Odilon Vanni de Queiroz

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.

A construção da base de dados nacional em Terapia Renal Substitutiva (TRS) centrada no indivíduo: aplicação do método de linkage determinístico-probabilístico

Os sistemas de informação em saúde são ferramentas fundamentais para subsidiar a tomada de decisões e auxiliar a organização dos serviços, por meio do planejamento das ações e do acompanhamento e avaliação dos objetivos propostos. O sistema de saúde brasileiro tem larga experiência com a captura e o uso de informações. No entanto, Morais e Gómez (2007) fazem uma reflexão de que os atuais pressupostos, práticas e saberes de informação e informática em saúde não mais dão conta da complexidade do processo saúde/doença/cuidado, apontando algumas questões: a fragmentação dos indivíduos entre diversas bases de dados em saúde, o que acar-

Determinants of expenditures on dialysis in the Unified National Health System, Brazil, 2000 to 2004

The aim of this study was to compare total outpatient expenditures on hemodialysis and peritoneal dialysis from 2000 to 2004 in patients that began dialysis in 2000 under the Unified National Health System (SUS). A historical cohort was developed, consisting of patients that began dialysis in 2000, identified by probabilistic matching in the database of Authorizations for High-Complexity/High-Cost Procedures (APAC). A multiple linear regression model was used, including individual and clinical attributes and health services supply variables. The cohort included 10,899 patients, 88.5% of whom began hemodialysis and 11.5% peritoneal dialysis. The dialysis modality explains 12% of the variance in expenditures, and patients in peritoneal dialysis showed 20% higher mean annual expenditure. The differences in expenditures are explained according to the State of Brazil and health services supply level. Individual risk variables did not alter the models explanatory power, while age and diabetes mellitus were significant. The study showed the importance of the National Health Systems payment mechanism for explaining differences in expenditures on dialysis treatment in Brazil.

Ciclosporina versus tacrolimus no transplante renal no Brasil: uma comparação de custos

In Brazil, the Unified National Health System (SUS) is responsible for the majority of kidney transplants. To maintain these interventions, the guidelines recommend the use of cyclosporine or tacrolimus, associated with corticosteroids and azathioprine or mycophenolate. Taking the perspective of the National Health System, an economic analysis was performed on the outpatient and hospital resources and medicines used by patient and therapeutic group. A cohort was constructed from 2000 to 2004, with 5,174 kidney transplant patients in use of cyclosporine or tacrolimus, identified by probabilistic record linkage from the National Health System. The cohort included 4,015 patients in use of cyclosporine and 1,159 using tacrolimus. The majority were males, age < 38 years, with nephritis, cardiovascular diseases, and indeterminate causes as the most frequent primary diagnoses. After 48 months of follow-up, the expenditures were higher for kidney transplants in hospitals in the Northeast, cadaver donors, patients in dialysis > 24 months before the transplant, and in the tacrolimus group. Total hospital and outpatient costs and expenditure on medication were higher in patients on tacrolimus as compared to the cyclosporine group.

Cyclosporine Versus Tacrolimus in Immunosuppressive Maintenance Regimens in Renal Transplants in Brazil: Survival Analysis from 2000 to 2004

BACKGROUND In Brazil, the National Health System (SUS) is responsible for almost all renal transplants. SUS protocols recommend using cyclosporine, in association with azathioprine and corticosteroids, to maintain the immunosuppression that is essential for successful renal transplant. Alternatively, cyclosporine can be replaced by tacrolimus. OBJECTIVE To evaluate the effectiveness of therapeutic schema involving cyclosporine or tacrolimus after renal transplant during a 60-month follow-up period. METHODS A historical cohort study, from 2000 to 2004, was conducted using 5686 patients who underwent renal transplant and received cyclosporine or tacrolimus. Uni - and multivariate analyses were performed using the Cox model to examine factors associated with progression to treatment failure. RESULTS Most of the patients were male, aged 38 years or older, for whom the most frequent primary diagnosis of chronic renal failure (CRF) was glomerulonephritis/nephritis. Higher risk of treatment failure was associated with: therapeutic regimen (tacrolimus, HR 1.38, 95% CI 1.14 to 1.67), patient age at transplantation (additional year, HR 1.01, 95% CI 1.00 to 1.02), donor type (deceased, HR 1.60, 95% CI 1.35 to 1.89), median time of dialysis prior to transplantation (>24 mo, HR 1.29, 95% CI 1.09 to 1.52), and primary CRF diagnosis (diabetes, HR 1.54, 95% CI 1.09 to 2.17). CONCLUSIONS The risk of treatment failure of patients receiving tacrolimus was observed to be 1.38 times that of those receiving cyclosporine, after adjusting the model for possible confounding factors such as patient sex, patient age, graft origin, prior time of dialysis, and cause of CRF. Our results were obtained from an observational study, and further studies are necessary to evaluate whether compliance with SUS clinical protocols could result in more effective care for renal transplant recipients.

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.

Perfil demográfico e epidemiológico dos usuários de medicamentos de alto custo no Sistema Único de Saúde

The Program for High-Cost Medicines of the Brazilian Health Ministry was set up to respond to the demand for high unit-cost medication or for medication used for chronic diseases that imply a high overall cost for treatment. To describe the epidemiological and demographic profiles of patients enrolled in the program, a probabilistic-deterministic connection was made between data in sections of the Health Ministrys databases (DATASUS), namely, the Outpatient Information System (APAC/SIA) and the Mortality Information System (SIM). The cohort formed by linking databases identified 611,419 individuals who began treatment between 2000 and 2004. The analyses were disaggregated by sex, region of residence, diagnoses and most widely used drugs.The construction of this historical cohort made possible a description of the epidemiological characteristics and drugs used by the programs users. The database generated can also provide analyses for specific diseases, with results that can contribute to evaluations of effectiveness and efficiency of clinical protocols, in order to better inform decision-makers regarding the planning and supplying of high-cost medication by the Brazilian Health Ministry.The Program for High-Cost Medicines of the Brazilian Health Ministry was set up to respond to the demand for high unit-cost medication or for medication used for chronic diseases that imply a high overall cost for treatment. To describe the epidemiological and demographic profiles of patients enrolled in the program, a probabilistic-deterministic connection was made between data in sections of the Health Ministry’s databases (DATASUS), namely, the Outpatient Information System (APAC/SIA) and the Mortality Information System (SIM). The cohort formed by linking databases identified 611,419 individuals who began treatment between 2000 and 2004. The analyses were disaggregated by sex, region of residence, diagnoses and most widely used drugs.The construction of this historical cohort made possible a description of the epidemiological characteristics and drugs used by the program’s users. The database generated can also provide analyses for specific diseases, with results that can contribute to evaluations of effectiveness and efficiency of clinical protocols, in order to better inform decision-makers regarding the planning and supplying of high-cost medication by the Brazilian Health Ministry.

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.

Perfil demográfico y epidemiológico de los usuarios de medicamentos de costo elevado en el Sistema Único de Salud

The Program for High-Cost Medicines of the Brazilian Health Ministry was set up to respond to the demand for high unit-cost medication or for medication used for chronic diseases that imply a high overall cost for treatment. To describe the epidemiological and demographic profiles of patients enrolled in the program, a probabilistic-deterministic connection was made between data in sections of the Health Ministrys databases (DATASUS), namely, the Outpatient Information System (APAC/SIA) and the Mortality Information System (SIM). The cohort formed by linking databases identified 611,419 individuals who began treatment between 2000 and 2004. The analyses were disaggregated by sex, region of residence, diagnoses and most widely used drugs.The construction of this historical cohort made possible a description of the epidemiological characteristics and drugs used by the programs users. The database generated can also provide analyses for specific diseases, with results that can contribute to evaluations of effectiveness and efficiency of clinical protocols, in order to better inform decision-makers regarding the planning and supplying of high-cost medication by the Brazilian Health Ministry.The Program for High-Cost Medicines of the Brazilian Health Ministry was set up to respond to the demand for high unit-cost medication or for medication used for chronic diseases that imply a high overall cost for treatment. To describe the epidemiological and demographic profiles of patients enrolled in the program, a probabilistic-deterministic connection was made between data in sections of the Health Ministry’s databases (DATASUS), namely, the Outpatient Information System (APAC/SIA) and the Mortality Information System (SIM). The cohort formed by linking databases identified 611,419 individuals who began treatment between 2000 and 2004. The analyses were disaggregated by sex, region of residence, diagnoses and most widely used drugs.The construction of this historical cohort made possible a description of the epidemiological characteristics and drugs used by the program’s users. The database generated can also provide analyses for specific diseases, with results that can contribute to evaluations of effectiveness and efficiency of clinical protocols, in order to better inform decision-makers regarding the planning and supplying of high-cost medication by the Brazilian Health Ministry.

Epidemiological profile of high cost medicines users in the Brazilian Health System

The Program for High-Cost Medicines of the Brazilian Health Ministry was set up to respond to the demand for high unit-cost medication or for medication used for chronic diseases that imply a high overall cost for treatment. To describe the epidemiological and demographic profiles of patients enrolled in the program, a probabilistic-deterministic connection was made between data in sections of the Health Ministrys databases (DATASUS), namely, the Outpatient Information System (APAC/SIA) and the Mortality Information System (SIM). The cohort formed by linking databases identified 611,419 individuals who began treatment between 2000 and 2004. The analyses were disaggregated by sex, region of residence, diagnoses and most widely used drugs.The construction of this historical cohort made possible a description of the epidemiological characteristics and drugs used by the programs users. The database generated can also provide analyses for specific diseases, with results that can contribute to evaluations of effectiveness and efficiency of clinical protocols, in order to better inform decision-makers regarding the planning and supplying of high-cost medication by the Brazilian Health Ministry.The Program for High-Cost Medicines of the Brazilian Health Ministry was set up to respond to the demand for high unit-cost medication or for medication used for chronic diseases that imply a high overall cost for treatment. To describe the epidemiological and demographic profiles of patients enrolled in the program, a probabilistic-deterministic connection was made between data in sections of the Health Ministry’s databases (DATASUS), namely, the Outpatient Information System (APAC/SIA) and the Mortality Information System (SIM). The cohort formed by linking databases identified 611,419 individuals who began treatment between 2000 and 2004. The analyses were disaggregated by sex, region of residence, diagnoses and most widely used drugs.The construction of this historical cohort made possible a description of the epidemiological characteristics and drugs used by the program’s users. The database generated can also provide analyses for specific diseases, with results that can contribute to evaluations of effectiveness and efficiency of clinical protocols, in order to better inform decision-makers regarding the planning and supplying of high-cost medication by the Brazilian Health Ministry.