0.006). Conclusions: Preoperative volemic status in patients undergoing renal transplantation has no association with the incidence of DGF, the volume status was similar between modalities (PD patients and hemodialysis). The data suggest that DP before transplantation decreases the chances of occurrence of DGF.