Elaine Leandro Machado

Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004

OBJECTIVE To describe the clinical and epidemiological profile of patients under renal replacement therapies, identifying risk factors for death. METHODS This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministic-probabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%). The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the final Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a first modality and not having renal transplantation. CONCLUSIONS There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and Northeast region and lack of renal transplant.OBJETIVO: Describir el perfil epidemiologico y clinico de pacientes en terapia renal substitutiva, identificando factores asociados al riesgo de muerte. METODOS: Estudio de observacion, prospectivo no concurrente, a partir de datos de 90.356 pacientes de la Base Nacional en Terapias Renales Substitutivas, en Brasil. Fue realizado reracionamiento deterministico-probabilistico del Sistema de Informacion de Mortalidad. Fueron incluidos todos los pacientes incidentes que iniciaron dialisis entre 1/1/2000 y 31/12/2004, acompanados hasta la muerte o final de 2004. Edad, sexo, region de residencia, enfermedad renal primaria, causa del obito fueron analizados. Se ajusto un modelo de riesgos proporcionales para identificar factores asociados al riesgo de muerte. RESULTADOS: Ocurrio un aumento promedio de 5,5% en la prevalencia de pacientes en terapia, con relacion a la incidencia se mantuvo estable en el periodo. Hemodialisis fue la modalidad inicial predominante (89%). La mayoria de los pacientes era del sexo masculino, con edad promedio de 53 anos, residente en la region Sureste y presentaba causa indeterminada como principal causa basica de la enfermedad renal cronica, seguida de la hipertension, diabetes y glomerulonefritis. De esos pacientes, 7% realizaron transplante renal y 42% evolucionaron a obito. Los pacientes en dialisis peritoneal eran mas ancianos y presentaban mayor prevalencia de diabetes. Entre los no transplantados, 45% fueron a obito y, entre los transplantadas 7%. En el modelo final de riesgos proporcionales de Cox, el riesgo de mortalidad estuvo asociado con el aumento de la edad, sexo femenino, tener diabetes, residir en la region Norte y Noreste, dialisis peritoneal como modalidad de entrada y no haber realizado transplante renal. CONCLUSIONES: Hubo aumento de la prevalencia de pacientes en terapia renal en Brasil. Pacientes con edad avanzada, diabetes, del sexo femenino, residentes en la region Norte y Noreste y sin transplante renal presentan mayor riesgo de muerte.

Perfil e desfecho clínico de pacientes em lista de espera por transplante renal, Belo Horizonte (MG, Brasil), 2000-2005

This is an observational, follow up study in order to characterize the patients profile in waiting list to kidney transplantation between 01/01/2000 and 12/31/2004 in Belo Horizonte (MG, Brazil) and their outcome in 12/31/2005. Sociodemographic and clinical characteristics of patients residents in Belo Horizonte city, 18 years of age or older was collected from State Transplantations Center of MG. Health professionals involved with transplantations answered to interviews to describe access barriers to it. Descriptive and comparative statistical analyses were performed with secondary data and qualitative analyses of the interviews were made. It was enrolled 835 patients. At the end of the study, 22.7% were transplanted, 15.6% died, 15.4% were drifted away and 46.2% remained on the waiting list. Transplanted patients were younger, professionally occupied, blood type A, have glomerulonephritis as basic ERSD cause, less diabetes prevalence and lower time between the beginning of the dialysis treatment until inclusion on the waiting list, compared with non-transplanted patients. Sociodemographic and clinical characteristics were associated with kidney transplantation access, described as a complex process which involves primary care determinants until kidney allocation.

Epidemiological profile of patients on renal replacement therapy in Brazil, 2000-2004.

OBJECTIVE To describe the clinical and epidemiological profile of patients under renal replacement therapies, identifying risk factors for death. METHODS This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministic-probabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%). The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the final Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a first modality and not having renal transplantation. CONCLUSIONS There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and Northeast region and lack of renal transplant.OBJETIVO: Describir el perfil epidemiologico y clinico de pacientes en terapia renal substitutiva, identificando factores asociados al riesgo de muerte. METODOS: Estudio de observacion, prospectivo no concurrente, a partir de datos de 90.356 pacientes de la Base Nacional en Terapias Renales Substitutivas, en Brasil. Fue realizado reracionamiento deterministico-probabilistico del Sistema de Informacion de Mortalidad. Fueron incluidos todos los pacientes incidentes que iniciaron dialisis entre 1/1/2000 y 31/12/2004, acompanados hasta la muerte o final de 2004. Edad, sexo, region de residencia, enfermedad renal primaria, causa del obito fueron analizados. Se ajusto un modelo de riesgos proporcionales para identificar factores asociados al riesgo de muerte. RESULTADOS: Ocurrio un aumento promedio de 5,5% en la prevalencia de pacientes en terapia, con relacion a la incidencia se mantuvo estable en el periodo. Hemodialisis fue la modalidad inicial predominante (89%). La mayoria de los pacientes era del sexo masculino, con edad promedio de 53 anos, residente en la region Sureste y presentaba causa indeterminada como principal causa basica de la enfermedad renal cronica, seguida de la hipertension, diabetes y glomerulonefritis. De esos pacientes, 7% realizaron transplante renal y 42% evolucionaron a obito. Los pacientes en dialisis peritoneal eran mas ancianos y presentaban mayor prevalencia de diabetes. Entre los no transplantados, 45% fueron a obito y, entre los transplantadas 7%. En el modelo final de riesgos proporcionales de Cox, el riesgo de mortalidad estuvo asociado con el aumento de la edad, sexo femenino, tener diabetes, residir en la region Norte y Noreste, dialisis peritoneal como modalidad de entrada y no haber realizado transplante renal. CONCLUSIONES: Hubo aumento de la prevalencia de pacientes en terapia renal en Brasil. Pacientes con edad avanzada, diabetes, del sexo femenino, residentes en la region Norte y Noreste y sin transplante renal presentan mayor riesgo de muerte.

Iniquities in the access to renal transplant for patients with end-stage chronic renal disease in Brazil

The objective of this present study is to analyze individual and contextual factors associated with access to renal transplant in Brazil. An observational, prospective and non-concurrent study was carried out, based on data from the National Database on renal replacement therapies in Brazil. Patients undergoing dialysis between 01/Jan/2000 and 31/Dec/2000 were included and monitored up to the point of transplant, death or until the end of the study period. Variables that were analyzed included: individual variables (age, sex, region of residence, primary renal disease, hospitalizations); and context variables concerning both the dialysis unit (level of complexity, juridical nature, hemodialysis machines and location) and the city (geographic region, location and HDI). Proportional hazard models were adjusted with hierarchical entry to identify factors associated with the risk of transplant. The results point to differentials in access according to socio-demographic, clinical, geographic and social factors, indicating that the organ allocation system has not eliminated avoidable disparities for those who compete for an organ in the nationwide waiting list.

Uma avaliação da satisfação de pacientes em hemodiálise crônica com o tratamento em serviços de diálise no Brasil

O objetivo deste artigo foi avaliar a satisfacao dos pacientes em tratamento hemodialitico cronico com o cuidado recebido nos servicos de dialise. Trata-se de estudo transversal desenvolvido a partir de amostra nacionalmente representativa de pacientes portadores de doenca renal cronica terminal (N = 3.036) em tratamento em servicos de dialise e centros transplantadores do Brasil. Os pacientes em hemodialise (HD) responderam a um questionario de satisfacao especifico para essa modalidade, cujas questoes envolveram satisfacao com equipe, ambiente e cuidado prestado, e impacto da dialise nas atividades diarias. Para obter um escore de satisfacao desses pacientes, foram utilizados modelos de Teoria de Resposta ao Item na analise dos 22 itens do questionario. A regressao linear foi utilizada para avaliar a associacao entre fatores socioeconomicos, demograficos, clinicos e estruturais dos servicos de dialise e os escores de satisfacao. Dos pacientes entrevistados, 1.621 estavam em HD no momento da entrevista. Todos responderam ao questionario de satisfacao. A maioria era do sexo masculino, cor da pele nao-branca, escolaridade < 11 anos e nao relataram depressao. A idade media foi de 49 anos. A analise dos dados revelou que ter menor idade, ter depressao, possuir maior tempo de tratamento dialitico e despender maior tempo de deslocamento da residencia ate o servico de dialise estiveram associados a menor nivel de satisfacao com os servicos de dialise. Sugere-se que, para avaliar a satisfacao dos usuarios, seja importante considerar, alem dos fatores individuais, os atributos relacionados aos servicos de saude, confirmando sua natureza multidimensional.

Fatores associados ao tempo de espera e ao acesso ao transplante renal em Belo Horizonte, Minas Gerais, Brasil

The objective of this study was to analyze factors associated with access to kidney transplants from living and cadaver donors in Belo Horizonte, Minas Gerais State, Brazil. The authors conducted a non-concurrent cohort study of patients on the waiting list for kidney transplants from 2000 to 2004 and followed until transplantation, death, exclusion, or continued presence on the line at the end of the study on December 31, 2005. The Cox model was used for competing risks. Of the 835 patients, 22.7% were transplanted. Lower risk of transplantation from living donors and cadavers was observed in patients with more time on dialysis and blood type O. Lower risk of transplantation from living donors was observed in residents in a high health risk area and in recipients with diabetes. The greatest disparity in access was observed in transplants from living donors, since there were no significant socio-demographic differences in transplants from cadaver donors. One can infer that the organ allocation system contributed to mitigating socio-demographic inequalities, and that clinical issues were more relevant in access to transplants from cadaver donors.

Planned dialysis and regular use of primary care by diabetic patients in the city of Belo Horizonte, Minas Gerais State, Brazil

The objective was to analyze factors associated with planned initiation of dialysis in diabetic patients in the city of Belo Horizonte, Minas Gerais State, Brazil. This was a cross-sectional study of 250 diabetic patients who began dialysis between January 2006 and December 2007. Initiating dialysis with an arteriovenous fistula or in peritoneal dialysis was classified as planned initiation. The study targeted socio-demographic, clinical, and health services use variables using a semi-structured interview. Multivariate analysis used Poisson regression. Seventy per cent of the patients began dialysis on an unplanned basis, and 67% of those consulted had been referred to a nephrologist more than four months previously. Attending a health center, not having the first nephrology appointment paid for by the Brazilian Unified National Health System, and having a choice of treatment for the kidney disease were associated with planned initiation of dialysis. Unplanned initiation of dialysis is common in the city of Belo Horizonte and occurs regardless of the time since referral to the nephrologist.

Diálise planejada e a utilização regular da atenção primária à saúde entre os pacientes diabéticos do Município de Belo Horizonte, Minas Gerais, Brasil

O objetivo foi de analisar os fatores associados ao inicio planejado da dialise dos pacientes diabeticos que iniciaram o tratamento no Municipio de Belo Horizonte, Minas Gerais, Brasil. Estudo transversal com 250 pacientes diabeticos que iniciaram dialise entre janeiro de 2006 e dezembro de 2007. Iniciar a dialise com fistula arteriovenosa ou em dialise peritoneal foi classificado como inicio planejado. Foram investigadas as variaveis sociodemograficas, clinicas e de utilizacao de servicos de saude por meio de entrevista semiestruturada. Para analise multivariada utilizou-se regressao de Poisson. Setenta por cento dos pacientes comecaram a dialise de forma nao planejada e 67% dos que consultaram com o nefrologista foram encaminhados com mais de quatro meses. Frequentar o centro de saude, nao ter a primeira consulta com nefrologista paga pelo SUS e ter tido opcao de escolha para o tratamento da doenca renal foram fatores relacionados ao inicio planejado da dialise. O inicio nao planejado da dialise e comum no Municipio de Belo Horizonte e ocorre independentemente do tempo de encaminhamento ao nefrologista.

Perfil epidemiológico de los pacientes en terapia renal substitutiva en Brasil, 2000-2004

OBJECTIVE To describe the clinical and epidemiological profile of patients under renal replacement therapies, identifying risk factors for death. METHODS This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministic-probabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%). The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the final Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a first modality and not having renal transplantation. CONCLUSIONS There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and Northeast region and lack of renal transplant.OBJETIVO: Describir el perfil epidemiologico y clinico de pacientes en terapia renal substitutiva, identificando factores asociados al riesgo de muerte. METODOS: Estudio de observacion, prospectivo no concurrente, a partir de datos de 90.356 pacientes de la Base Nacional en Terapias Renales Substitutivas, en Brasil. Fue realizado reracionamiento deterministico-probabilistico del Sistema de Informacion de Mortalidad. Fueron incluidos todos los pacientes incidentes que iniciaron dialisis entre 1/1/2000 y 31/12/2004, acompanados hasta la muerte o final de 2004. Edad, sexo, region de residencia, enfermedad renal primaria, causa del obito fueron analizados. Se ajusto un modelo de riesgos proporcionales para identificar factores asociados al riesgo de muerte. RESULTADOS: Ocurrio un aumento promedio de 5,5% en la prevalencia de pacientes en terapia, con relacion a la incidencia se mantuvo estable en el periodo. Hemodialisis fue la modalidad inicial predominante (89%). La mayoria de los pacientes era del sexo masculino, con edad promedio de 53 anos, residente en la region Sureste y presentaba causa indeterminada como principal causa basica de la enfermedad renal cronica, seguida de la hipertension, diabetes y glomerulonefritis. De esos pacientes, 7% realizaron transplante renal y 42% evolucionaron a obito. Los pacientes en dialisis peritoneal eran mas ancianos y presentaban mayor prevalencia de diabetes. Entre los no transplantados, 45% fueron a obito y, entre los transplantadas 7%. En el modelo final de riesgos proporcionales de Cox, el riesgo de mortalidad estuvo asociado con el aumento de la edad, sexo femenino, tener diabetes, residir en la region Norte y Noreste, dialisis peritoneal como modalidad de entrada y no haber realizado transplante renal. CONCLUSIONES: Hubo aumento de la prevalencia de pacientes en terapia renal en Brasil. Pacientes con edad avanzada, diabetes, del sexo femenino, residentes en la region Norte y Noreste y sin transplante renal presentan mayor riesgo de muerte.