Barreiras à adequação em diálise peritoneal: um estudo de coorte prospectivo

Abstract

Introduction: Chronic kidney disease (CKD) is a serious global public health problem, affecting 10% of the population and related to aging and chronic degenerative diseases. Data indicate a large disparity between supply and demand for renal replacement therapies (RRT), with a greater deficit in countries with low socioeconomic levels. In this context, peritoneal dialysis (PD) has been losing ground to other RRT due to several factors. The objective of the study was to outline a profile of PD patients and, over the course of a year, evaluate clinical and laboratory parameters of dialysis adequacy, as well as outcomes. Thus, we seek to detect adequacy barriers to better serve patients and generate subsidies to disseminate the treatment. Patients and methods: Prospective cohort, in PD patients at the University Hospital of the Federal University of Juiz de Fora (UFJF) during the period. Variables analyzed: sociodemographic data, caregiver, comorbidities, etiology of CKD, self-sufficiency and indication of the method, adherence, previous RRT, nephrological monitoring, clinical and laboratory data measured monthly, quality of life (QoL) score (SF-12), score of malnutrition and inflammation (MIS), perceived social support scale (PSSS), health literacy score (SAHLPA) and outcomes. Statistical analysis: description in mean, standard deviation, median or percentage of categorical, ordinal or numerical variables. Subsequently, t-test for independent samples, chi-square, mann-whitney or ANOVA, comparing incidents versus prevalent in relation to sociodemographic, clinical, laboratory variables, method complications, scores (SAHLPA, MIS, PSSS and SF-12) and outcomes . This analysis was carried out between patients on target versus off target (considered 80% of the time on target) to assess the association. The outcomes were compared with the goals to verify which factors interfered. We correlated PSSS and QoL scores with sociodemographic and clinical variables, complications, hospitalizations and deaths and, in the end, we performed a linear regression model to evaluate the variables associated with the QoL outcome (physical and mental components) and logistic regression to evaluate the dichotomous hospitalization outcomes, failure of the technique and death; these models were adjusted for confounding variables with biological plausibility and/or statistical relevance. We used SPSS 25.0 Chicago, Illinois and 95% CI. Results: 56 patients were evaluated, 73.2% prevalent and 26.8% incident to the method. There was a predominance of elderly (61.2±13.9 years old), white (62.5%), retired (82.1%), low socioeconomic conditions, high illiteracy (41%), with social support and who opted for PD by choice (71.4%). Among the comorbidities, 100% were hypertensive and 30% diabetic, with the main etiology of CKD being undetermined (26.8%). Low levels of health literacy and QoL were noted. Among the adequacy goals, BP control was the most difficult clinical goal to achieve (30.4%) and phosphorus was the most difficult to control laboratory goal (28.6%). 57.1% of patients were hospitalized, 23.2% died and 16% had technical failure. Through multivariate analysis, it was noted that QoL, as an outcome variable, correlated in its mental component with the age group and, in its physical component, with the MIS. Conclusion: Achieving the BP and phosphorus targets was a major challenge. The factors that were most associated with achieving goals were: age, previous nephrologist, dementia, diabetes mellitus (DM) and adherence.