RESUMEN

Coronavirus disease 2019 (COVID-19) has been declared a pandemic. Peritoneal dialysis (PD), being a home therapy, allows for physical distancing measures and movement restrictions. In order to prevent COVID-19 contagioun among the Dominican Republic National Health System PD program patients, a follow-up virtual protocol for this group was developed. The aim of this study is to outline the protocol established by the PD program's healthcare team using telemedicine in order to avoid COVID-19 transmission and to report initial results and outcomes of this initiative. This is an observational prospective longitudinal study with 946 patients being treated in seven centers distributed throughout the country between April 1 and June 30. The protocol was implemented focusing on the patient follow-up; risk mitigation data were registered and collected from electronic records. During the follow-up period, 95 catheters were implanted, 64 patients initiated PD, and the remaining were in training. A total of 9532 consultations were given by the different team specialists, with 8720 (91%) virtual and 812 (9%) face-to-face consultations. The transfer rate to hemodialysis was 0.29%, whereas the peritonitis rate was 0.11 episode per patient/year. Eighteen adults tested positive for COVID-19. The implementation of the protocol and telemedicine utilization have ensured follow-up and monitoring, preserved therapy, controlled complications, and PD lives protected.

Asunto(s)

COVID-19/prevención & control , Protocolos Clínicos , Continuidad de la Atención al Paciente/estadística & datos numéricos , Diálisis Peritoneal/métodos , Telemedicina/métodos , Adulto , Anciano , Anciano de 80 o más Años , República Dominicana , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pandemias , Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Peritonitis/prevención & control , Estudios Prospectivos , SARS-CoV-2 , Adulto Joven

RESUMEN

INTRODUCTION: Data on impact of high body mass index (BMI) on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Objective: To evaluate impact of BMI on cohort of incident elderly PD patients over time. METHODS: Prospective multicenter cohort study (December / 2004-October/2007) with 674 patients. Socio-demographic and clinical data evaluated with patients followed until death, transfer to hemodialysis (HD), recovery of renal function, loss of follow-up or transplant. Patients were divided into incident on renal replacement therapy (RRT) for PD (PD first: 230) and transferred from hemodialysis (HD first: 444). Analysis was performed comparing these two groups using chi-square or Kruskal Wallis. Similar analysis was used to compare patients on automated peritoneal dialysis (APD) vs. continuous ambulatory peritoneal dialysis (CAPD). Data were compared between patients according to BMI by ANOVA, Kruskal Wallis or chi-square. For analysis of survival, Kaplan Meier method was used and to adjust confounding variables, Cox regression proportional hazard. Joint model for longitudinal and time-dependent data was conducted, assessing impact that a longitudinal variable displays on time of survival. RESULTS: Malnourished patients (76.79 ± 7.53 years) were older (p < 0.0001) with higher percentage of death (44.6%, p = 0.001); diabetes mellitus showed high prevalence in obese patients (68%, p < 0.0001); higher blood pressure levels (p = 0.002) were present in obese and overweight patients. CONCLUSIONS: Increased BMI variation over time proved to be a protective factor, with a decrease of about 1% in risk of death for every BMI unit earned.

Asunto(s)

Índice de Masa Corporal , Diálisis Peritoneal/mortalidad , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Estudios Prospectivos

RESUMEN

Abstract Introduction: Data on impact of high body mass index (BMI) on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Objective: To evaluate impact of BMI on cohort of incident elderly PD patients over time. Methods: Prospective multicenter cohort study (December / 2004-October/2007) with 674 patients. Socio-demographic and clinical data evaluated with patients followed until death, transfer to hemodialysis (HD), recovery of renal function, loss of follow-up or transplant. Patients were divided into incident on renal replacement therapy (RRT) for PD (PD first: 230) and transferred from hemodialysis (HD first: 444). Analysis was performed comparing these two groups using chi-square or Kruskal Wallis. Similar analysis was used to compare patients on automated peritoneal dialysis (APD) vs. continuous ambulatory peritoneal dialysis (CAPD). Data were compared between patients according to BMI by ANOVA, Kruskal Wallis or chi-square. For analysis of survival, Kaplan Meier method was used and to adjust confounding variables, Cox regression proportional hazard. Joint model for longitudinal and time-dependent data was conducted, assessing impact that a longitudinal variable displays on time of survival. Results: Malnourished patients (76.79 ± 7.53 years) were older (p < 0.0001) with higher percentage of death (44.6%, p = 0.001); diabetes mellitus showed high prevalence in obese patients (68%, p < 0.0001); higher blood pressure levels (p = 0.002) were present in obese and overweight patients. Conclusions: Increased BMI variation over time proved to be a protective factor, with a decrease of about 1% in risk of death for every BMI unit earned.

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Resumo Introdução: Dados sobre o impacto do índice de massa corporal (IMC) sobre mortalidade de pacientes em diálise peritoneal (DP), especialmente entre os idosos, são inconsistentes. Objetivo: Avaliar o impacto do IMC sobre a mortalidade de coorte de pacientes incidentes idosos em DP ao longo do tempo. Métodos: Estudo de coorte prospectivo multicêntrico (dezembro de 2004 a outubro de 2007), com 674 pacientes. Avaliados dados sociodemográficos, clínicos e pacientes acompanhados até morte, transferência para hemodiálise (HD), recuperação da função renal, perda de seguimento ou transplante. Pacientes foram divididos em incidentes em terapia renal substitutiva por PD (230) e transferidos da hemodiálise (444). A análise foi feita comparando estes dois grupos usando Qui-Quadrado ou Kruskal Wallis. Análise semelhante foi utilizada para comparar os pacientes em diálise peritoneal automatizada vs. diálise peritoneal ambulatorial contínua. Os dados foram comparados entre pacientes de acordo com o IMC por ANOVA, Kruskal Wallis ou Qui-Quadrado. Para análise de sobrevivência, método de Kaplan Meier foi utilizado e, para ajustar variáveis confundidoras, usada regressão de Cox. Um modelo conjunto para dados longitudinais tempo-dependente foi utilizado, avaliando o impacto de variações longitudinais sobre a sobrevida. Resultados: Pacientes desnutridos (76,79 ± 7,53 anos), eram mais velhos (p < 0,0001) e apresentaram maior mortalidade (44,6%, p = 0,001). Diabetes mellitus foi mais prevalente em obesos (68%, p < 0,0001); níveis mais elevados de pressão arterial (p = 0,002) também foram mais frequentes em obesos e com sobrepeso. Conclusão: A variação positiva do IMC ao longo do tempo provou ser um fator de proteção, com uma diminuição de cerca de 1% no risco de morte por unidade de elevação do IMC.

Asunto(s)

Humanos , Masculino , Femenino , Anciano , Índice de Masa Corporal , Diálisis Peritoneal/mortalidad , Estudios Prospectivos , Estudios de Cohortes

RESUMEN

BACKGROUND: Insulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial. METHODS: This was a multicenter, open-label study with balanced randomization (1:1) and two parallel-groups. Inclusion criteria were non-diabetic adult patients on automated peritoneal dialysis (APD) for at least 3 months on therapy prior to randomization. Patients assigned to the intervention group were treated with 2L of icodextrin 7.5%, and the control group with glucose 2.5% during the long dwell and, at night in the cycler, with a prescription of standard glucose-based PD solution only in both groups. The primary end-point was the change in insulin resistance measured by homeostatic model assessment (HOMA) index at 90 days. RESULTS: Sixty patients were included in the intervention (n = 33) or the control (n = 27) groups. There was no difference between groups at baseline. After adjustment for pre-intervention HOMA index levels, the group treated with icodextrin had the lower post-intervention levels at 90 days in both intention to treat [1.49 (95% CI: 1.23-1.74) versus 1.89 (95% CI: 1.62-2.17)], (F = 4.643, P = 0.03, partial η(2) = 0.078); and the treated analysis [1.47 (95% CI: 1.01-1.84) versus 2.18 (95% CI: 1.81-2.55)], (F = 7.488, P = 0.01, partial η(2) = 0.195). CONCLUSIONS: The substitution of glucose for icodextrin for the long dwell improved insulin resistance measured by HOMA index in non-diabetic APD patients.

Asunto(s)

Soluciones para Diálisis/farmacología , Glucanos/farmacología , Glucosa/farmacología , Resistencia a la Insulina/fisiología , Diálisis Peritoneal Ambulatoria Continua/métodos , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Icodextrina , Masculino , Persona de Mediana Edad , Factores de Riesgo

RESUMEN

INTRODUCTION: In an attempt to decrease mortality in patients with end-stage renal disease, an increase in the lifetime of these patients without much focus on health-related quality of life (HRQOL) was pursued for a long period of time. However, lately, an improvement in the quality of this extended lifetime has focused on both the physical as well as the social and emotional aspects, as these parameters may be associated with clinical outcomes in end-stage renal disease patients. AIM: To evaluate the impact of self-determined HRQOL at admission on survival of incident peritoneal dialysis (PD) patients. PATIENTS AND METHODS: A total of 1,624 incident Brazilian PD patients participating in a multicenter prospective cohort study (BRAZPD) were evaluated. HRQOL was assessed using the SF-36, divided into mental and physical components. Cox proportional regression analysis was used to determine the influence of HRQOL (mental and physical components) on mortality. Multivariate Cox proportional hazards analyses were used to adjust gradually for more potential explanatory variables: first for demographic variables, followed by additional adjustment for socioeconomic, clinical and laboratory variables. The significance level in all analyses was set at p < 0.05. All analyses were carried out with SPSS 17.0. RESULTS: Incident PD patients presented with low HRQOL scores on admission to therapy. Even after correction for sociodemographic variables, comorbidities, PD modality and laboratory parameters, HRQOL (both the mental and the physical components) remained a predictor [HR: 0.97 (CI: 0.95-0.98); HR: 0.97 (CI: 0.96-0.99), respectively] of survival. CONCLUSION: On admission to therapy, patients presenting with low HRQOL scores for both the mental and the physical components were associated with a higher mortality. These results suggest that early and timely intervention measures to improve the QOL of these patients are important.

Asunto(s)

Diálisis Peritoneal/mortalidad , Diálisis Peritoneal/psicología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores Socioeconómicos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto Joven

RESUMEN

INTRODUCTION: Peritonitis remains the main cause of peritoneal dialysis (PD) technique failure worldwide, despite significant reductions in infection rates observed over the past decades. Several studies have described risk factors for peritonitis, technique failure and mortality. However, there are scarce data regarding predictors of complications during and after a peritonitis episode. The aim of our study was to analyze predictors of peritonitis-related outcome in the Brazilian Peritoneal Dialysis study (BRAZPD) cohort. METHODS: All adult incident patients recruited in the BRAZPD Study between December 2004 and October 2007, who remained at least 90 days on PD and presented their first peritonitis episode (n = 474 patients) were included in the study. The endpoints analyzed were non-resolution, death due to a peritonitis episode and long-term technique survival after a peritonitis episode. RESULTS: In the multivariable regression, non-resolution was independently associated with older age (odds ratio (OR) 1.02; p < 0.01), collagenosis as the primary renal disease (OR 4.6; p < 0.05) and Pseudomonas spp as etiological agent (OR 2.9; p < 0.05). Patients who were transferred from APD to CAPD during peritonitis therapy presented a higher risk of non-response (OR 2.5; p < 0.05). The only factor associated with death during a peritonitis episode was older age (OR 1.04; p < 0.05). Exposure to vancomycin and male gender were the independent predictors of long-term technique failure (OR 2.2; p < 0.01). CONCLUSION: Apart from confirming previous observations of the negative impact of older age and Pseudomonas spp peritonitis on outcomes, we observed that collagenosis may negatively impact response to treatment and exposure to vancomycin may possibly reduce long-term technique survival. It is important to emphasize that the association of vancomycin with technique failure does not prove causality. These findings shed light on new factors predicting outcome when peritonitis is diagnosed.

Asunto(s)

Fallo Renal Crónico/terapia , Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Adulto , Anciano , Brasil , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Peritonitis/mortalidad , Análisis de Regresión , Factores de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

BACKGROUND AND OBJECTIVES: A large proportion of the patients on peritoneal dialysis (PD) in Brazil have low levels of education and family income. The present study assessed whether education level and family income are associated with baseline and longitudinal changes in health-related quality of life (HRQOL) scores during the first year of PD therapy. METHODS: We evaluated 1624 incident patients from the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) at baseline, and 486 of them after 12 months. The SF-36 was used to determine HRQOL and the Karnofsky index (KI), physical performance. RESULTS: At baseline, patients received high KI scores compared with scores on the SF-36. The means of the mental and physical components at baseline and after 12 months were 39.9 ± 10.5 compared with 38.7 ± 11.7 and 41.8 ± 9.6 compared with 40.7 ± 9.8 respectively, which were not statistically different. A multivariate regression analysis showed that age, sex, diabetes, and cardiovascular disease were predictors of the mental component (respectively, ß = 0.12, p < 0.001; ß = 0.11, p < 0.001; ß = -0.08, ß = 0.007; and ß = -0.07, p = 0.007) and that age, sex, diabetes, cardiovascular disease, hemoglobin, glucose, and creatinine were predictors of the physical component (respectively, ß = -0.28, p < 0.001; ß = 0.06, p = 0.009; ß = -0.09, p = 0.002; ß = -0.09, p = 0.001; ß = 0.07, p = 0.004; ß = -0.05, p = 0.040; and ß = 0.05, p = 0.040). Education level and family income were not significantly associated with HRQOL (mental and physical components) in the multivariate regression. CONCLUSIONS: The results indicate that, as predictors, family income and education level have no impact on HRQOL, supporting the idea that socio-economic status should not be a barrier to the selection of PD as a treatment modality in Brazil.

Asunto(s)

Estado de Salud , Diálisis Peritoneal , Calidad de Vida , Adulto , Anciano , Brasil , Escolaridad , Femenino , Indicadores de Salud , Humanos , Renta , Masculino , Persona de Mediana Edad , Análisis Multivariante

RESUMEN

INTRODUCTION: Automated assisted peritoneal dialysis (AAPD) has been shown to be successful as renal replacement therapy for elderly and physically incapable end-stage renal disease (ESRD) patients. In early 2003, a pioneer AAPD program was initiated at GAMEN Renal Clinic in Rio de Janeiro, Brazil. ♢ OBJECTIVE: We evaluated the results of an AAPD program offered as an option to elderly ESRD patients with physical or cognitive debilities or as last resort to patients with vascular access failure or hemodynamic instability during hemodialysis. ♢ METHODS: A cohort of 30 consecutive patients started AAPD from January 2003 to March 2008 and was followed to July 2009. Demographics, clinical and laboratory parameters, causes of death, and patient and technique survival were analyzed. ♢ RESULTS: Median age of the patients was 72 years (range: 47 - 93 years), with 60% being older than 65. The Davies score was greater than 2 in 73% of patients, and the Karnofsky index was less than 70 in 40%. The overall peritonitis rate was 1 episode in 37 patient-months. The total duration of AAPD ranged from 3 to 72 months. Patient survival was 80% at 12 months, 60% at 24 months, and 23.3% at 48 months. The most common cause of death was cardiovascular problems (70%). ♢ CONCLUSIONS: In this clinical observational study, AAPD fulfilled its expected role, offering an opportune, reliable, and effective homecare alternative for ESRD patients with no other renal replacement therapy options.

Asunto(s)

Servicios de Atención de Salud a Domicilio/organización & administración , Diálisis Peritoneal/métodos , Anciano , Anciano de 80 o más Años , Brasil , Causas de Muerte , Comorbilidad , Femenino , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal/normas , Peritonitis/epidemiología , Desarrollo de Programa

RESUMEN

BACKGROUND: There are no available epidemiologic studies about the impact of ethnicity on outcomes of patients treated with peritoneal dialysis (PD) in South America. This study aims to assess the effect of ethnicity on the mortality of incident PD patients in Brazil. STUDY DESIGN: Prospective observational cohort study of incident patients treated with PD. SETTINGS & PARTICIPANTS: Patients 18 years or older who started PD therapy between December 2004 and October 2007 in 114 Brazilian dialysis centers. PREDICTORS: Self-reported ethnicity defined by the Brazilian Institute of Geography and Statistics as black and brown versus white patients and baseline demographic, socioeconomic, clinical, and laboratory data were collected at baseline. OUTCOME: Mortality, using cumulative mortality curves in which kidney transplantation and transfer to hemodialysis therapy were treated as competing end points. Multivariate Cox proportional hazards analysis was used to adjust for gradually more potential explanatory variables, censored for kidney transplantation and transfer to hemodialysis therapy. Analyses were performed for all patients, as well as stratified for elderly (aged ≥65 years) and nonelderly patients. RESULTS: 1,370 patients were white, 516 were brown, and 273 were black. The competing-risk model showed higher mortality in white patients compared with black and brown patients. With white patients as the reference, Cox proportional hazards analysis showed a crude HR for mortality of 0.77 (95% CI, 0.56-1.05) for black and 0.74 (95% CI, 0.59-0.94) for brown patients. After adjusting for potential explanatory factors, HRs were 0.67 (95% CI, 0.48-0.95) and 0.77 (95% CI, 0.43-1.01), respectively. The same results were observed in elderly and nonelderly patients. LIMITATIONS: Ethnicity was self-determined and some misclassification might have occurred. CONCLUSIONS: Black and brown Brazilian incident PD patients have a lower mortality risk compared with white patients.

Asunto(s)

Población Negra/etnología , Fallo Renal Crónico/etnología , Fallo Renal Crónico/mortalidad , Diálisis Peritoneal/mortalidad , Población Blanca/etnología , Adulto , Anciano , Brasil/etnología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de Supervivencia/tendencias

RESUMEN

OBJECTIVES: To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients. PATIENTS AND METHODS: Patients (n = 1911) older than 18 years of age recruited from 114 dialysis centers (Dec/ 2004-Oct/2007) and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died). RESULTS: Survival analyses were performed using Kaplan-Meier survival curves and Cox proportional hazards. Total follow-up was 34 months. The mean age was 59 years (54% female). The weight category percentages were as follows: underweight: 8%; normal: 51%; overweight: 29%; and obese 12%. The multivariate model showed a higher risk of death for a body mass index <18.5 kg/m², a neutral risk between 25 and 29.9 kg/m² and a protective effect for an index >30 kg/m². Patients were divided into five categories according to quintiles of body weight changes during the first year of dialysis: <-3.1%, -3.1 to+0.12%, +0.12 to <+3.1% (reference category), +3.1 to +7.1% and >+7.1%. Patients in the lowest quintile had significantly higher mortality, whereas no negative impact was observed in the other quintiles. CONCLUSION: These findings suggest that overweight/obesity and a positive body weight variation during the first year of peritoneal dialysis therapy do not increase mortality in incident dialysis patients in Brazil.

Asunto(s)

Tamaño Corporal/fisiología , Sobrepeso/fisiopatología , Diálisis Peritoneal/mortalidad , Adulto , Anciano , Índice de Masa Corporal , Brasil , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatología , Factores de Riesgo , Distribución por Sexo , Resultado del Tratamiento

RESUMEN

OBJECTIVES: To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients. PATIENTS AND METHODS: Patients (n = 1911) older than 18 years of age recruited from 114 dialysis centers (Dec/ 2004-Oct/2007) and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died). RESULTS: Survival analyses were performed using Kaplan-Meier survival curves and Cox proportional hazards. Total follow-up was 34 months. The mean age was 59 years (54% female). The weight category percentages were as follows: underweight: 8%; normal: 51%; overweight: 29%; and obese 12%. The multivariate model showed a higher risk of death for a body mass index <18.5 kg/m², a neutral risk between 25 and 29.9 kg/m² and a protective effect for an index >30 kg/m². Patients were divided into five categories according to quintiles of body weight changes during the first year of dialysis: <-3.1%, -3.1 to+0.12%, +0.12 to <+3.1% (reference category), +3.1 to +7.1% and >+7.1%. Patients in the lowest quintile had significantly higher mortality, whereas no negative impact was observed in the other quintiles. CONCLUSION: These findings suggest that overweight/obesity and a positive body weight variation during the first year of peritoneal dialysis therapy do not increase mortality in incident dialysis patients in Brazil.

Asunto(s)

Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño Corporal/fisiología , Sobrepeso/fisiopatología , Diálisis Peritoneal/mortalidad , Índice de Masa Corporal , Brasil , Métodos Epidemiológicos , Obesidad/fisiopatología , Factores de Riesgo , Distribución por Sexo , Resultado del Tratamiento

RESUMEN

OBJECTIVES: Peritoneal dialysis (PD) patients may suffer changes in nutritional status after starting PD. Several markers can be used to evaluate these modifications, such as body mass index (BMI), serum albumin, and serum creatinine. Fluid overload should be considered because it can overestimate or underestimate nutritional status. The objective of this study was to evaluate the BMI changes over time in incident PD patients and identify interactions among BMI, signs of fluid overload, serum albumin, and serum creatinine. DESIGN: The study included a cohort of 1,997 incident PD patients of the BRAZPD recruited from 2004 to 2007. Sociodemographic data and BMI classification were obtained at baseline. The evolutions of BMI and body weight were assessed over a period of 29 months. Changes in the evolution were analyzed when a patient presented with albumin < 3.8 g/dL, creatinine < 7.0 mg/dL, or the presence of edema. Data analysis was performed using linear mixed-effects regression models as the main statistical procedure. RESULTS: BMI increased over time (29 months) by an average of 0.05 kg/m(2) per month, and body weight increased by 0.11 kg/month for a total increase of 3.08 kg. BMI decreased by 0.12 kg/m(2) in the presence of albumin < 3.8 g/dL and by 0.38 kg/m(2) in the presence of creatinine < 7.0 mg/dL. BMI increased by 0.61 kg/m(2) in the presence of edema. BMI increased in the presence of edema and albumin < 3.8 mg/dL or edema and creatinine < 7.0 mg/dL. CONCLUSIONS: There is a mean increase in the BMI of incident PD patients over time, and these changes may be, at least partly, due to fluid overload, leading to distortions of body weight. When the patients presented with lower serum albumin or creatinine levels, the BMI values were reduced, suggesting that a reduction in lean mass and an increase in fat mass may be occurring in these patients.

Asunto(s)

Índice de Masa Corporal , Diálisis Peritoneal/efectos adversos , Síndrome Debilitante/fisiopatología , Anciano , Biomarcadores/sangre , Peso Corporal , Creatinina/sangre , Femenino , Humanos , Masculino , Estado Nutricional , Estudios Prospectivos , Análisis de Regresión , Albúmina Sérica/análisis , Factores Socioeconómicos

RESUMEN

BACKGROUND/AIMS: The objective of this study was to analyze the prevalence of anemia and variability of hemoglobin (Hb) values in peritoneal dialysis (PD) patients, to establish its associated factors and their impact on clinical outcomes in a large cohort of patients starting PD treatment. METHODS: Data were collected monthly in incident patients, who were followed until the primary endpoint (death from all causes) or until leaving the study. RESULTS: 2,156 patients starting PD were included. The prevalence of Hb lower than 11 g/dl was 57% at baseline and decreased to 38% at the 4th month. Lack of adequate predialysis care and previous treatment with hemodialysis were the most important factors associated with anemia. Anemia was an independent predictor of mortality. There were no differences in patient survival throughout the different groups of Hb variability. CONCLUSION: Our data point to the need of identifying other risk factors for anemia and aggressively interfere with the modifiable ones in order to correct anemia and decrease mortality in this group of high-risk patients.

Asunto(s)

Anemia/epidemiología , Anemia/etiología , Hemoglobinas/metabolismo , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Diálisis Peritoneal/efectos adversos , Adulto , Anciano , Anemia/mortalidad , Brasil/epidemiología , Femenino , Ferritinas/sangre , Humanos , Fallo Renal Crónico/sangre , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo

RESUMEN

Systematic data collection of patients undergoing renal replacement therapy is critical to the epidemiological and clinical understanding of the treatment. These data may allow more rational use of economic resources and identify interventions to improve treatment and decrease the morbidity and mortality of these patients. The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD), an observational cohort study of peritoneal dialysis (PD) patients in Brazil, aimed to collect monthly demographics, clinical, laboratory and outcome data of PD patients treated in 114 dialysis clinics around the country, was started in December 2004 and ended in September 2011. BRAZPD has been generating solid and important information, which is very useful as a reality check of the PD therapy for all Brazilian PD centers.

Asunto(s)

Diálisis Peritoneal , Brasil , Recolección de Datos , Humanos , Proyectos de Investigación , Estadística como Asunto

RESUMEN

A good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion operator on early catheter complications and on technique survival in a large national multicentric cohort study (Brazilian Peritoneal Dialysis Multicentric Study, BRAZPD). Adult incident patients recruited in the BRAZPD from December 2004 to October 2007 having undergone first PD catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months after catheter insertion and adjusted for comorbidities. Valid data of 736 patients (mean age of 59 ± 16 years old, 52% women, 61% white) were analyzed. Mechanical (HR 0.99 [CI 0.56-1.76]; p = 0.98) and infectious (HR 0.63 [CI 0.32-1.23]; p = 0.17) early complication rates were similar between groups. Long-term catheter survival was also similar between groups. Early complications rates and catheter survival were similar between groups defined by operator profile (nephrologist or surgeon), supporting the role of interventional nephrology in the placement of PD catheters.

Asunto(s)

Cateterismo/métodos , Diálisis Peritoneal/instrumentación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Brasil/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Modelos de Riesgos Proporcionales , Factores de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

BACKGROUND AND OBJECTIVES: Although low socioeconomic status has been considered a contraindication to peritoneal dialysis (PD), no published data clearly link it to poor outcomes. The goal of this study was assessing the effect of income on survival in the Brazilian Peritoneal Dialysis Multicenter STUDY. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Incident PD patients enrolled in this prospective cohort from December 2004 to October 2007 were divided according to monthly family income. The median age was 59 years, 54% were women, 60% Caucasians, 41% diabetics, and 24% had cardiovascular disease. Most of them were in continuous ambulatory PD, had not received predialysis care, had <4 school years, and had a family income of <5 minimum wage (80%). Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model adjusting the results for age, gender, educational status, predialysis care, first therapy, PD modality, calendar year, and comorbidities. RESULTS: There were no differences in technique (log rank test χ² = 4.36) and patient (log rank test χ² = 2.92) survival between the groups. In the multivariate analysis, low family income remained not associated either to worse technique survival (hazard ratio [HR] = 1.29; 95% confidence interval [CI] = 0.91 to 1.84) or to patient survival (HR = 1.40; 95% CI = 0.99 to 1.99). CONCLUSIONS: According to these results, economic status is not independently associated with outcomes in this large cohort and should not be considered a barrier for PD indication.

Asunto(s)

Renta , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria Continua/mortalidad , Diálisis Peritoneal/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Brasil/epidemiología , Distribución de Chi-Cuadrado , Contraindicaciones , Femenino , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Selección de Paciente , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento

Asunto(s)

Femenino , Humanos , Masculino , Persona de Mediana Edad , Diálisis Peritoneal , Calidad de Vida , Brasil , Fallo Renal Crónico/terapia , Estudios Prospectivos

RESUMEN

INTRODUCTION: The number of patients on peritoneal dialysis (PD) in Brazil is significant, with a higher prevalence of diabetic and elderly individuals on PD than on hemodialysis. These data point to a selection bias in that population. OBJECTIVE: To assess the quality of life (QOL) of patients starting PD in Brazil. METHODS: The study assessed 6,198 patients participating in a multicenter prospective cohort study, using data from BRAZPD. The QOL was assessed by use of the Karnofsky index (QOL assessment by health professionals) and the SF-36 (patient's self-assessment) in 1,624 incident patients. RESULTS: Of the patients analyzed, 40% were diabetic and 47% were elderly (over the age of 60 years). Patients had low QOL scores in all the SF-36 domains, the "physical role" domain being the most affected and the "social functioning" domain having the best score. On the other hand, according to the Karnofsky index, most patients had high QOL scores. Elderly and diabetic patients had lower QOL as compared with non-elderly and non-diabetic by using both the SF-36 and Karnofsky index. CONCLUSION: The overall evaluation by use of the SF-36 showed a reduction in the QOL. The Karnofsky index showed a better QOL as compared with the SF-36 assessment, but similar results were found in the subgroups evaluated: the ederly and the diabetic patients had the worst QOL in both assessments.

Asunto(s)

Diálisis Peritoneal , Calidad de Vida , Brasil , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos