Estrategia restrictiva vs liberal de transfusión de hemoderivados en pacientes con enfermedad renal crónica en el Hospital General del Norte de Guayaquil IEES Ceibos en el periodo de diciembre del 2022 a diciembre del 2023.

Abstract

Introduction: Chronic kidney disease (CKD) is frequently associated with anemia, commonly treated with blood transfusions. There are two transfusion strategies: a restrictive approach (Hb ≤ 7 g/dL) and a liberal one (Hb > 7 g/dL), and their impact on the prognosis of CKD patients remains debated. Objective: To determine whether there are differences in prognosis and adverse events between a restrictive transfusion strategy compared to a liberal approach in CKD patients. Materials and Methods: A retrospective cohort study in 682 patients with CKD hospitalized from December 2022 to December 2023. Groups with restrictive and liberal transfusion groups based on pretransfusion hemoglobin thresholds. Qualitative variables were analyzed using Chi-square and Fisher's exact test, while quantitative variables were analyzed using Student's t-test or median. A logistic regression model was fitted, showing Odds Ratios (OR) with 95% confidence intervals, considering p < 0.05 significant. Results: Out of 934 CKD patients who received transfusions during the study period, 682 were included after applying exclusion criteria. Of these, 61.9% were men with a mean age of 58 ± 14 years. The most prevalent comorbidities were hypertension (56.9%), diabetes mellitus (30.6%), and ischemic heart disease (9.4%). More mild adverse events were observed in the liberal group (25.2% vs. 12.6%, p < 0.001), as well as moderate to severe adverse events (9.7% vs. 3.8%, p < 0.001) and hospital stays exceeding 10 days (32% vs. 10.5%, p < 0.001) in the liberal group compared to the restrictive group. Conclusion: The findings of this study support that the restrictive transfusion approach in CKD patients with anemia is more favorable in terms of adverse events and hospital stay duration compared to the liberal approach.