Estudo de uma coorte de pacientes com doença renal crônica terminal em hemodiálise em uma operadora de plano de saúde de Belo Horizonte, Minas Gerais

Abstract

Introduction: This study aimed to describe epidemiological data and to compare clinical outcomes of end-stage renal disease in hemodialysis (HD) patients in a healthcare organization from 2004 to 2008. Methods: Data from a cohort of patients with ESRD incidents in HD were collected from the database of a healthcare organization by means of a business intelligence tool (Prodige®). Independent variables were sex, age, time elapsed between consultation with a nephrologist and beginning of HD, type of initial vascular access, diabetes mellitus (DM), death, duration of treatment, length of hospital stay (LHS) by year of treatment, number of hospital admissions, time as an enrollee, and type of health plan and coverage contracted with the healthcare organization. Dependent variables for survival analysis were time between beginning of HD and death. Dependent variable for analysis of factors associated with higher LHS by year of treatment was the total number of days spent in the hospital from the beginning of HD. Descriptive statistics, followed by the Pearson Qui-square test, were used for comparison between independent variables and the outcomes of death and LHS by year of treatment in univariate analysis and Kaplan-Meier method for survival analysis. The Cox method and logistic regression were used to estimate the hazard ratio (HR) of death and odds ratio (OR) of LHS higher than 45 days by year of treatment, respectively. The software STATA® 10.0 was used for statistical analysis. Results: 311 patients with ESRD in HD were included in the study, with median age of 62 ± 16.6 years and 55.5% being male. Prevalence, but not incidence, showed a significant increase from the beginning to the end of the study. Survival analysis showed a higher mortality rate among older patients, patients that did not consult with a nephrologist, those with a catheter as the initial access to HD, patients with DM, and those who were admitted to the hospital within a month of beginning HD. The Cox method showed that HR of death was associated with older age, lack of consultation with a nephrologist, LHS by year of treatment higher than 45 days, and hospital admission within a month of beginning HD. Logistic regression showed increased OR for LHS higher than 45 days by year of treatment in patients aging from 45 to 64 years and decreased OR for this outcome in patients with an arteriovenous fistula as the first access to HD and in those who were in treatment for more than 12 months. Conclusion: Age profile of HD patients in the healthcare organization was similar to that reported in developed countries and, due to a higher prevalence among older patients, it is associated with a higher risk of death. Most deaths have occurred during the first year of treatment, and a higher risk was associated with lack of consultation with a nephrologist, hospital admission within the month of beginning HD, and LHS by year of treatment higher than 45 days. Consultation with a nephrologist and an arteriovenous fistula as first access to HD should be process indicators in the care of ESRD patients, aiming to reduce hospital admissions, LHS, and mortality.