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Clin J Am Soc Nephrol. 2010 Apr;5(4):637-44. doi: 10.2215/CJN.04840709. Epub 2010 Feb 18.

Allocation of initial modality for renal replacement therapy in Brazil.

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  • 1Department of Social and Preventive Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, sala 706, Belo Horizonte, MG 30130-100, Brazil.

Abstract

BACKGROUND AND OBJECTIVES:

The use of dialysis modalities for ESRD varies around the world. There is no consensus in literature regarding the most appropriate choice of dialysis method. The aim of this study was to analyze the initial modality for ESRD in Brazil and evaluate the factors determining patients' allocation to either hemodialysis (HD) or peritoneal dialysis (PD).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

A retrospective cohort study was performed using national administrative registries of all patients financed by the public system who began renal replacement therapy in 2000 in Brazil. Logistic regression analysis was used to investigate factors associated with the probability of receiving HD or PD at the start of treatment. Independent variables tested were age, sex, presence of diabetes, geographic region of residence, and health care supply indicators.

RESULTS:

Of 11,563 patients analyzed, 88% started on HD and 12% started on PD. Patients were more likely to be assigned to HD if they were male (odds ratio: 1.44; 95% confidence interval: 1.23 to 1.68) and nondiabetic (odds ratio: 0.71; 95% confidence interval: 0.60 to 0.84). With regard to age, the youngest and the elderly showed lower probability of being in HD. In addition, the state of residence at the start of treatment was very important to explain initial modality allocation.

CONCLUSIONS:

Our findings suggest that patient allocation in Brazil is not random. The probability of allocation to HD or PD is highly associated with individual attributes and supply variables.

PMID:
20167688
[PubMed - indexed for MEDLINE]
PMCID:
PMC2849690
Free PMC Article
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