Será que algum(ns) desses medicamentos e/ou a hemodiálise poderiam estar na gênese das quedas da paciente?

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Será que algum(ns) desses medicamentos e/ou a hemodiálise poderiam estar na gênese das quedas da paciente?

Mensagem  Vanessa Cristine em Ter Out 21, 2014 2:30 pm

[justify]Acompanhei em 09/out/2014 o atendimento do professor Nathan. Mulher, 65 anos, faz hemodiálise três vezes por semana em Mariana e usa os seguintes medicamentos:

• Ácido Fólico MID
• Atenolol 50 mg MID
• Carbonato de Cálcio 500 mg 2 cápsulas BID
• Complexo B MID
• Furosemida 40 mg MID
• Losartana 50 mg BID
• Nifedipina 20 mg BID

Procurou o ESF Nova Aliança na semana anterior (02/out/2014), pois havia caído da própria altura na rua. Foram feitos curativos e a paciente recebeu alta. Na data de nossa consulta, uma semana depois do ocorrido, a paciente retornou ao posto e contou que, desde o último atendimento, sofreu duas quedas da própria altura, também na rua. Indagada sobre tontura, vertigem, lipotimia e demais sinais e sintomas que poderiam estar associados às quedas, paciente negou todos eles. Observamos que ela fazia uso de chinelos no momento da consulta e foi orientado que ela tentasse trocar os calçados por sandálias ou sapatos fechados (tênis, por exemplo), pelo menos quando fosse sair de casa, a fim de evitar a ocorrência das quedas. Constatamos no prontuário que o médico Norberto já está acompanhando o caso, fato que nos deixou mais tranquilos.

Objetivo de aprendizagem: Será que algum(ns) desses medicamentos e/ou a hemodiálise poderiam estar na gênese das quedas da paciente?


Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study.
McAdams-DeMarco MA; Suresh S; Law A; Salter ML; Gimenez LF; Jaar BG; Walston JD; Segev DL.
BMC Nephrol; 14: 224, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24131569

BACKGROUND: Patients undergoing hemodialysis are at high risk of falls, with subsequent complications including fractures, loss of independence, hospitalization, and institutionalization. Factors associated with falls are poorly understood in this population. We hypothesized that insights derived from studies of the elderly might apply to adults of all ages undergoing hemodialysis; we focused on frailty, a phenotype of physiological decline strongly associated with falls in the elderly. METHODS: In this prospective, longitudinal study of 95 patients undergoing hemodialysis (1/2009-3/2010), the association of frailty with future falls was explored using adjusted Poisson regression. Frailty was classified using the criteria established by Fried et al., as a combination of five components: shrinking, weakness, exhaustion, low activity, and slowed walking speed.[/color]RESULTS: Over a median 6.7-month period of longitudinal follow-up, 28.3% of study participants (25.9% of those under 65, 29.3% of those 65 and older) experienced a fall. After adjusting for age, sex, race, comorbidity, disability, number of medications, marital status, and education, frailty independently predicted a 3.09-fold (95% CI: 1.38-6.90, P=0.006) higher number of falls. This relationship between frailty and falls did not differ for younger and older adults (P=0.57). CONCLUSIONS: Frailty, a validated construct in the elderly, was a strong and independent predictor of falls in adults undergoing hemodialysis, regardless of age. [/color] Our results may aid in identifying frail hemodialysis patients who could be targeted for multidimensional fall prevention strategies.

[Falls and renal function: a dangerous association].
De Giorgi A; Fabbian F; Pala M; Mallozzi Menegatti A; Misurati E; Manfredini R.
G Ital Nefrol; 29(3): 293-300, 2012 May-Jun.
Artigo em Italiano | MEDLINE | ID: mdl-22718453

Falls are an important health problem and the risk of falling increases with age. The costs due to falls are related to the progressive decline of patients' clinical conditions, with functional inability inducing increasing social costs, morbidity and mortality. Renal dysfunction is mostly present in elderly people who often have several comorbidities. Risk factors for falls have been classified as intrinsic and extrinsic, and renal dysfunction is included among the former. Chronic kidney disease per se is an important risk factor for falls, and the risk correlates negatively with creatinine clearance. Vitamin D deficiency, dysfunction of muscles and bones, nerve degeneration, cognitive decline, electrolyte imbalance, anemia, and metabolic acidosis have been reported to be associated with falls.[/color] Falls seem to be very frequent in dialysis patients: 44% of subjects on hemodialysis fall at least once a year with a 1-year mortality due to fractures of 64%. Male sex, comorbidities, predialysis hypotension, and a history of previous falls are the main risk factors, together with events directly related to renal replacement therapy such as biocompatibility of the dialysis membrane, arrhythmias, fluid overload and length of dialysis treatment. Peripheral nerve degeneration and demyelination as well as altered nerve conduction resulting in muscular weakness and loss of peripheral sensitivity are frequent when the glomerular filtration rate is less than 12 mL/min. Moreover, depression and sleep disorders can also increase the risk of falls. Kidney function is an important parameter to consider when evaluating the risk of falls in the elderly, and the development of specific guidelines for preventing falls in the uremic population should be considered.[/color]

Geriatric comorbidities, such as falls, confer an independent mortality risk to elderly dialysis patients.
Li M; Tomlinson G; Naglie G; Cook WL; Jassal SV.
Nephrol Dial Transplant; 23(4): 1396-400, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18057068

BACKGROUND: As the number of patients aged >/=65 years starting haemodialysis (HD) continues to increase, more patients are at risk of falls, functional decline and cognitive impairment. In an earlier prospective cohort study, we showed that 44% of elderly HD patients had more than one fall within a 1-year period. The objective of this study was to assess whether falls remained predictive of increased mortality risk even after controlling for age, comorbidity, dialysis vintage and laboratory variables. METHODS: Using a prospective, cohort study design, patients aged >/=65 years and on chronic HD during the period April 2002-2003 were recruited. Patients were followed biweekly, and falls occurring within the first year were recorded. Outcome data were collected until death, study end (30 December 2006), transplantation or transfer to another dialysis centre. RESULTS: A total of 162 patients were followed for a median of 32.7 months (quartiles 14-57). In a univariate Cox model with a time-dependent variable for falls status, survival was worse amongst fallers compared to non-fallers (HR 2.13, 95% CI 1.32-3.45; P = 0.002). After adjustment for age, dialysis vintage, comorbidity and laboratory variables, falls were a significant predictor of mortality (HR 1.78, 95% CI 1.07-2.98, P = 0.03). Exclusion of falls associated with concurrent illnesses did not alter the results (HR 1.63, CI 1.02-2.28 P = 0.05). CONCLUSIONS: We conclude that the occurrence of more than one accidental fall in a community-dwelling HD patient aged >/=65 years is associated with an independent increased risk of death. As fall interventions are effective, screening HD patients for falls may be a simple measure of clinical importance.

Long-term morbidity and mortality related to falls in hemodialysis patients: role of age and gender - a pilot study.
Abdel-Rahman EM; Yan G; Turgut F; Balogun RA.
Nephron Clin Pract; 118(3): c278-84, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21212691

BACKGROUND: Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are prone to falls. In this pilot study, we aimed to determine the incidence of falls in a cohort of HD patients during a 1-year period, to identify any specific risk factors that may predict falls in this cohort, and to assess whether falls can ind
ependently predict hospitalization, nursing home admissions and/or mortality over an additional 2 years. MATERIALS AND METHODS: Baseline assessments followed by documentation of falls prospectively during a 1-year period were done on 76 HD patients. Patients were followed for an additional 2 years and four outcomes were recorded: all-cause death, nursing home admission, the number and duration of all hospitalizations. RESULTS: 20 patients (26.3%) fell over a 12-month period. Elderly and females had a higher risk of falls than the younger and male population (
p = 0.034 and 0.006 respectively). During the 2-year follow-up, compared to non-fallers, fallers had a 2.13-fold increase in risk of death, a 3.5-fold increase in risk of nursing home admission, and nearly a 2-fold increase in the number and duration of hospitalizations. CONCLUSIONS: Falls are common in HD patients, with a higher incidence in females and elderly, and are associated with worse outcomes, more so in recurrent fallers.

Objetivo de aprendizagem: Com base nesta pesquisa bibliográfica, pude perceber que a falência renal (que provoca a necessidade de hemodiálise) tem contribuição significativa para quedas em pacientes no estágio final da doença renal, fato que pode ser identificado na paciente em questão. Encontrei que o Losartano tem como alguns de seus efeitos colaterais a tontura (4%), a hipotensão exagerada e a hipotensão ortostática. Além disso, a Nifedipina tem como alguns de seus efeitos colaterais hipotensão grave, tontura, fraqueza e, nos pacientes em diálise (como a do caso) ou com hipertensão maligna e hipovolemia, pode ocorrer queda exagerada da PA devido à vasodilatação. Assim, não podemos descartar o papel do Losartano e da Nifedipina na gênese das quedas da paciente.

Vanessa Cristine

Mensagens : 5
Data de inscrição : 20/08/2014

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