Validação de um registro e caracterização de uma coorte de usuários com doença renal crônica pré-dialítica em um centro multiprofissional de atendimento em doenças crônicas não transmissíveis

Abstract

Introduction: Chronic diseases are responsible today for the majority of deaths in Brazil. Among these, hypertension and diabetes mellitus are the main causes of chronic kidney disease (CKD). The CKD in its dialytic phase in Brazil represents a high financial cost and impacts the quality of life of the users, which justifies the need for an earlier diagnosis and a control in the pre-dialytic phase. In 2010, the Centro Hiperdia Juiz de Fora (CHJF) was inaugurated in Juiz de Fora, MG, Brazil, which expanded the service previously provided by Prevenrim. This program was only used for pre-dialytic renal patients. With the creation of CHJF, care was added to hypertensive and diabetic users with inadequate metabolic control. For this, an electronic record was created where these visits are recorded. The use of electronic records has been expanded worldwide to track dialysis users, however pre-dialysis registries are rare. The objective of this study was to validate the data from this registry for use in research and program management. Finally, the clinical characterization of the cohort in relation to the demographic profile and clinical quality indicators of these three diseases was done. Material and Methods: The registry was validated initially. The validation of an electronic health record is a continuous procedure in the programming of any data system. We know that there may be occurrences that have not been previously defined and that impact on data quality. After this standardization, we evaluated the cohort. We worked with 63,146 records of CHJF users' consultations from August 2010 to December 2014. Users 18 years old or older with at least two visits in the CKD outpatient clinic was included. We analyzed the following variables: sociodemographic, cause of kidney disease, main medications, main clinical indicators of CKD, systemic arterial hypertension (SAH), Diabetes mellitus (DM). Results: Data from 1,977 users with mean of follow-up time of 21 months were exported, converted and validated. Of these, 51.4% were men, 58% were> 64 years of age and 81.6% were overweight. The main medications used were diuretics (82.9%), angiotensin receptor blocker (ARB) (62%), Statin (60.7%) and ACE inhibitors (49.9%). The percentage of users with a decline in the glomerular filtration rate was 33.7%. Regarding glycated hemoglobin, users with CKD and DM, 36% were within the initial goal and 52.1% of the final. Regarding blood pressure, users were on target at admission at 34.3% and 49.8% at the end of follow-up. Conclusion: We conclude that the validated data is of vital importance for health managers to monitor users. We observed that our population is predominantly elderly, obese, polypharmacy patient, has a low level of education, is low income and therefore a vulnerable population, requiring intensive multi-professional care to delay the progression of the disease and reduce morbidity and mortality. It is important to highlight that since the glomerular filtration rate (GFR) presents a positive delta, it then indicates that we are achieving the main goal: to delay the onset of renal replacement therapy, thereby improving quality of life and lowering costs.