Nível de complexidade da estrutura dos serviços de diálise no Brasil: associação com as condições socioeconômicas do município e autoavaliação de saúde dos pacientes

Abstract

INTRODUCTION: Chronic Kidney Disease (CKD) is a public health problem characterized by high morbidity and mortality and an economic, social, private, and health system impact. Patients with CKD that develop the final stage of the disease need dialysis (hemodialysis or peritoneal dialysis) for the rest of their lives or renal transplantation, carried out in specified health services. It is the high complexity health care (analogous to tertiary care) system's role to guarantee the access and the quality of the dialysis treatments, with the purpose of making a positive impact on survival rates, morbidity, and the quality of life, and to guarantee equity in the waiting list for kidney transplants. Albeit an extensive regulation for the accreditation and the functioning of the public and private dialysis services has been made by the Ministry of Health and the National Health Surveillance Agency, the results of the treatment given to the aforementioned patients at various locations throughout the country still present significant problems. OBJECTIVES: 1) Evaluate the association between the socioeconomic characteristics of the municipalities where the dialysis services are located and the level of complexity of the structure of the services provided; 2) Estimate the prevalence of self-analyzed bad health in hemodialysis patients; 3) Investigate the sociodemographic, clinical and dialysis service characteristics associated with the self-analyzed bad health in hemodialysis patients; 4) Investigate the association between the dialysis service characteristics and the health self-analysis after the control by the sociodemographic and clinical characteristics. METHODS: Dialysis services and municipality data were collected from the National Register of Health Facilities (CNES) and Human Development Atlas 2010 respectively. Data of individuals on hemodialysis under the Unified Health System (SUS) were collected through the phase II survey of the TRS Project - "Economic and Epidemiologic Evaluation of Modalities of Renal Replacement Therapy in Brazil". A principal component analysis was utilized for the construction of an indicator for the characterization of the level of complexity of the structure of the services. Pearson's chi-squared test was used to evaluate the association between the level of complexity of the structure of the services and the variables of the municipalities. Multilevel regression was used to estimate the association between the patients' self-analysis and the sociodemographic, clinical patients and between dialysis service characteristics. RESULTS: The frequency of the dialysis services characterized as having a high complexity in their structure was higher in the municipalities of the Southeast region in municipalities that present two or more dialysis services, with the highest population, highest income inequality and high human development. Hemodialysis patients using services with high levels of complexity in its structure present a lower chance of self-analyzing themselves as having bad health. CONCLUSION: Municipalities with better socioeconomic conditions present a better structure for treating patients with dialysis in Brazil. This work highlights the impact service structure has in the self-analysis of the SUS hemodialysis patients. It is expected that this work can contribute in the drafting of public policy that lower the inequalities in the distribution of dialysis services according to the structure component as to better the results of the renal replacement therapy patients' health in Brazil.