Diálise peritoneal no Brasil: descrição de uma coorte e fatores de risco para sobrevivência da técnica e do paciente

Abstract

Systematic registers of local and national data on patients in renal replacement therapy (TRS) are critical to the epidemiological knowledge of the reality of the dialysis treatment. These data may allow more rational use of economic resources, identify interventions to improve the treatment, and to decrease morbidity and mortality of these patients. In Brazil, the most recent dialysis register made available by the Brazilian Society of Nephrology is based on data obtained from 1999 patients on renal replacement therapy. This study aimed to collect demographic, clinical, laboratory and outcomes (death, recovery of renal function, transfer to hemodialysis, the technical failure, kidney transplantation, transfer to another center or loss of follow-up) of patients on peritoneal dialysis (PD) treated in dialysis clinics located in all regions of Brazil to describe the epidemiological characteristics of this population and assess the factors related to the risk of the technique failure and mortality of patients. A multicenter study was designed involving patients of 102 centers in all the regions of the Brazil, initiated in December of 2004, with the last set of date obtained in October 2007. A software was designed with the data registered offline and sent online to a central server. The data were extracted in MySQL and originating a database that was initially validated and then transfered to the statistical software SPSS 13.0 and SAS. This extraction was performed in two stages. At the end of the study, 6198 patients were analyzed. Brazil has a low number of patients on peritoneal dialysis, with a selection bias for this treatment modality, where the majority of patients presents numerous co-morbidities and and has peritoneal dialysis as the only therapeutic option. There is a low rate of infectious complications (1 episode of peritonite/30 months) and the rate of drop-out during the study was 37.7%, with an annual average of 13.3%. The more difficult goal to be achieved is the hemoglobin, especially in diabetic patients and arising from hemodialysis. The main cause of drop-out was death (21%), being the cardiovascular diseases the most prevalent (40%). Age, diabetes mellitus, cardiovascular disease were among the main factors related to mortality and failure of the technique. It was seen a positive direct relationship of mortality when the general population was compared with patients on peritoneal dialysis. Furthermore, we observed marked regional differences in the rates and reasons for dropouts of patients in the different regions of the country. It was also seen the existence of the "reverse epidemiology" of obesity in these patients. In conclusion, our study allowed us to outline an epidemiological profile of peritoneal dialysis in Brazil and confirm the good quality of PD that is offered to our patients when compared to developed European countries, despite of the selection bias at the choice of TRS.