International urology and nephrology · 2025
Registry of access to chronic dialysis initiation at the Public Health System in Brazil.
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Samaan Farid, Clemente Áurea Maria Izabel, Zaicaner Raquel, Kirsztajn Gianna Mastroianni, Sesso Ricardo
Аннотация
INTRODUCTION: We aim to analyze the requests for the initiation of kidney replacement therapy (KRT) in the public health system of the state of São Paulo, Brazil.
METHODS: Initial KRT requests sent to the Regulation Center of the State Department of Health between 01/01/2023 and 12/31/2024 were evaluated. KRT initiation was considered "planned" if it occurred outside the hospital environment or the patient started hemodialysis (HD) with an arteriovenous fistula (AVF).
RESULTS: A total of 8451 individuals from 17 healthcare macroregions were included [median interquartile range (IQR)] age: 62 (51-71) years; male sex: 60%; etiology of CKD: 57% hypertension and 21% diabetes). Conservative predialysis treatment of CKD was implemented for 26% of patients in the state, ranging from 4 to 44% in the macroregions. The percentage of patients initiating HD with AVF was 10% (variation in macroregions: 4-25%), and people who initiated KRT in hospital were 70% (37-94%). The initial modality was HD in 95% of the patients (range: 73-100%) (peritoneal dialysis in 5% [(0-27%)], and the median waiting time for a KRT slot vacancy was 12 (IQR: 6-29) days (1 (1-4) to 31 (14-75) in macroregions). Multiple regression analysis revealed that conservative treatment of CKD was independently associated with planned initiation of KRT (odds ratio [OR] [95% confidence interval (CI) = 4.99 (4.48-5.54); p < 0.001].
CONCLUSION: The results demonstrate the need to adopt actions to implement pre-dialysis care for people with CKD and to mitigate regional inequalities in access to chronic dialysis in this population.
METHODS: Initial KRT requests sent to the Regulation Center of the State Department of Health between 01/01/2023 and 12/31/2024 were evaluated. KRT initiation was considered "planned" if it occurred outside the hospital environment or the patient started hemodialysis (HD) with an arteriovenous fistula (AVF).
RESULTS: A total of 8451 individuals from 17 healthcare macroregions were included [median interquartile range (IQR)] age: 62 (51-71) years; male sex: 60%; etiology of CKD: 57% hypertension and 21% diabetes). Conservative predialysis treatment of CKD was implemented for 26% of patients in the state, ranging from 4 to 44% in the macroregions. The percentage of patients initiating HD with AVF was 10% (variation in macroregions: 4-25%), and people who initiated KRT in hospital were 70% (37-94%). The initial modality was HD in 95% of the patients (range: 73-100%) (peritoneal dialysis in 5% [(0-27%)], and the median waiting time for a KRT slot vacancy was 12 (IQR: 6-29) days (1 (1-4) to 31 (14-75) in macroregions). Multiple regression analysis revealed that conservative treatment of CKD was independently associated with planned initiation of KRT (odds ratio [OR] [95% confidence interval (CI) = 4.99 (4.48-5.54); p < 0.001].
CONCLUSION: The results demonstrate the need to adopt actions to implement pre-dialysis care for people with CKD and to mitigate regional inequalities in access to chronic dialysis in this population.