Access to treatment for chronic kidney disease by children and adolescents in Brazil

Abstract

This study aimed to identify main factors associated with child and adolescent access to chronic kidney disease (CKD) treatment in Brazil. Multi-center cross-sectional study conducted in eight pediatric nephrology centers across all Brazilian geographic regions. Information was collected on characteristics associated with referral and treatment of patients with CKD. The following outcomes were analyzed as follows: (1) age at first consultation, and (2) time elapsed between referral and treatment at the specialized service. Three hundred thirty-five children were assessed. Variables associated with age at first consultation were as follows: CAKUT (HR=1.7; 95%CI 1.3–2.2, p<0.01); private health plan (HR=1.54; 95%CI 1.06–2.23, p=0.02); modified Medical Outcomes Study Social Support Survey mMOS-SS score (HR=1.02; 95%CI 1.00–1.03, p=0.024); maternal age (HR=0.96; 95%CI 0.95–0.97, p<0.01); and number of siblings in the household (HR=0.86; 95%CI 0.79–0.83, p<0.01). Significant variables associated with time elapsed between referral and treatment at the specialized service were as follows: each additional occupant sharing the household (HR=0.94; 95%CI:0.89–0.99, p=0.02), residing in the Northeast (HR=0.81; 95%CI:0.67–0.98, p=0.03) and having someone to take them to the physician (HR=1.36; 95%CI 1.07–1.74, p=0.01). The median time interval between patient referral and treatment by the service was 11 days (IQR 10–31). There are potentially modifiable factors hampering access of children with CKD to specialized treatment. The importance of the role of social support for the two outcomes should serve as an alert for health managers and professionals to consider this aspect throughout all steps of the care process of children with CKD.