Acompanhamento de doentes renais crônicos em hemodiálise através da monitoração não invasiva da pressão intracraniana.

Abstract

Chronic kidney disease (CKD) is a major cause of mortality and morbidity, in addition to an increasing public health problem. Hemodialysis is the most used treatment, however, it has been associated with frequent complications during sessions, where the most severe form is known as dialysis disequilibrium syndrome (DDS), which contributes to cerebral edema and increased intracranial pressure (ICP). Previous studies suggest that end-stage CKD and hemodialysis impact cerebral compliance, however, the literature on this subject is scarce. In this context, this study aimed to monitor a group of patients with CKD (terminal stage) undergoing hemodialysis by monitoring non-invasive ICP before and at the end of the sessions, seeking to understand how this parameter behaves during the dialysis treatment, correlating the results obtained with the clinical and laboratory profile of the patients. This is a prospective longitudinal study, in which 42 patients with end-stage CKD undergoing hemodialysis treatment were included three times a week, followed up for a period of 6 months. Twenty volunteers with no known chronic kidney disease were also included to make up the control group. Clinical and laboratory data were obtained via electronic medical records and dialysis session files, in addition to non-invasively monitored ICP by the Brain4care® method before and at the end of dialysis sessions. The data were processed using the SPSS 17.0® statistical program. Within the follow-up period, a total of 4,881 PIC monitors were obtained. There was a reduction in the parameters of PIC, time to peak (TTP) and P2/P1 ratio, post-dialysis, considering the different moments (1st, 2nd and 3rd dialysis session) and the different months of follow-up (p<0.01, paired student t-test). Cerebral compliance was more altered in the first hemodialysis session of the week (p<0.05, ANOVA for repeated measures). Hemodialysis was able to improve the volunteers' brain compliance regardless of gender and Kt/V values. There was no significant correlation between mean arterial pressure, heart rate and interdialytic weight gain and TTP parameters and P2/P1 ratio (p>0.05, Person correlation). There was a significant positive correlation between serum potassium levels and TTP parameters and P2/P1 ratio (p<0.05, Person correlation) and it was noticed that the P2/ P1 ratio of patients with CKD on hemodialysis is significantly higher compared to the control group. It is concluded, based on the results presented, that patients on hemodialysis have a worse cerebral compliance, comparing them with individuals without known CKD; that there are differences between predialysis and post-dialysis ICP, with more altered values before hemodialysis treatment; that the pattern of changes remains over the months and that worse brain compliance is seen in the first session of the week.