Profile of the clinical manifestations occured with patients of terminal chronic renal insufficience submitted to the hemodialysis

Terminal Chronic Renal Insufficience (TCRI) characterized by the gradual loss, persistent and irreversible of the renal functions increases each year. With the objective to identify the profile of the clinical manifestations that appear in the chronic renal under hemodialysis, a prospective longitudinal study was realized over 83 patients of three clinics of hemodialysis in Fortaleza. A questionnaire was used as main instrument of collection of data, being applied to the patients by interview. The patients had been observed during two sessions of hemodialysis for week and followed by two months, corresponding to 1,328 analyzed sessions of hemodialysis. The results had demonstrated that 45 (54,2%) were of the male sex with a average of age of 47 Â16 years and in relation the familiar income this if it found between 1 and 2 minimum wages for 56 (67,5%) of the patients. About the illness to the IRCT, it was verified that in 40% of the patients the cause was not identified, in 22% was hypertension and in 13% was diabetes. About the use of drugs in this population, an average of 10 drugs for patient was verified. Relating the drug total with the average of presented clinical manifestations, it was identified how much the bigger drug number, bigger the manifestations number was observed (p=0,001). About 80% of the individuals at some moment of the study they had left to receive the âexceptional drugsâ that the Public System of Health would have to supply. It was verified presence of cardiovascular manifestations (81%), musculoskeletal (69%), neurological (87%), dermatological (55%), gastrointestinal (66%) and anemia (65%). Relating to the gastrointestinal manifestations was verified that patient with Reduction of Urea Tax <65% they had two times more possibility to present such manifestations (RR-1.90) CI 95% (1.43-2.5). Of the total of patients: 43% had presented a type of infection, which the vein access (fistula arterial-vein or catheter) was responsible by 36% of these infections. A positive sorology for Hepatitis C was observed in 25% of the individuals. Patients with more than 5 years treating dialysis had 4 times more chance to suffer from Hepatitis C (RR- 3.99, CI 95% - 1.72-9.20). During the hemodialysis sessions, chronic headache (76%) was the manifestation most frequently observed. The presence of a clinical manifestation was verified in 100% of the patients. Those individuals who had more time of hemodialysis (> 5 years) presented greater number of manifestations when compared with individuals with lesser time (< 5 years) - p=0.043. The Public System of Health is the greatest supplier of the dialitic treatment, being the responsible for 94% of the treatments. It was concluded that male individuals half-illiterate >45 years old and income between 1 and 2 minimum wage were the individuals more reached by the IRCT, even so this it can reach any person in any period of the life. The more frequent clinical manifestations had been neurological, cardiovascular and musculoskeletal. The guarantee of the access to the drugs is denied the majority of these patients. The lack of the drugs takes the inefficiency of all therapy, causing upheaval to the patient and decreasing its quality of life.A InsuficiÃncia Renal CrÃnica Terminal (IRCT) caracterizada pela perda progressiva, persistente e irreversÃvel das funÃÃes renais vem aumentando consideravelmente a cada ano. Com o objetivo de conhecer o perfil das manifestaÃÃes clÃnicas que acometem os renais crÃnicos sob terapia hemodialÃtica, realizou-se um estudo longitudinal prospectivo envolvendo 83 pacientes procedentes de trÃs clinicas de hemodiÃlises na cidade de Fortaleza. Utilizou-se como principal instrumento de coleta de dados um questionÃrio que foi aplicado aos pacientes por meio de entrevista. Os pacientes foram observados durante duas sessÃes de hemodiÃlise por semana e seguidos por dois meses, correspondendo assim a 1.328 sessÃes de hemodiÃlise analisadas. Os resultados demonstraram que 45 (54%) eram do sexo masculino com uma mÃdia de idade de 47 anos (DP  16) e em relaÃÃo a renda familiar esta se encontrava entre 1 e 2 salÃrios mÃnimo para 57 (69,5%) dos pacientes. Quanto à doenÃa determinante da IRCT verificou-se que 40% dos pacientes tiveram causa nÃo identificada. Em se tratando da utilizaÃÃo de medicamentos verificou-se uma mÃdia de 10 medicamentos por paciente e houve uma relaÃÃo quanto maior o nÃmero de medicamentos maior o nÃmero de manifestaÃÃes clÃnicas observadas (p=0,001). Cerca de 80% dos indivÃduos em algum momento do estudo deixaram de receber pelo menos um dos medicamentos excepcionais. Verificou-se a presenÃa de manifestaÃÃes neurolÃgicas (87%), cardiovasculares (81%), musculoesquelÃticas (69%), gastrointestinais (66%), anemia (66%) e dermatolÃgicas (55%). Em relaÃÃo Ãs manifestaÃÃes gastrointestinais verificou-se que pacientes com Taxa de ReduÃÃo da UrÃia <65% tinham duas vezes mais chance de apresentar tais manifestaÃÃes (RR-1,90) Ic 95% (1,43-2,5). A sorologia positiva para hepatite C foi observada em 25% dos indivÃduos. Sendo que pacientes com mais de 5 anos em tratamento dialÃtico tem 4 vezes mais chances de ter hepatite C. (RR 3,99) Ic 95% (1,72-9,20). Das manifestaÃÃes observadas durante as sessÃes de hemodiÃlises a mais freqÃente foi a cefalÃia 66% (55). A presenÃa de alguma manifestaÃÃo clÃnica foi verificada em 100% dos pacientes e aqueles que tinham mais tempo de hemodiÃlise (> 5 anos) apresentaram maior nÃmero de manifestaÃÃes quando comparados com indivÃduos com menor tempo em HD (< 5 anos), sendo esta diferenÃa estatisticamente significante (p=0,043). O Sistema Ãnico de SaÃde foi o responsÃvel por 94% dos atendimentos. Conclue-se que indivÃduos semi-analfabeto do sexo masculino com idade superior aos 45 anos e renda entre 1 e 2 salÃrio mÃnimos sÃo os indivÃduos mais atingidos pela IRCT embora esta possa atingir qualquer pessoa em qualquer perÃodo da vida. As manifestaÃÃes clÃnicas mais freqÃentes foram neurolÃgicas, cardiovasculares e musculoesquelÃticas. A garantia do acesso ao medicamento à negada a grande maioria destes pacientes, a falta do medicamento leva a ineficiÃncia de todo processo terapÃutico ocasionando transtorno ao paciente e diminuindo sua qualidade de vida