Boccia, Natalia; Abib, Anabel; Guzman, Jenny; Laham, Gustavo

Language: Spanish
References: 16
Page: 91-99
PDF size: 449.16 Kb.

ABSTRACT

Introduction: Several factors influence mortality in dialysis patients; however, the influence of the healthcare system on survival in this group is unknown. We aimed to assess the influence of the healthcare system on end-stage renal disease patients starting hemodialysis and its impact on mortality. Materials and Methods: We evaluated 503 patients admitted to hemodialysis at CEMIC between January 1995 and June 2020. Considering the healthcare system, the patients were divided into two groups: private (PHC n=360) and government (GHC n=143). Results: The median follow-up time was 30.9 months (12.9-50). In the GHC group, patients were older (66.5 vs. 58.8 years p‹0.0001), admitted with a lower percentage of AVF/prosthesis (44.1 vs. 55.3% p ‹ 0.029), phosphorus (5.5 vs. 6 mg /dl p‹0.009) and lower albumin (3.7 vs. 3.8 g/dl p‹0.038) with mean glomerular filtration rate estimated by CKD-EPI without significant difference with the PHC group (PHC 7.9 ± 3 .8, GHC 7.7 ± 3.8, p 0.613). The proportion of transplanted patients was higher in the PHC group, 40.6 vs 14.7% in the GHC group(p‹0.0001), and this group had a higher survival rate (Log-Rank test p ‹0.021). In multivariate analysis, GHC was one of the predictors of mortality (OR 1.384, 95% CI 1.015-1.888, p 0.040), showing this factor's influence on dialysis patients' survival. Conclusions: Starting hemodialysis with GHC was associated with higher mortality. This patient's group had less access to kidney transplantation.

REFERENCES

1. Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008 Apr 11;8:117. doi: 10.1186/1471-2458-8-117. PMID: 18405348; PMCID: PMC2377260.

2. Sarnak MJ. Cardiovascular complications in chronic kidney disease. Am J Kidney Dis. 2003 Jun;41(5 Suppl):11-7. doi: 10.1016/s0272-6386(03)00372-x. PMID: 12776309.

3. Otero A, de Francisco A, Gayoso P, García F; EPIRCE Study Group. Prevalence of chronic renal disease in Spain: results of the EPIRCE study. Nefrologia. 2010;30(1):78-86. doi: 10.3265/Nefrologia.pre2009.Dic.5732. Epub 2009 Dec 14. PMID: 20038967.

4. Rodriguez-Poncelas A, Garre-Olmo J, Franch-Nadal J, Diez-Espino J, Mundet-Tuduri X, Barrot-De la Puente J, Coll-de Tuero G; RedGDPS Study Group. Prevalence of chronic kidney disease in patients with type 2 diabetes in Spain: PERCEDIME2 study. BMC Nephrol. 2013 Feb 22; 14:46. doi: 10.1186/1471-2369-14-46. PMID: 23433046; PMCID: PMC3598539.

5. Marinovich S, Bisigniano L, Hansen Krogh D, Celia E, Tagliafichi V, Rosa Diez G, Fayad A: Registro Argentino de Diálisis Crónica SAN-INCUCAI 2013. Sociedad Argentina de Nefrología e Instituto Nacional Central Único Coordinador de Ablación e Implante. Buenos Aires, Argentina. 2023

6. Ma L, Zhao S. Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis. Int J Cardiol. 2017 Jul 1;238:151-158. doi: 10.1016/j.ijcard.2017.02.095. Epub 2017 Feb 22. PMID: 28341375.

7. Tummalapalli SL, Ibrahim SA. Alternative Payment Models and Opportunities to Address Disparities in Kidney Disease. Am J Kidney Dis. 2021 May;77(5):769-772. doi: 10.1053/j.ajkd.2020.09.008. Epub 2020 Oct 21. PMID: 33098924; PMCID: PMC7577223.

8. Marinovich S, Lavorato C, Rosa-Diez G, Bisigniano L, Fernández V, Hansen-Krogh D. The lack of income is associated with reduced survival in chronic hemodialysis. Nefrologia. 2012;32(1):79-88. English, Spanish. doi: 10.3265/Nefrologia.pre2011.Nov.11110. PMID: 22294006.

9. Dirección General de Estadística y Censos. 2019 tipo de cobertura en salud de la población. Ministerio de Hacienda y Finanzas GCBA. https://www.estadisticaciudad.gob.ar/si/genero/principal-indicador?annio=2019&indicador=tip_cob_sal&cortante={%22sexo%22:true,%22annio%22:true,%22t_cob_sal%22:true}#

10. Devereaux PJ, Schünemann HJ, Ravindran N, Bhandari M, Garg AX, Choi PT, Grant BJ, Haines T, Lacchetti C, Weaver B, Lavis JN, Cook DJ, Haslam DR, Sullivan T, Guyatt GH. Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. JAMA. 2002 Nov 20;288(19):2449-57. doi: 10.1001/jama.288.19.2449. Erratum in: JAMA. 2004 Jan 14;291(2):186. PMID: 12435258.

11. Soleymanian T, Niyazi H, Noorbakhsh Jafari Dehkordi S, Savaj S, Argani H, Najafi I. Predictors of Clinical Outcomes in Hemodialysis Patients: a Multicenter Observational Study. Iran J Kidney Dis. 2017 May;11(3):229-236. PMID: 28575884.

12. Ifanti AA, Argyriou AA, Kalofonou FH, Kalofonos HP. Financial crisis and austerity measures in Greece: their impact on health promotion policies and public health care. Health Policy. 2013 Nov;113(1-2):8-12. doi: 10.1016/j.healthpol.2013.05.017. Epub 2013 Jun 19. PMID: 23790265.

13. Paes-Sousa R, Schramm JMA, Mendes LVP. Fiscal austerity and the health sector: the cost of adjustments. Cien Saude Colet. 2019 Dec;24(12):4375-4384. doi: 10.1590/1413-812320182412.23232019. Epub 2019 Aug 9. PMID: 31778488.

14. JM Peña, JM Logroño, R Pernaute, C Laviades, R Virto, C Vicente de Vera. Late nephrology referral influences on morbidity and mortality. Nefrología. 2006;26(1):1-156.

15. Curtis BM, Ravani P, Malberti F, Kennett F, Taylor PA, Djurdjev O, Levin A. The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes. Nephrol Dial Transplant. 2005; Jan;20(1):147-54. doi: 10.1093/ndt/gfh585. Epub 2004 Dec 7. PMID: 15585514.

16. Kelly JT, Palmer SC, Wai SN, Ruospo M, Carrero JJ, Campbell KL, Strippoli GFM. Healthy Dietary Patterns and Risk of Mortality and ESRD in CKD: A Meta-Analysis of Cohort Studies. Clin J Am Soc Nephrol. 2017; Feb 7;12(2):272-279. doi: 10.2215/CJN.06190616. Epub 2016 Dec 8. PMID: 27932391; PMCID: PMC5293335