Monitorização dos diferentes estágios da doença renal crônica: aplicação de sensor niICP BrainCare® e avaliação laboratorial

Abstract

Chronic Kidney Disease (CKD) is characterized by the gradual and irreversible loss of renal function over time, primarily caused by diabetes and high blood pressure. Due to its increasing prevalence worldwide and its negative impact on patients' quality of life and the associated treatment costs, it represents a significant public health issue. The loss of renal function leads to a range of complications, including neurological dysfunctions, with a focus on the alteration of intracranial compliance in individuals undergoing hemodialysis. Information about intracranial pressure (ICP) in the course of CKD is very limited, and the objective of this study was to improve the understanding of this association. The structure of this work is organized into chapters: the first chapter comprises a literature review, addressing the main aspects of CKD and ICP, with a focus on the non-invasive monitoring medical technology brain4care. The second chapter pertains to the study conducted with CKD patients who have not yet undergone replacement therapy and a control group at a renal replacement therapy center in Ponta Grossa, PR, Brazil. The research involved a total of 206 participants, of which 186 had CKD. The main findings of the study include the observation that there is no difference in ICP between CKD stages, providing evidence of compromised cerebral autoregulation in CKD patients. It also reflects on the possibility of variables such as physical exercise, nutritional monitoring, and the control of sodium, TSH, and ferritin levels influencing ICP in renal patients. Finally, it highlights the importance of establishing cutoff points for the P2/P1 ratio in various conditions and pathologies. The third chapter presents a comparison between the ICP parameter data of the individuals in the study from Chapter II and a study conducted with hemodialysis patients. The results indicate that hemodialysis plays a significant role in controlling intracranial compliance in advanced CKD patients, as ICP parameters demonstrated better conditions in these patients. The fourth and final chapter presents the accounts of two cases that stood out due to their remarkable conditions. The first describes a diabetic patient whose ICP was monitored in February and September 2020. On the day of the first monitoring, a significant change in ICP and impaired visual acuity was detected. Between the two monitoring sessions, there was a deterioration in laboratory tests, but despite that, the ICP parameters were close to normal, and visual acuity improved, likely due to a change in diuretics. The second case reports a patient with systemic lupus erythematosus (SLE) whose ICP parameters were significantly below the standard, indicating the possibility of intracranial hypotension, corroborated by symptoms of orthostatic headache and vestibular-cochlear symptoms.